Department of Internal Medicine II (Infectious Diseases, Immunology, Rheumatology, Pneumology), Medical University of Innsbruck, A-6020 Innsbruck, Austria.
Viruses. 2023 Feb 8;15(2):470. doi: 10.3390/v15020470.
Reverse transcription polymerase chain reaction (RT-PCR) on respiratory tract swabs has become the gold standard for sensitive and specific detection of influenza virus, respiratory syncytial virus (RSV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this retrospective analysis, we report on the successive implementation and routine use of multiplex RT-PCR testing for patients admitted to the Internal Medicine Emergency Department (ED) at a tertiary care center in Western Austria, one of the hotspots in the early coronavirus disease 2019 (COVID-19) pandemic in Europe. Our description focuses on the use of the Cepheid Xpert Xpress closed RT-PCR system in point-of-care testing (POCT). Our indications for RT-PCR testing changed during the observation period: From the cold season 2016/2017 until the cold season 2019/2020, we used RT-PCR to diagnose influenza or RSV infection in patients with fever and/or respiratory symptoms. Starting in March 2020, we used the RT-PCR for SARS-CoV-2 and a multiplex version for the combined detection of all these three respiratory viruses to also screen subjects who did not present with symptoms of infection but needed in-hospital medical treatment for other reasons. Expectedly, the switch to a more liberal RT-PCR test strategy resulted in a substantial increase in the number of tests. Nevertheless, we observed an immediate decline in influenza virus and RSV detections in early 2020 that coincided with public SARS-CoV-2 containment measures. In contrast, the extensive use of the combined RT-PCR test enabled us to monitor the re-emergence of influenza and RSV detections, including asymptomatic cases, at the end of 2022 when COVID-19 containment measures were no longer in place. Our analysis of PCR results for respiratory viruses from a real-life setting at an ED provides valuable information on the epidemiology of those infections over several years, their contribution to morbidity and need for hospital admission, the risk for nosocomial introduction of such infection into hospitals from asymptomatic carriers, and guidance as to how general precautions and prophylactic strategies affect the dynamics of those infections.
呼吸道拭子的逆转录聚合酶链反应 (RT-PCR) 已成为敏感和特异性检测流感病毒、呼吸道合胞病毒 (RSV) 和严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 的金标准。在这项回顾性分析中，我们报告了在奥地利西部一家三级护理中心的内科急诊部 (ED) 连续实施和常规使用多重 RT-PCR 检测的情况，该中心是欧洲早期 2019 年冠状病毒病 (COVID-19) 大流行的热点之一。我们的描述重点是在床边即时检测 (POCT) 中使用 Cepheid Xpert Xpress 封闭 RT-PCR 系统。在观察期间，我们进行 RT-PCR 检测的指征发生了变化：从 2016/2017 年的寒冷季节到 2019/2020 年的寒冷季节，我们使用 RT-PCR 诊断发热和/或呼吸道症状患者的流感或 RSV 感染。从 2020 年 3 月开始，我们将 RT-PCR 用于 SARS-CoV-2 检测，并使用多重版本同时检测这三种呼吸道病毒，以筛查没有感染症状但因其他原因需要住院治疗的患者。预计，向更宽松的 RT-PCR 检测策略的转变导致检测数量大幅增加。然而，我们观察到 2020 年初流感病毒和 RSV 检测的急剧下降，这与 SARS-CoV-2 公共控制措施的实施同时发生。相比之下，广泛使用联合 RT-PCR 检测使我们能够在 2022 年底 COVID-19 控制措施不再实施时监测流感和 RSV 检测的再次出现，包括无症状病例。我们对 ED 真实环境中呼吸道病毒的 PCR 结果进行的分析提供了有关这些感染在几年内的流行病学、它们对发病率和住院需求的贡献、无症状携带者将此类感染引入医院的院内风险，以及一般预防措施和预防策略如何影响这些感染动态的宝贵信息。
