Diagnosis Of Respiratory Virus Infections Research Articles

Precision Diagnosis of Viral Respiratory Infections: Unleashing the Power of Multiplex Polymerase Chain Reaction (PCR) for Enhanced Infection Management

Precision Diagnosis of Viral Respiratory Infections: Unleashing the Power of Multiplex Polymerase Chain Reaction (PCR) for Enhanced Infection Management

Impact of respiratory syncytial virus infection among patients with hematological cancer in the era of post-coronavirus pandemic.

400 Background: Two vaccine is recently approved for elderly patient with compromised immunity. Despite the recommendation by Center for Disease Control and Prevention (CDC), RSV vaccination is remains low among patient with hematological malignancy, when compare to influenza vaccination. Thus, we conducted an observational study to estimate the impact of RSV infection among patients with hematological malignancy. Methods: We conducted a population-based retrospective cohort utilized the TritNetx dataset, which consist of patients across 63 U.S. healthcare organization. This study included patient who had respiratory viral infection after a diagnosis of hematological malignancy during 6/1/2022 - 4/1/2022. Hematological malignancy was identified using ICD-10 codes. CPT code and ICD-10 code were used to identify diagnosis of respiratory viral infection after respiratory pathogen panel testing. Patient who was diagnosed with RSV, influenza or COVID-19 were paired based on the following variable, including demographics, body mass index, comorbidities, and anti-neoplastic therapy. Hazard ratio (HR) was estimated by Cox proportional hazard regression models and log-rank test. Risk ratio (RR) was calculated by logistic regression. Results: A total of 6,088 patients with hematological malignancy contracted RSV, influenza or COVID during the observation period. When compare to influenza, patients with RSV infection were associate with high healthcare utilization, including emergency visit (HR: 1.20, 95% CI:[1.00-1.41]), and hospitalization (HR: 1.29, 95% CI:[1.06-1.57]). RSV infection was also resulted in higher acuity including viral pneumonia (HR: 15.42, 95% CI:[9.26-25.68]), use of antibiotics (HR: 1.54, 95% CI:[1.28-1.86]), renal replacement therapy (HR: 2.09, 95% CI:[1.10-3.96]), and acute respiratory failure (HR: 1.54, 95% CI:[1.14-2.07]). When compare to COVID-19, RSV infection showed similar trend including more frequent emergency visit (HR: 1.30, 95% CI:[1.10-1.54]), and high risk of developing viral pneumonia (HR 23.48, 95% CI: [12.79-43.09]). Interestingly, the intubation rate, 28 days all-cause mortality and 90 days all-cause mortality were similar between the three cohort. Conclusions: RSV infection was associated with higher rate of pneumonia and healthcare utilization. RSV vaccination should be considered to prevent RSV-associated morbidity among patients with hematological malignancy.

Rapid and on-site wireless immunoassay of respiratory virus aerosols via hydrogel-modulated resonators

Rapid and accurate detection of respiratory virus aerosols is highlighted for virus surveillance and infection control. Here, we report a wireless immunoassay technology for fast (within 10 min), on-site (wireless and battery-free), and sensitive (limit of detection down to fg/L) detection of virus antigens in aerosols. The wireless immunoassay leverages the immuno-responsive hydrogel-modulated radio frequency resonant sensor to capture and amplify the recognition of virus antigen, and flexible readout network to transduce the immuno bindings into electrical signals. The wireless immunoassay achieves simultaneous detection of respiratory viruses such as severe acute respiratory syndrome coronavirus 2, influenza A H1N1 virus, and respiratory syncytial virus for community infection surveillance. Direct detection of unpretreated clinical samples further demonstrates high accuracy for diagnosis of respiratory virus infection. This work provides a sensitive and accurate immunoassay technology for on-site virus detection and disease diagnosis compatible with wearable integration.

ADLM Guidance Document on Laboratory Diagnosis of Respiratory Viruses.

Respiratory viral infections are among the most frequent infections experienced worldwide. The COVID-19 pandemic has highlighted the need for testing and currently several tests are available for the detection of a wide range of viruses. These tests vary widely in terms of the number of viral pathogens included, viral markers targeted, regulatory status, and turnaround time to results, as well as their analytical and clinical performance. Given these many variables, selection and interpretation of testing requires thoughtful consideration. The current guidance document is the authors' expert opinion based on the preponderance of available evidence to address key questions related to best practices for laboratory diagnosis of respiratory viral infections including who to test, when to test, and what tests to use. An algorithm is proposed to help laboratories decide on the most appropriate tests to use for the diagnosis of respiratory viral infections.

Application value of metagenomics next-generation sequencing in the diagnosis of respiratory virus infection after congenital heart surgery.

Timely and accurate pathogen diagnosis can be challenging in children who contract a respiratory virus following congenital heart surgery (CHS). This often results in suboptimal drug use and treatment delays. Metagenomics next-generation sequencing (mNGS) is a swift, efficient, and unbiased method for obtaining microbial nucleic acid sequences. This technology holds promise as a comprehensive diagnostic tool, especially for pathogens undetectable by traditional methods. However, the efficacy of mNGS in the context of congenital heart disease infections remains uncertain. This study aimed to explore the diagnostic value of mNGS for respiratory virus infections post-CHS. We conducted a retrospective analysis of patients who developed respiratory tract infections post-CHS and were admitted to our cardiac center between July 2021 and December 2022. The patients were categorized into the following two groups based on the diagnostic method used: (I) the mNGS group (comprising 62 patients); and (II) the conventional microbiological test (CMT) group (comprising 70 patients). Bronchoalveolar lavage fluid (BALF) samples from these patients were tested to identify pathogens. The mNGS group had significantly higher detection rates for both viral infections and mixed viral infections than the CMT group (56.45% vs. 17.14%, P<0.001, and 80.00% vs. 16.67%, P<0.001, respectively). In the mNGS group, 19.35% of the patients received antiviral therapy, and 61.29% received an anti-infective regimen adjustment. Conversely, in the CMT group, only 4.29% received antiviral therapy, and 28.57% received an anti-infective regimen adjustment. A higher percentage of patients showed improved respiratory symptoms in the mNGS group than the CMT group (74.19% vs. 44.29%, P=0.001). Additionally, the mNGS group had a shorter duration of mechanical ventilation and a reduced length of stay in the cardiac intensive care unit than the CMT group (P=0.012). Using mNGS for BALF enhances the detection of respiratory viral infections and coexisting viral infections post-CHS. This facilitates more precise treatment strategies and could potentially lead to improved patient outcomes.

Wireless, battery-free, multifunctional integrated bioelectronics for respiratory pathogens monitoring and severity evaluation

The rapid diagnosis of respiratory virus infection through breath and blow remains challenging. Here we develop a wireless, battery-free, multifunctional pathogenic infection diagnosis system (PIDS) for diagnosing SARS-CoV-2 infection and symptom severity by blow and breath within 110 s and 350 s, respectively. The accuracies reach to 100% and 92% for evaluating the infection and symptom severity of 42 participants, respectively. PIDS realizes simultaneous gaseous sample collection, biomarker identification, abnormal physical signs recording and machine learning analysis. We transform PIDS into other miniaturized wearable or portable electronic platforms that may widen the diagnostic modes at home, outdoors and public places. Collectively, we demonstrate a general-purpose technology for rapidly diagnosing respiratory pathogenic infection by breath and blow, alleviating the technical bottleneck of saliva and nasopharyngeal secretions. PIDS may serve as a complementary diagnostic tool for other point-of-care techniques and guide the symptomatic treatment of viral infections.

B-158 Application of Statistical Analysis as a Tool to Monitor the Variation of SARS-CoV-2 and Other Respiratory Viruses

Abstract Background After the emergence of SARS-CoV-2 and its worldwide spread, only a few studies have correlated its co-circulation with other respiratory viral pathogens (RVP). The current report aims to identify the pattern of SARS-CoV-2 positivity in individuals co-infected with influenza A (FluA), influenza B (FluB), or respiratory syncytial virus (RSV) in São Paulo, Brazil. Methods Study Population and Characteristics: This study was a retrospective analysis from a clinical laboratory database in São Paulo, Brazil from January 15 to March 10, 2022. Test results for respiratory viral co-infections were recorded for individuals with SARS-CoV-2, FluA, FluB, or RSV. Nasopharyngeal swab samples were evaluated for the molecular diagnosis of respiratory virus infections using a real-time multiplex-PCR panel to search for specific genes for the detection of SARS-CoV-2, FluA, FluB, and RSV. Only samples positive for one or more pathogens (including SARS-CoV-2) were included in the study. We further stratified the specimens by SARS-CoV-2 positivity, comparing those that also tested positive for an RVP in each group. Statistical Analysis: Kruskal-Wallis analysis of variance followed by Dunn’s multiple comparison tests was used. Results with P &amp;lt; 0.05 were considered statistically significant. Georeferencing analysis of SARS-CoV-2 mono-infection or co-infection with another respiratory virus was performed using an online available software application. Results A total of 28 932 samples were positive for at least one RVP, meeting the study criteria. Among those, a total of 93.13% were from individuals diagnosed with SARS-CoV-2 only, 2.99% positive for SARS-CoV-2 and FluA, and 0.99% positive for SARS-CoV-2 and RSV. There was no significant difference observed between genders nor individuals with mono-infection or co-infection. The analysis of age group showed a significant variation in positive cases between SARS-CoV-2 vs SARS-CoV-2 and FluA in the 0 to 10-year-old population (P = 0.017) and between SARS-CoV-2 vs SARS-CoV-2 and RSV in the 0 to 5-year-old population (P = 0.018). The highest number of positive samples for both SARS-CoV-2 and RSV was detected in the southern region of São Paulo (55.7%), compared to the north and east regions (44.3%). Conclusion Differences in diagnostic patterns of COVID-19 compared to other respiratory viral infections RVP co-infections are important for a better understanding of clinical outcomes, improved patient management, and better public health planning.

Contribution of the FilmArray BioFire® Technology in the Diagnosis of Viral Respiratory Infections during the COVID-19 Pandemic at Ibn Sina University Hospital Center in Rabat: Epidemiological Study about 503 Cases.

Respiratory viruses are the most involved pathogens in acute respiratory infections. During the COVID-19 pandemic, new elements have been brought to this topic, especially at the diagnostic and therapeutic level. The objective of this work is to describe the epidemiology of respiratory viruses in patients admitted to the Ibn Sina University Hospital of Rabat during a period characterized by the emergence and spread of SARS-CoV-2. We conducted a retrospective study from January 1 to December 31. We included all patients treated for acute respiratory infection and for whom a multiplex respiratory panel PCR was requested. Virus detection was performed using a FilmArray RP 2.1 plus BioFire multiplex respiratory panel. The study population was relatively adults with a mean age of 39 years. The sex ratio M/F was 1.20. The survey revealed a high prevalence of 42.3% of patients hospitalized in the adult intensive care unit whose respiratory distress was the most common reason for hospitalization (58%). The positivity rate was 48.1%. This rate was higher in the pediatric population 83.13% compared to adults 29.7%. Monoinfection was found in 36.4% of cases, and codetection in 11.7% of cases. This survey revealed that a total of 322 viruses were detected, HRV being the most incriminated virus (48.7%), followed by RSV in 13.8% of patients. Considering the five most detected viruses in our study (HRV, RSV, PIV3, ADV, and hMPV), we found that the incidence was significantly higher in the pediatric population. SARS-CoV-2 was detected only in adult's population. In our study, we found that influenza A and B viruses, PIV2, MERS, and all bacteria were not detected by this kit during the study period. Regarding the seasonal distribution, RSV and hMPV showed a significantly high incidence during autumn and summer and SARS-CoV-2 and CoV OC43 showed a high peak during winter. In this study, we found a lack of detection of influenza virus and a shift in the usual winter peak of RSV to the summer, while the detection of ADV and HRV was less affected. This difference in detection could be due on the one hand to the difference in stability between enveloped and nonenveloped viruses and on the other hand to the escape of certain viruses to the different sanitary measures introduced after the declaration of the COVID-19 pandemic. These same measures were effective against enveloped viruses such as RSV and influenza viruses. The emergence of SARS-CoV-2 has modified the epidemiology of other respiratory viruses, either directly by viral interference or indirectly by the preventive measures taken.

Respiratory Virus Infections during the COVID-19 Pandemic Revealed by Multiplex PCR Testing in Japan.

Under the strict quarantine policy imposed to combat the COVID-19 (coronavirus disease 2019) pandemic in Japan, the prevalence of respiratory infections by viruses other than SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) has been largely unknown. However, such information on viral circulation is important in order to develop better management policies that are based on scientific data. Here, we retrospectively investigated respiratory virus infections in individuals who visited a community hospital with respiratory symptoms between June of 2020 and September of 2021 with the use of the BioFire FilmArray Respiratory Panel 2.1. Virus was detected in 65 out of a total of 328 subjects, with SARS-CoV-2 (67.7%), rhino/enterovirus (18.5%), and parainfluenza virus 3 (7.7%) accounting for most of the infections. No influenza virus or respiratory syncytial virus (RSV) infections were detected. The monthly cases of rhino/enterovirus infection were highest from winter to spring, with this temporal pattern differing from that of SARS-CoV-2. SARS-CoV-2 was detected more frequently (P < 0.001) in subjects with cough (31/104 cases, 29.8%) than in those without cough (13/224 cases, 5.8%), suggesting that cough might contribute to the prediction of COVID-19. Our findings also suggest that testing for rhino/enterovirus and parainfluenza virus 3, in addition to SARS-CoV-2, may be important for the rigorous diagnosis of respiratory virus infections. IMPORTANCE Influenza virus, RSV, adenovirus, and rhino/enterovirus were the major respiratory viruses before COVID-19 pandemic. Circulating respiratory viruses may have been affected by our strong quarantine policy during the COVID-19 pandemic. We checked the circulating respiratory viruses from our outpatients by using a multiplex PCR kit that had recently been released. SARS-CoV-2 was the most frequently detected virus, and it was followed by rhino/enterovirus and parainfluenza virus 3. No influenza virus or RSV infections were detected during our study period, suggesting that influenza virus and RSV became almost extinct. COVID-19 cases frequently experienced cough, and this frequency was statistically significantly higher than that observed in the cases without SARS-CoV-2 detection. The cough can be an indicator of COVID-19.

Introduction of graphene oxide-supported multilayer-quantum dots nanofilm into multiplex lateral flow immunoassay: A rapid and ultrasensitive point-of-care testing technique for multiple respiratory viruses.

A lateral flow immunoassay (LFA) biosensor that allows the sensitive and accurate identification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other common respiratory viruses remains highly desired in the face of the coronavirus disease 2019 pandemic. Here, we propose a multiplex LFA method for the on-site, rapid, and highly sensitive screening of multiple respiratory viruses, using a multilayered film-like fluorescent tag as the performance enhancement and signal amplification tool. This film-like three-dimensional (3D) tag was prepared through the layer-by-layer assembly of highly photostable CdSe@ZnS−COOH quantum dots (QDs) onto the surfaces of monolayer graphene oxide nanosheets, which can provide larger reaction interfaces and specific active surface areas, higher QD loads, and better luminescence and dispersibility than traditional spherical fluorescent microspheres for LFA applications. The constructed fluorescent LFA biosensor can simultaneously and sensitively quantify SARS-CoV-2, influenza A virus, and human adenovirus with low detection limits (8 pg/mL, 488 copies/mL, and 471 copies/mL), short assay time (15 min), good reproducibility, and high accuracy. Moreover, our proposed assay has great potential for the early diagnosis of respiratory virus infections given its robustness when validated in real saliva samples.Electronic Supplementary MaterialSupplementary material (Section S1 Experimental section, Section S2 Calculation of the maximum number of QDs on the GO@TQD nanofilm, Section S3 Optimization of the LFA method, and Figs. S1–S17 mentioned in the main text) is available in the online version of this article at 10.1007/s12274-022-5043-6.

(Digital Presentation) Biomimic Nanotemplating Assay Based on Molecularly Imprinted Polymers for the Impedimetric Detection of Sars-Cov-2 and Influenza A Spike Proteins in Untreated Saliva

With the continuously fluctuating incidence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), critical gaps in the field of rapid diagnostic testing have been exposed, particularly in the diagnosis of viral respiratory infections. Current gold standard methods rely on real time quantitative polymerase chain reaction (RT-qPCR) for the detection of viral nucleic acids, but these tests are challenged with long turnaround times, costly centralized laboratory equipment and the need for trained personnel to execute the protocols. With the growing number of emerging variants that can evade both immune responses and inoculation, addressing current testing challenges is critical to manage the spread of viral infections. Here, we propose the design of a novel assay based on our previously studied gold nano/micro islands (NMIs) as a core for the fabrication of an ultrathin molecularly imprinted polymer (MIP) for the impedimetric detection of SARS-CoV-2 and Influenza A spike proteins (SPs) in untreated saliva within 10 minutes. The proposed electrofabrication protocol is rapidly adaptable to a diverse repertoire of protein biomarkers; in this work, we demonstrate the impedimetric detection of the SARS-CoV-2 original strain, Alpha B.1.1.7, Delta B.1.617.2 and Omicron B.1.1.529 variant SP, as well as the Influenza A SP within physiologically relevant ranges and at a low limit of detection to enable the diagnosis of acute infections. Validation was performed at two unique test sites with 51 SARS-CoV-2 patient samples to demonstrate an overall 100% sensitivity and 100% specificity of the NMIs/MIPs assay. Robust quantification of the electrochemical assay was confirmed against RT-qPCR, which effectively enabled statistically significant (p < .0005) viral load quantification on a rapid, miniaturized, and ultrasensitive platform. This novel technology presents the development of a quantitative and versatile electrochemical assay with the potential for the rapid detection of current and future viral respiratory infections, which can guide future electrochemical clinical and commercial point-of-care testing platforms.

Retrospective evaluation of viral respiratory tract infections in a university hospital in Ankara, Turkey (2016-2019).

Viruses are responsible for two-thirds of all acute respiratory tract infections. This study aims to retrospectively detect respiratory tract viruses in patients from all age groups who visited the hospital. A total of 1592 samples from 1416 patients with respiratory tract symptoms were sent from several clinics to the Molecular Microbiology Laboratory at Gazi University Hospital from February 2016 to January 2019. Nucleic acid extraction from nasopharyngeal swabs, throat swabs or bronchoalveolar lavage (BAL) samples sent to our laboratory was done using a commercial automated system. Extracted nucleic acids were amplified by a commercial multiplex-real time Polymerase Chain Reaction (PCR) method, which can detect 18 viral respiratory pathogens. Among 1592 samples, 914 (57.4%) were positive for respiratory viruses. The most prevalent were rhinovirus (25.2%) and influenza A virus (12.1%), the least prevalent was the bocavirus (2.6%). Rhinovirus was the most detected as a single agent (21.2%, 194/914) among all positive cases, followed by coronavirus (9.3%, 85/914). The detection rates of coronavirus, human adenovirus, respiratory syncytial virus A/B, human parainfluenza viruses, human metapneumovirus-A/B, human parechovirus, enterovirus and influenza B virus were 9.9%, 8%, 7.7%, 5%, 3.4%, 3.1%, 3%, and 2.8%, respectively. The most detected viral agents in our study were influenza A virus and rhinovirus. Laboratory diagnosis of respiratory viruses is helpful to prevent unnecessary antibiotic use and is essential in routine diagnostics for antiviral treatment. Multiplex Real-time PCR method is fast and useful for the diagnosis of viral respiratory infections.

Epidemiologic Characteristics and Clinical Significance of Respiratory Viral Infections Among Adult Patients Admitted to the Intensive Care Unit.

BackgroundThe diagnosis of respiratory viral infections (RVIs) in critically ill patients is important for determining treatment options and adhering to infection-control protocols. However, data on the incidence and occurrence patterns of RVIs are scarce. We investigated the epidemiology and clinical impact of RVIs in critically ill patients.MethodsThis retrospective observational study was conducted in a tertiary hospital in South Korea between November 2014 and September 2020. Adult patients (≥ 18 years of age) who tested positive for an RVI by multiplex polymerase chain reaction (mPCR) and were admitted to the intensive care unit (ICU) were included in the study. Clinical characteristics and outcomes were obtained by reviewing electronic medical records. Pearson's χ2 test and Fisher's exact test, Mann-Whitney U test was used to compare between groups of patients. Trend analysis and the χ2-based Q test was used to analyze test behavior of physicians performing mPCR test.ResultsAmong 22,517 patients admitted to the ICU during the study period, 2,222 (9.9%) underwent mPCR testing for an RVI. The median timing of mPCR testing after ICU admission was 1 day (IQR, 0–2). A total of 335 (15.1%) non-duplicative RVI-positive cases were included in the analysis. The incidence rate of RVIs in ICU patients was 30.45 per 10,000 patient-days. The most frequently detected RVI was influenza A (27.8%), followed by rhinovirus (25.4%). Thirty-two (9.6%) RVI-positive patients were diagnosed with upper respiratory infections, 193 (64.1%) with community-acquired, and 108 (35.9%) with hospital-acquired pneumonia. All-cause mortality and mortality related to respiratory tract infection (RTI) were 30.7% and 22.1%, respectively. The initial presentation of septic shock, requirement for mechanical ventilation, and lymphocytopenia were significant predictors of RTI-related mortality. Of the RVI-positive patients, 151 (45.1%) had nonviral coinfections and presented with higher clinical severity and longer hospital stays than patients infected solely with viral pathogens.ConclusionThe incidence of RVIs in ICU patients is common. ICU patients with RVIs had high mortality and frequently presented with coinfections with nonviral pathogens, which were associated with a higher clinical severity than sole RVI. Increased testing for RVIs will enhance infection-control efforts and improve patient care.

Epidemiology of respiratory virus before and during COVID-19 pandemic.

The COVID pandemic has forcefully turned the spotlight on the importance of the diagnosis of respiratory virus infections. Viruses have always been a frequent and common cause of respiratory tract infections. Rapid molecular diagnostics applied to the diagnostics of respiratory virus infections has revolutionized microbiology laboratories only a few years ago. Few studies illustrate the epidemiology of respiratory viruses, and fewer still those that have compared the pre-pandemic to the pandemic period. During the first year of the pandemic (2020-2021) it was clear to everyone to witness a sudden disappearance of the circulation of all the other respiratory viruses, especially those typically isolated during the winter time, such as RSV and Influenza virus. In our study we wanted to verify this phenomenon and to study the epidemiology of our local reality, analyzing three consecutive flu seasons (2018-2019, 2019-2020, 2020-2021). The results lead us to note that the prevalence of positivity to respiratory virus infections went from 49.8% (2018-2019) and 39% (2019-2020) to 13.4% (2020-2021). This decrease is at least partly attributable to the security measures adopted (social distancing and mask), but it certainly opens up new scenarios when the restriction measures will be terminated. We believe such studies can provide real-world evidence of the effectiveness of public health interventions implemented during current and future pandemics.

Diagnostic Stewardship of Respiratory Pathogen Panel Utilization

Background: Diagnostic stewardship modifies the ordering, performing, and reporting of diagnostic tests to optimize clinical care and infection prevention while conserving healthcare resources. Timely and accurate diagnosis of respiratory virus infections can optimize the use of antibiotics, antivirals, ancillary tests, and inpatient beds. Influenza-like illnesses (ILIs) are frequently caused by viruses. However, before COVID-19, specific antiviral medication was commonly used only for the treatment of influenza virus infections. Methods: Eskenazi Health (EH) had 2 respiratory PCR assays: influenza/RSV ($58.18 per assay) and a 20-pathogen respiratory pathogens panel (RPP) ($129 per assay). An inpatient ILI algorithm was developed and implemented in the electronic health record (EHR) in October 2018 to guide the selection of the appropriate assay (Figure 1). Ambulatory testing defaulted to the influenza/RSV assay. Prescribers retained the ability to override recommendations. We performed a retrospective chart review of all orders for RPP and influenza/RSV assays before implementation of the ILI algorithm (October 1, 2017, to September 30, 2018) and after implementation (October 1, 2018, to September 30, 2019). The primary end point was the number of RPP assays ordered. The secondary end point was the appropriateness of RPP assays ordered (ie, met ≥1 criteria) and number of influenza/RSVs assays ordered with virus detected. Results: Before the implementation of the intervention, 1,882 orders were reviewed. After implementation 1,621 orders were reviewed. All influenza/RSV and RPP assays were included if they were ordered between October 1, 2017, and September 30, 2019, at EH. There were no exclusion criteria. After implementation, RPP assays decreased ~40% (Table 1), with associated cost savings of $35,368.68 (22.6% of total assay costs; $163,742.88 before implementation and $128,374.20 after implementation). Although some of this reduction could be attributed to the lower number of overall assays ordered, the 40% reduction in RPP assays exceeded the 14% decrease in overall orders, demonstrating improvement in utilization of RPP assays. A corresponding increase in influenza/RSV assay orders was not observed; both groups had similar total influenza/RSV orders. Both groups also had similar percentages of viruses detected with influenza/RSV and RPP (33% before vs 31% after). After implementation, 1,522 (94%) of 1,621 orders followed the recommendations of the ILI algorithm (Table 2). Several prescribers ordered influenza/RSV despite the patient meeting criteria for RPP assay; of these 26 assays, 4 (15%) resulted in virus detection. Of the 73 instances in which prescribers bypassed recommendations for the influenza/RSV assay and ordered an RPP assay, 14 (19%) of the assays resulted in virus detection; only 1 of 14 was a virus that would have been detected by the influenza/RSV. We were unable to identify any trends that would assist in developing additional order questions to capture these patients. Conclusions: Implementation of the ILI algorithm was associated with high adherence, improvement in the appropriateness of ordering, and significant cost savings.Funding: NoDisclosures: None

Differential diagnosis of respiratory viral infections in children in the COVID-19 pandemic time

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Wawryk-Gawda E, Emeryk A, Chojęta A. Differential diagnosis of respiratory viral infections in children in the COVID-19 pandemic time. Family Medicine & Primary Care Review. 2021;23(4):501-507. doi:10.5114/fmpcr.2022.110372. APA Wawryk-Gawda, E., Emeryk, A., & Chojęta, A. (2021). Differential diagnosis of respiratory viral infections in children in the COVID-19 pandemic time. Family Medicine & Primary Care Review, 23(4), 501-507. https://doi.org/10.5114/fmpcr.2022.110372 Chicago Wawryk-Gawda, Ewelina, Andrzej Emeryk, and Agnieszka Chojęta. 2021. "Differential diagnosis of respiratory viral infections in children in the COVID-19 pandemic time". Family Medicine & Primary Care Review 23 (4): 501-507. doi:10.5114/fmpcr.2022.110372. Harvard Wawryk-Gawda, E., Emeryk, A., and Chojęta, A. (2021). Differential diagnosis of respiratory viral infections in children in the COVID-19 pandemic time. Family Medicine & Primary Care Review, 23(4), pp.501-507. https://doi.org/10.5114/fmpcr.2022.110372 MLA Wawryk-Gawda, Ewelina et al. "Differential diagnosis of respiratory viral infections in children in the COVID-19 pandemic time." Family Medicine & Primary Care Review, vol. 23, no. 4, 2021, pp. 501-507. doi:10.5114/fmpcr.2022.110372. Vancouver Wawryk-Gawda E, Emeryk A, Chojęta A. Differential diagnosis of respiratory viral infections in children in the COVID-19 pandemic time. Family Medicine & Primary Care Review. 2021;23(4):501-507. doi:10.5114/fmpcr.2022.110372.

1103. Respiratory Virus Infections In Solid Organ Transplant Recipients: A Single Center Experience

BackgroundCommunity acquired respiratory virus infections (RVI) are a major concern in solid organ transplant (SOT) recipients due to severe complications such as lower respiratory tract infection (LRTI), superimposed fungal and bacterial pneumonia, intensive care admission and mortality. Besides influenza and respiratory syncytial virus (RSV), there is paucity of data of RVI in SOT recipients.Table 1: Patients characteristics Table 2: Concomitant infections MethodsRetrospective cohort study of a single large transplant center was performed. Data of multiplex qualitative PCR-based respiratory viral panel (RVP) samples collected between January 2017 and December 2019 were included. It is important to mention that our institution generally performs the RSV/influenza rapid detection assay as an initial test; if negative, the multiplex PCR panel is usually done. We did not include results from the RSV/influenza rapid test in this study.ResultsOne hundred transplant patients with a single positive RVP were included (table 1). Transplanted organs include kidney (40%), followed by lung (33%) and liver (9%). Most common presenting symptoms were cough (52%), shortness of breath (28%) and rhinorrhea (26%). Of note fever was seen in only 24%. Most common RVI was Rhinovirus/Enterovirus (RHV/ENT) (59%), followed by non-SARS-CoV-2 Coronavirus (19%) and Parainfluenza (PIV) (14%). None of the patients had neutropenia, however, 52% had lymphocytopenia. Lung transplant patients developed LRTI in 70% of cases compared to non-lung transplant 64% (p=0.412). Multivariate analysis showed patients with PIV 3 were less likely to develop LRTI (p= 0.038). Significant Cytomegalovirus DNAemia (>137 IU/mL) was noted in 9.8% of the recipients. No proven or probable pulmonary fungal infection were noted within 3 months after diagnosis of RVI. Five patients were admitted to the Intensive care unit due to septic shock. Three patients died at 4, 5 and 35 days after diagnosis of RHV/ENT, PIV-3 and RHV/ENT respectively.ConclusionMost of the cases of RVI were due to RHV/ENT. Patients with PIV 3 were less likely to develop LRTI. Lung transplant recipients developed LRTI with similar incidence to non-lung recipients. Our data shows a very low mortality of 3% after RVI in our SOT cohort, which warrants larger studies.DisclosuresMichele I. Morris, MD, Viracor Eurofins (Advisor or Review Panel member)

Sputum versus nasopharyngeal samples for the molecular diagnosis of respiratory viral infection in cystic fibrosis: A pilot study

Viruses are important agents in lung function deterioration in Cystic Fibrosis (CF). To date, no standard operating procedures (SOPs) have been established to determine which sampling method is the most effective for an optimal virological diagnosis of respiratory viral infections in CF. Here we investigated the performances of two sampling sites, sputum samples versus nasopharyngeal (NP) swabs, for thirty participants from three CF centres presenting an acute respiratory infection. Sputum and NP samples were simultaneously collected and multiplex PCR targeting 16 to 18 viruses were performed. Viruses were detected for 18/30 patients (60%). A high concordance between the sputum and NP samples was observed in 25 (83%) paired samples of which 13 tested positive and 12 tested negative. These results highlighted the relevance of sputum sampling for diagnostic of respiratory viruses in CF, which is less invasive and better accepted by CF patients than NP, and allows accurate bacterial detection.

Clinical evaluation of fully automated molecular diagnostic system \u201cSimprova\u201d for influenza virus, respiratory syncytial virus, and human metapneumovirus

Influenza virus, respiratory syncytial virus, and human metapneumovirus commonly cause acute upper and lower respiratory tract infections, especially in children and the elderly. Although rapid antigen detection tests for detecting these infections have been introduced recently, these are less sensitive than nucleic acid amplification tests. More recently, highly sensitive point-of-care testings (POCTs) have been developed based on nucleic acid amplification tests, which are easy to use in clinical settings. In this study, loop-mediated isothermal amplification (LAMP)-based POCT “Simprova” to detect influenza A and B viruses, respiratory syncytial virus, and human metapneumovirus was developed. Simprova system is fully automated and does not require skilled personnel. In addition, positive results can be achieved faster than with PCR. In this study, the accuracy of the POCT was retrospectively analyzed using 241 frozen stocked specimens. Additionally, the usability of the Simprova at clinical sites was assessed in a prospective clinical study using 380 clinical specimens and compared to those of real-time PCR and rapid antigen detection test. The novel LAMP-based POCT demonstrated high sensitivity and specificity in characterizing clinical specimens from patients with influenza-like illnesses. The Simprova is a powerful tool for early diagnosis of respiratory viral infections in point-of-care settings.

Role of rapid diagnostics for viral respiratory infections in antibiotic prescribing decision in the emergency department.

To describe the frequency of antibiotic prescriptions in patients with known viral respiratory infections (VRIs) diagnosed by polymerase chain reaction (PCR) in 3 emergency departments (EDs) and to identify patient characteristics that influence the prescribing of antibiotics by ED physicians despite PCR confirmation of viral cause. Retrospective, observational analysis of patients with PCR-diagnosed VRI discharged from 3 acute-care hospital EDs within 1 health system. In total, 323 patients were discharged from the ED with a VRI diagnosis, of whom 68 were prescribed antibiotics (21.1%). These patients were older (median, 59.5 vs 43 years; P = .04), experienced symptoms longer (median, 4 vs 2 days; P = .002), were more likely to have received antibiotics in the preceding 7 days (27.9% vs 9.8%; P &lt; .001), and had higher proportions of abnormal chest X-rays (64.5% vs 28.4%; P &lt; .001). Patients were more likely to receive antibiotics for a diagnosis of pneumonia (39.7% vs 1.6%; P &lt; .001) or otitis media (7.4% vs 0.4%; P = .002), and were less likely with diagnosis of upper respiratory infection (2.9% vs 13.7%; P = .02) or influenza (20.6% vs 44.3%; P &lt; .001). Despite a diagnosis of VRI, one-fifth of ED patients were prescribed antibiotics. Patient characteristics including age, duration of symptoms, abnormal chest X-rays, and specific diagnosis may increase provider concern for concurrent bacterial infections. Opportunities exist for antimicrobial stewardship strategies to incorporate rapid diagnostics in promoting judicious antibiotic usage in the ED.