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A Service Evaluation of Simultaneous near Patient Testing for Influenza, RSV, Clostridium difficle and Norovirus in a UK District General Hospital
Journal of Hospital Infection ( IF 6.9 ) Pub Date : 2019-09-05 , DOI: 10.1016/j.jhin.2019.08.022
J. Haigh , M.-T. Cutino-Moguel , M. Wilks , C.A. Welch , M. Melzer

Background

The Cepheid® GeneXpert® (GXP) can simultaneously test for norovirus (NV), Clostridium difficile (CD), influenza A/B (IFA/B) and respiratory syncytial virus (RSV).

Aim

To compare centralised multiplex polymerase chain reaction (PCR) testing with localised GXP testing at a district general hospital.

Methods

From December 2017 – December 2018, samples received at Whipps Cross University Hospital (WCUH) were first tested at the local laboratory before transport centrally to the Royal London Hospital (RLH). At the RLH, a non-proprietary multiplex reverse transcriptase (RT) PCR assay was performed, which also tested for GI or Respiratory pathogens not tested for by the GXP.

Findings

1,111 stool and respiratory samples were processed at both sites. 591 were respiratory and 520 were stool samples. Compared to centralised testing, the GXP gave sensitivity, specificity, and NPV all in excess of 97%, with the exception of RSV. The RSV assay had a sensitivity of 66.7% (95%CI 24.1, 94.0) but a NPV of 99.7% (95%CI 98.6, 99.9). At the RLH, 65 (5.9%) additional respiratory or GI viruses were detected, predominantly rhinovirus 35 (3.2%) and adenovirus 11 (1.0%). Compared to centralised testing, the median time saved for local respiratory and gastro-intestinal sample testing was 19 hours and 46 min and 17 hours and 06 min.

Conclusions

Local GXP testing compared to centralised multiplex PCR testing for IF, NV and CD, demonstrated sensitivities, specificities and NPV between 95% - 100%. Turnaround times were faster, enabling quicker infection prevention and control decision making. In our local setting (WCUH), the GXP demonstrated the potential to reduce NV and IFA/B outbreaks.



中文翻译:

在英国地区综合医院对患者进行流感,RSV,梭状芽孢杆菌和诺如病毒的同时近距离检测服务评估

背景

Cepheid®GeneXpert®(GXP)可同时检测诺如病毒(NV),艰难梭菌(CD),A / B流感(IFA / B)和呼吸道合胞病毒(RSV)。

目的

用来比较区域综合医院的集中式多重聚合酶链反应(PCR)测试与本地化GXP测试。

方法

从2017年12月至2018年12月,首先在当地实验室对在Whipps Cross大学医院(WCUH)收到的样本进行测试,然后将其集中运送到皇家伦敦医院(RLH)。在RLH,进行了非专有的多重逆转录酶(RT)PCR检测,还检测了GXP未检测到的GI或呼吸道病原体。

发现

在两个地点均处理了1,111份粪便和呼吸道样本。呼吸系统疾病591例,粪便样本520例。与集中式测试相比,除了RSV之外,GXP的灵敏度,特异性和NPV均超过97%。RSV测定的灵敏度为66.7%(95%CI 24.1,94.0),但NPV为99.7%(95%CI 98.6,99.9)。在RLH,还检测到65种(5.9%)其他呼吸道或胃肠道病毒,主要是鼻病毒35种(3.2%)和腺病毒11种(1.0%)。与集中式测试相比,本地呼吸和胃肠道样本测试节省的中位时间为19小时46分钟,17小时和06分钟。

结论

与针对IF,NV和CD的集中式多重PCR测试相比,本地GXP测试显示出95%-100%的敏感性,特异性和NPV。周转时间更快,可以更快地预防和控制感染。在我们的本地环境(WCUH)中,GXP展示了减少NV和IFA / B爆发的潜力。

更新日期:2019-09-05
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