Clinical and financial benefits of rapid detection of respiratory viruses: an outcomes study
Clinical and financial benefits of rapid detection of respiratory viruses: an outcomes study
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DOI：
10.1128/jcm.38.8.2824-2828.2000
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发表时间：
2000-08-01
影响因子：
9.4
通讯作者：
Troutt, T
中科院分区：
文献类型：
--
作者：
Barenfanger, J;Drake, C;Troutt, T
为了评估快速报告呼吸道病毒的预期益处，我们比较了使用酶免疫测定、壳瓶测定和培养管测定等标准技术处理样本的患者（第一年）和使用相同标准技术处理样本并直接对细胞离心样本进行免疫荧光检测（FA）的患者（第二年）。细胞自旋FA筛选甲型和乙型流感病毒、呼吸道合胞病毒（RSV）、副流感病毒1至3和腺病毒（DAKO诊断有限公司）。细胞自旋FA对所有病毒的特异性均为100%。对甲型流感病毒和RSV的敏感性分别为90%和98%，但对乙型流感病毒和腺病毒的敏感性分别为14.3%和0%。然而，由于前一种病毒占临床标本分离物的85%，因此细胞自旋FA是一种很好的筛选试验，因为在数小时内就可以获得阳性结果。所有阳性病毒的平均周转时间在第1年为4.5天，在第2年为0.9天（P = 0.001）。这种快速报告使医生能够更快地获得信息，从而实现更适当的治疗。呼吸道病毒分离株住院患者的平均住院时间在第一年为10.6天，而在第二年为5.3天。这些患者第一年的平均可变成本为7893美元，第二年为2177美元。在减去试剂成本和工艺时间后，可变成本节省为144,332美元/年。综上所述，细胞自旋FA显著缩短了周转时间，并与降低死亡率、住院时间和费用以及更好的抗生素管理有关。
To assess the expected benefits of rapid reporting of respiratory viruses, we compared patients whose samples were processed using standard techniques such as enzyme immunoassays, shell vial assays, and culture tube assays (year 1) to patients whose samples were processed with the same standard techniques in addition to immunofluorescent testing (FA) directly on cytocentrifuged samples (year 2). The cytospin FA screened for influenza A and B viruses, respiratory syncytial virus (RSV), parainfluenza viruses 1 to 3, and adenovirus (DAKO Diagnostics Ltd.). The specificity of the cytospin FA for all viruses was 100%. The sensitivities fur influenza A virus and RSV were 90 and 98%, respectively, but the sensitivities for influenza B virus and adenovirus were unacceptable (14.3 and 0%, respectively). However, since the former viruses account for >85% of our isolates from clinical specimens, the cytospin FA is an excellent screening test since the positive result was available within hours. The mean turnaround time for all positive viruses was 4.5 days in year 1 and 0.9 day in year 2 (P = 0.001). This rapid reporting resulted in physicians having access to information sooner, enabling more appropriate treatment, The mean length of stay in the hospital for inpatients with respiratory viral isolates was 10.6 days for year 1 versus 5.3 days for year 2. Mean variable costs for these patients was $7,893 in year 1 and $2,177 in year 2. After subtracting reagent costs and technological time, the savings in variable costs was $144,332/year. Summarizing, the cytospin FA markedly decreased turnaround time and was associated with decreased mortality, length of stay, and costs and with better antibiotic stewardship.