Abstract
Rapid diagnosis of respiratory infections is of great importance for adequate isolation and treatment. Due to the batch-wise testing, laboratory-developed real-time polymerase chain reaction (PCR) assays (LDT) often result in a time to result of one day. Here, LDT was compared with rapid ePlex® Respiratory Pathogen (RP) Panel testing of GenMark Diagnostics (Carlsbad, CA, USA) with regard to time to result, installed isolation precautions, and antibacterial/antiviral treatment. Between January and March 2017, 68 specimens of 64 patients suspected of an acute respiratory infection were tested with LDT and the ePlex® RP panel. The time to result was calculated as the time between sample reception and result reporting. Information regarding isolation and antibacterial/antiviral treatment was obtained from the patient records. Thirty specimens tested LDT positive (47%) and 29 ePlex® RP panel positive (45%). The median time to result was 27.1 h (range 6.5–96.6) for LDT versus 3.4 h (range 1.5–23.6) for the RP panel, p-value < 0.001. In 14 out of 30 patients, isolation was discontinued based on the ePlex® RP panel results, saving 21 isolation days. ePlex® RP panel test results were available approximately one day ahead of the LDT results in the 19 patients receiving antiviral/antibacterial treatment. In addition, two bacterial pathogens, not requested by the physician, were detected using the RP panel. Analysis of respiratory infections with the ePlex® RP panel resulted in a significant decrease in time to result, enabling a reduction in isolation days in half of the patients. Furthermore, syndromic RP panel testing increased the identification of causative pathogens.
Highlights
Respiratory tract infections are a leading cause of hospital admission, morbidity, and mortality [1,2,3,4]
Six samples failed in the ePlex® Respiratory Pathogen (RP) panel, of which two gave a valid result upon retesting
None of the samples failed in the Laboratory-developed testing (LDT)
Summary
Respiratory tract infections are a leading cause of hospital admission, morbidity, and mortality [1,2,3,4]. Etiological agents of the respiratory tract infection cannot be identified solely based on clinical signs and symptoms. Since only a minority of the infections is being caused by bacteria, this empiric antibiotic treatment approach is Currently, the diagnosis of respiratory infections is usually based on (a combination of) molecular amplification methods and bacterial culture. Laboratory-developed real-time polymerase chain reaction (PCR) multiplex assays (LDT) are used that show excellent sensitivity and specificity. This approach is limited by the number of targets per multiplex reaction and the need for batch-wise testing. The assays are performed once daily, with a time to result of approximately 20 h
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