Department of Clinical Microbiology, University Limerick Hospital Group, Limerick, Ireland; Department of Serology and Immunology, University Limerick Hospital Group, Limerick, Ireland; Centre for Interventions in Infection, Inflammation & Immunity (4i) and School of Medicine, University of Limerick, Limerick, Ireland.
Department of Clinical Microbiology, University Limerick Hospital Group, Limerick, Ireland.
J Hosp Infect. 2021 Apr;110:45-51. doi: 10.1016/j.jhin.2021.01.004. Epub 2021 Jan 19.
Seasonal influenza causes significant morbidity and mortality, and represents a recurring financial burden for community- and hospital-based treatment. Nosocomial outbreaks exacerbate the impact of influenza. Rapid diagnosis of influenza has been shown to reduce transmission. However, point-of-care testing (POCT) in emergency departments and prudent direction of patients with the virus to reduce hospital-acquired infection (HAI) have not been evaluated widely.
To assess performance characteristics of the Abbott ID NOW™ Influenza A & B 2 system, impact on incidence of hospital-acquired influenza, and admission rate ratio for patients who have POCT compared with laboratory testing. POCT was introduced in the 2018-2019 influenza season. Data from then were compared with preceding and subsequent seasons.
Records of POCT and laboratory testing for the 2017-2018, 2018-2019, and 2019-2020 influenza seasons were analysed. Sensitivity and specificity of POCT were compared pairwise with Xpert Flu A/B/RSV. Patient admission rates and time of waiting for admission were compared.
Compared to laboratory assay, POCT demonstrated sensitivity of 90.6% (95% confidence interval (CI): 78.6-96.5) and specificity of 99.2% (95.2-100) for influenza A, with 51.4% and 41.9% reductions in numbers of HAIs observed in the two seasons when POCT was available, respectively. The admission rate ratio for influenza cases diagnosed by POCT compared with laboratory diagnosis was 0.72 (95% CI: 0.53-0.97; P = 0.031).
POCT for influenza appears a feasible strategy for testing of patients during peak influenza virus season, with potential to reduce HAI. The relatively rapid turnaround time may also benefit clinical management of patients presenting at emergency departments with suspected influenza.
季节性流感会导致严重的发病率和死亡率，并且给社区和医院治疗带来持续的经济负担。医院内爆发会加重流感的影响。已证明快速诊断流感可以减少传播。然而，尚未广泛评估在急诊室进行即时检测（POCT）和谨慎指导携带病毒的患者以减少医院获得性感染（HAI）。
评估 Abbott ID NOW™ Influenza A & B 2 系统的性能特征，评估对医院获得性流感发病率的影响，以及与实验室检测相比，POCT 对患者的入院率比。POCT 于 2018-2019 流感季节推出。然后将当时的数据与之前和之后的季节进行比较。
分析了 2017-2018、2018-2019 和 2019-2020 流感季节的 POCT 和实验室检测记录。将 POCT 的敏感性和特异性与 Xpert Flu A/B/RSV 进行了两两比较。比较了患者入院率和等待入院的时间。
与实验室检测相比，POCT 对流感 A 的敏感性为 90.6%（95%置信区间（CI）：78.6-96.5），特异性为 99.2%（95.2-100），当两个季节都可使用 POCT 时，观察到 HAI 的数量分别减少了 51.4%和 41.9%。POCT 诊断的流感病例与实验室诊断相比，入院率比为 0.72（95%CI：0.53-0.97；P=0.031）。
POCT 似乎是流感病毒高发季节患者检测的可行策略，有降低 HAI 的潜力。相对较快的周转时间也可能有利于急诊科疑似流感患者的临床管理。
