416. Diagnostic Yield of Serial COVID-19 Testing in Hospitalized Patients

Abstract

BackgroundAccurate and rapid diagnosis of SARS-CoV-2 infection is essential to prevent nosocomial transmission. Patients with negative COVID-19 tests at admission may still be in the incubation phase during hospitalisation. False negative results can occur when patients are tested too early. The incidence of COVID-19 infections in Montréal, Canada started to increase in December 2020. Because of this rise, on January 4th, 2021, the Infection Control Service of the McGill University Health Centre (MUHC) recommended serial COVID-19 testing for all admitted patients on days 5 and 10 after admission. The aim of this study is to examine the diagnostic yield of serial COVID-19 testing.MethodsWe retrospectively analyzed SARS-CoV-2 test results for patients admitted to the MUHC between January 4, 2021, and April 30, 2021. Nasopharyngeal swabs were collected from patients for SARS-CoV-2 PCR testing. Multiple testing platforms were used (Roche Cobas 6800, Thermo ScientificTM King Fisher and Cepheid GeneXpert) because of the high volume of samples. Tests were classified as admission, day 5, and day 10 tests if they were done on days 0 to 2, 3 to 7, and 8 to 12 respectively. Patients positive for SARS-CoV-2 on admission were excluded from the analyses. The diagnostic yield of serial testing for patients admitted during each month was calculated by dividing the number of patients testing positive on day 5 or day 10 by the total number of patients who underwent serial testing during that month.ResultsThere were 2945 admissions of 5 days or more and 1777 admissions of 10 days or more. Of these, 1509 patients and 841 patients respectively were serially tested for SARS-CoV-2 as recommended for a compliance rate of 51% at day 5 and 47% at day 10. Ten (0.7%) and 12 (1.4%) patients tested positive on days 5 and 10 respectively. The diagnostic yield of serial testing was highest for patients admitted in January 2021 at 2.2%, when the average daily incidence of COVID-19 was highest in Montréal (see Figure). The diagnostic yield of serial testing for each month, compared to the average daily COVID-19 incidence rate in Montréal, Québec, Canada.ConclusionThe diagnostic yield of serial SARS-CoV-2 testing in hospitalized patients is low when the overall community incidence is low. However, diagnostic yield of serial testing increases when community incidence of COVID-19 is higher and should be considered in this situation.Disclosures All Authors: No reported disclosures