371. Adding sputum and saliva to nasopharyngeal swab samples for PCR detection of Respiratory Syncytial Virus in adults hospitalized with acute respiratory illness may double case detection
371. Adding sputum and saliva to nasopharyngeal swab samples for PCR detection of Respiratory Syncytial Virus in adults hospitalized with acute respiratory illness may double case detection
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DOI：
10.1093/ofid/ofac492.449
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发表时间：
2022-12-15
影响因子：
4.2
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中科院分区：
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在住院患者中，鼻咽 (NP) 拭子是呼吸道合胞病毒 (RSV) PCR 检测最常见的样本。然而，众所周知，添加痰液可以提高诊断率，并且唾液已成功用于病毒性呼吸道感染的诊断。我们试图比较因急性呼吸道疾病 (ARI) 住院的成年患者中仅使用 NP 拭子与 NP 拭子加唾液和痰进行 PCR 检测检测到的 RSV 患病率。这项正在进行的前瞻性队列研究纳入了肯塔基州路易斯维尔 4 家医院因 ARI 住院的年龄≥40 岁的患者（第 1 季：21 月 27 日至 4 月 22 日）。 NP 拭子、唾液和痰样本在入组时获取或从标准护理样本中采集（所有样本均在入院后 ≤3 天内收集），并使用 Luminex ARIES FluA/B/RSV 平台进行 PCR 测试。我们按样本类型为所有患者制作了 RSV 阳性样本的维恩图，并仅限于具有所有 3 种样本类型的患者。仅 NP 拭子的 RSV 患病率计算为 RSV 阳性 NP 拭子的患者人数除以测试的患者总数。按 NP 拭子加唾液和痰计算的 RSV 患病率计算为 RSV 阳性 NP 拭子、唾液或痰样本的患者人数除以测试的患者总数。 RSV PCR 检测阳性的维恩图 我们招募了 653 名患者，并收集了 NP 拭子（100% 的患者）、唾液（96%）和痰（总体 43%，303 名产生痰的患者中的 93%）。在所有患者中，28 名患者检测出 RSV 呈阳性（图 1A），当仅限于所有 3 个样本的患者时（图 1B），有 14 名患者检测呈阳性。仅通过 NP 拭子检测的总体队列 RSV 患病率为 1.8% (12/653)，通过 NP 拭子加唾液和/或痰检测的 RSV 患病率为 4.3% (28/653)：添加唾液和痰样本后，RSV 患病率高出 2.33 倍。在所有 3 种样本类型的患者中，RSV 患病率增加相同，并且仅通过 NP 拭子检测没有阳性结果。 （左）A. 整个队列中 653 名患者的 RSV PCR 检测呈阳性（右）B. 275 名患者的 RSV PCR 检测呈阳性，并获得全部 3 个样本。 RSV 最常见于唾液样本中。目前使用 NP 拭子进行 RSV PCR 检测的护理标准似乎低估了住院 ARI 成年患者的真实 RSV 患病率超过 2 倍。 Alan Junkins，博士，D(ABMM)，生物梅里埃：顾问/顾问 Paul S. Schulz，医学博士，吉利德：顾问/顾问|吉利德：资助/研究支持|吉利德：酬金|默克：顾问/顾问|默克：酬金/研究支持|默克：酬金 Robin Hubler，MS，辉瑞公司：员工|辉瑞公司：股票/债券 Paula Peyrani, MD, 辉瑞公司: 员工|辉瑞公司: 员工|辉瑞公司: 股票/债券|辉瑞公司: 股票/债券 Paula Peyrani, MD, 辉瑞公司: 员工|辉瑞公司: 员工|辉瑞公司: 股票/债券|辉瑞公司: 股票/债券 刘清, M.S., 辉瑞公司: 我是一名全职员工辉瑞的全职员工并持有辉瑞股票 Bradford J. Gessner，医学博士、公共卫生硕士，辉瑞公司：员工|辉瑞公司：股票/债券 Elizabeth Begier，医学博士、公共卫生硕士，辉瑞：员工|辉瑞：股票/债券。
In hospitalized patients, nasopharyngeal (NP) swabs are the most common samples obtained for Respiratory Syncytial Virus (RSV) PCR testing. However, adding sputum is known to increase diagnostic yield, and saliva has been successfully used for viral respiratory infection diagnosis. We sought to compare RSV prevalence detected by PCR testing of NP swab alone versus NP swab plus saliva and sputum in adult patients hospitalized with acute respiratory illness (ARI). This ongoing, prospective cohort study enrolled patients aged ≥40 years hospitalized for ARI in 4 hospitals in Louisville, Kentucky (Season 1: 27 Dec 21 – 1 Apr 22). NP swab, saliva, and sputum samples were obtained at enrollment or scavenged from standard-of-care specimens (all collected ≤3 days of admission), and PCR tested with Luminex ARIES FluA/B/RSV platform. We produced Venn diagrams of RSV positive samples by sample type for all patients and restricted to those with all 3 sample types. RSV prevalence for NP swab alone was calculated as number of patients with RSV-positive NP swabs divided by total number of patients tested. RSV prevalence by NP swab plus saliva and sputum was calculated as number of patients with RSV-positive NP swab, saliva, or sputum samples divided by total number of patients tested. Venn diagrams of positive RSV PCR tests We enrolled 653 patients and collected NP swabs (100% of patients), saliva (96%), and sputum (43% overall and 93% of the 303 sputum-producing patients). Among all patients, 28 patients tested RSV positive (Figure 1A), and when restricted to those with all 3 samples (Figure 1B), 14 tested positive. The overall cohort’s RSV prevalence by NP swab alone was 1.8% (12/653) and by NP swab plus saliva and/or sputum was 4.3% (28/653): 2.33 times higher with addition of saliva and sputum samples. Among patients with all 3 specimen types, the RSV prevalence increase was the same, and none were positive by NP swab only. (Left) A. Positive RSV PCR tests for 653 patients in overall cohort (Right) B. Positive RSV PCR tests for 275 patients with all 3 samples obtained. RSV was most commonly detected in saliva samples. Current standard-of-care utilizing NP swab for RSV PCR testing appears to underestimate true RSV prevalence in hospitalized adult patients with ARI by more than 2-fold. Alan Junkins, PhD, D(ABMM), Biomerieux: Advisor/Consultant Paul S. Schulz, MD, Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Gilead: Honoraria|Merck: Advisor/Consultant|Merck: Grant/Research Support|Merck: Honoraria Robin Hubler, MS, Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds Paula Peyrani, MD, Pfizer, Inc: Employee|Pfizer, Inc: Employee|Pfizer, Inc: Stocks/Bonds|Pfizer, Inc: Stocks/Bonds Paula Peyrani, MD, Pfizer, Inc: Employee|Pfizer, Inc: Employee|Pfizer, Inc: Stocks/Bonds|Pfizer, Inc: Stocks/Bonds Qing Liu, M.S., Pfizer Inc.: I am a full time employee of Pfizer and hold Pfizer stocks Bradford J. Gessner, M.D., M.P.H., Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds Elizabeth Begier, M.D., M.P.H., Pfizer: Employee|Pfizer: Stocks/Bonds.