Department of Medicine for Older People, Amsterdam University Medical Center, Amsterdam Public Health Research Institute, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
Amsta Healthcare Organization, Amsterdam, The Netherlands.
Eur Geriatr Med. 2022 Jun;13(3):711-718. doi: 10.1007/s41999-021-00584-3. Epub 2021 Nov 19.
To assess whether one swab can be used to perform both the antigen-detection rapid diagnostic test (Ag-RDT) and reverse transcriptase polymerase chain reaction (RT-PCR) for COVID-19 detection during an outbreak in the nursing home (NH) setting.
The single-swab method (SSM), where the Ag-RDT is performed with the transport medium used for RT-PCR, was evaluated in three Dutch NHs and compared to the laboratory setting. We collected Ag-RDT and RT-PCR results, NH resident characteristics and symptomatology. In addition, two focus groups were held with the involved care professionals to gain insight into the feasibility of the SMM in the NH setting.
In the NH setting, the SSM had a sensitivity of 51% and a specificity of 89% compared to RT-PCR. These were lower than in the laboratory setting (69% and 100% respectively). Yet, when stratified for cycle threshold values, the sensitivity became comparable between the settings. Symptoms occurred more frequent in the Ag-RDT+ group than Ag-RDT- group. Resident characteristics did not differ between these groups. Based on the focus groups, the SSM was feasible to perform if certain requirements, such as availability of staff, equipment and proper training, were met. However, the rapid availability of the test results were perceived as a dilemma.
The advantages and disadvantages need to be considered before implementation of the SSM can be recommended in the NH setting. For the vulnerable NH residents, it is important to find the right balance between effective testing policy and the burden this imposes.
评估在养老院（NH）爆发期间，是否可以使用一个拭子同时进行抗原检测快速诊断测试（Ag-RDT）和逆转录聚合酶链反应（RT-PCR）以检测 COVID-19。
在三个荷兰 NH 中评估了单拭子方法（SSM），即用 RT-PCR 所用的转运培养基进行 Ag-RDT，并将其与实验室设置进行比较。我们收集了 Ag-RDT 和 RT-PCR 结果、NH 居民特征和症状。此外，还与相关护理专业人员进行了两次焦点小组讨论，以深入了解 SMM 在 NH 环境中的可行性。
在 NH 环境中，与 RT-PCR 相比，SSM 的敏感性为 51%，特异性为 89%。这低于实验室设置（分别为 69%和 100%）。然而，当按循环阈值值分层时，这两个设置之间的敏感性变得可比。在 Ag-RDT+组中，症状比 Ag-RDT-组更频繁发生。这些组之间的居民特征没有差异。根据焦点小组的讨论，如果满足某些要求，如员工、设备和适当培训的可用性，那么 SSM 是可行的。然而，测试结果的快速可用性被认为是一个困境。
在 NH 环境中推荐实施 SSM 之前，需要考虑其优缺点。对于脆弱的 NH 居民，重要的是要在有效的检测政策和实施该政策带来的负担之间找到正确的平衡。
