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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

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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

    J Hosp Infect. 2019 Sep 5. pii: S0195-6701(19)30357-3. doi: 10.1016/j.jhin.2019.08.022. [Epub ahead of print]
    A Service Evaluation of Simultaneous near Patient Testing for Influenza, RSV, Clostridium difficle and Norovirus in a UK District General Hospital.

    Haigh J1, Cutino-Moguel MT2, Wilks M2, Welch CA3, Melzer M4.
    Author information

    1 Royal London and Whipps Cross University Hospital, Barts Health NHS Trust, 3'rd Floor Pathology and Pharmacy Building, 80 Newark St, London. E1 2ES. Electronic address: john.haigh3@nhs.net. 2 Royal London Hospital, Barts Health NHS Trust, 3'rd Floor Pathology and Pharmacy Building, 80 Newark St, London. E1 2ES. 3 Department of Cardiovascular Sciences, University of Leicester, Leicester. LE1 7RH. 4 Microbiology and Infectious Diseases, Royal London and Whipps Cross University Hospital, Barts Health NHS Trust, 3'rd Floor Pathology and Pharmacy Building, 80 Newark St, London. E1 2ES.

    Abstract

    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.
    Copyright © 2019 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.


    KEYWORDS:

    Cepheid; Clostridium difficile; GeneXpert; Infection Prevention; Influenza; Norovirus; RSV

    PMID: 31494128 DOI: 10.1016/j.jhin.2019.08.022
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