Infectious Diseases Society of America Guidelines on the Diagnosis of COVID-19 (June 2020)
Infectious Diseases Society of America Guidelines on the Diagnosis of COVID-19 (June 2020)
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DOI：
10.1093/cid/ciaa760
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发表时间：
2020-09-08
影响因子：
11.8
通讯作者：
Mustafa, Reem A.
中科院分区：
文献类型：
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作者：
Hanson, Kimberly E.;Caliendo, Angela M.;Mustafa, Reem A.
IDSA免责声明截至本文发布之时，IDSA的COVID-19诊断指南已经更新。有关这些指南的最新版本，请访问https://www.idsociety.org/covid19guidelines.Background准确的分子诊断测试是确诊2019冠状病毒病（COVID-19）的必要条件。直接检测呼吸道标本中的严重急性呼吸综合征冠状病毒2（SARS-CoV-2）核酸可为患者、医疗机构和公共卫生层面的决策提供信息。可用的SARS-CoV-2核酸检测测试的数量正在迅速增加，COVID-19诊断文献也是如此。因此，美国传染病协会（IDSA）认识到一个显着的需要经常更新的文献，以告知循证最佳实践guidance. ObjectiveThe IDSA的目标是制定一个循证诊断指南，以协助临床医生，临床实验室，患者和决策者在决策有关的最佳使用SARS-CoV-2核酸扩增测试。此外，该学会还为理解分子诊断检测性能提供了一个概念框架，讨论了在各种实践环境中检测结果解释的细微差别，并强调了COVID-19诊断检测竞技场中重要的未满足的研究需求。方法IDSA召集了一个由传染病临床医生，临床微生物学家，和专家进行系统的文献综述，以确定和优先考虑与使用SARS-CoV-2分子诊断相关的临床问题和结果。结果专家组就15项诊断建议达成一致。结论普及准确的SARS-CoV-2核酸检测对于患者护理、医院感染预防和公众应对COVID-19大流行至关重要。关于可用检测的临床性能的信息正在迅速涌现，但目前文献的证据质量被认为是低至非常低。认识到这些局限性，IDSA专家组权衡了现有的诊断证据，并建议对所有疑似患有COVID-19的症状个体进行核酸检测。此外，建议对与COVID-19病例有过已知或疑似接触的无症状个体进行检测。当结果会影响隔离/检疫/个人防护设备使用决策、决定手术资格或告知免疫抑制治疗给药时，建议对无已知暴露的无症状个体进行检测。最终，检测的优先次序将取决于机构特定的资源和不同患者群体的需求。
IDSA Disclaimer As of the time of this publication, updates have been made to IDSA's Guidelines on the Diagnosis of COVID-19. For the most updated version of these guidelines, please go to https://www.idsociety.org/covid19guidelines.Background Accurate molecular diagnostic tests are necessary for confirming a diagnosis of coronavirus disease 2019 (COVID-19). Direct detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acids in respiratory tract specimens informs patient, healthcare institution, and public health-level decision-making. The number of available SARS-CoV-2 nucleic acid detection tests is rapidly increasing, as is the COVID-19 diagnostic literature. Thus, the Infectious Diseases Society of America (IDSA) recognized a significant need for frequently updated systematic reviews of the literature to inform evidence-based best practice guidance.Objective The IDSA's goal was to develop an evidence-based diagnostic guidelines to assist clinicians, clinical laboratorians, patients, and policy makers in decisions related to the optimal use of SARS-CoV-2 nucleic acid amplification tests. In addition, the society provides a conceptual framework for understanding molecular diagnostic test performance, discusses the nuance of test result interpretation in a variety of practice settings, and highlights important unmet research needs in the COVID-19 diagnostic testing arena.Methods IDSA convened a multidisciplinary panel of infectious diseases clinicians, clinical microbiologists, and experts in systematic literature review to identify and prioritize clinical questions and outcomes related to the use of SARS-CoV-2 molecular diagnostics. Grading of Recommendations Assessment, Development and Evaluation methodology was used to assess the certainty of evidence and make testing recommendations.Results The panel agreed on 15 diagnostic recommendations.Conclusions Universal access to accurate SARS-CoV-2 nucleic acid testing is critical for patient care, hospital infection prevention, and the public response to the COVID-19 pandemic. Information on the clinical performance of available tests is rapidly emerging, but the quality of evidence of the current literature is considered low to very low. Recognizing these limitations, the IDSA panel weighed available diagnostic evidence and recommends nucleic acid testing for all symptomatic individuals suspected of having COVID-19. In addition, testing is recommended for asymptomatic individuals who have had a known or suspected contact with a COVID-19 case. Testing asymptomatic individuals without known exposure is suggested when the results will impact isolation/quarantine/personal protective equipment usage decisions, dictate eligibility for surgery, or inform administration of immunosuppressive therapy. Ultimately, prioritization of testing will depend on institution-specific resources and the needs of different patient populations.