1
|
Kaku N, Urabe T, Iida T, Yun C, Nishida Y, Onitsuka Y, Hashiguchi K, Hirose K, Tomonaga A, Izumikawa K, Mukae H, Yanagihara K. Gargle sample is an effective option in a novel fully automated molecular point-of-care test for influenza: a multicenter study. Virol J 2023; 20:41. [PMID: 36869389 PMCID: PMC9983540 DOI: 10.1186/s12985-023-01993-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 02/16/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND We conducted a multicenter study to evaluate the performance of a novel fully automated molecular point-of-care test using transcription-reverse transcription concerted reaction that can detect influenza A and B within 15 min in nasopharyngeal swabs and gargle samples (TRCsatFLU). METHODS Patients who visited or were hospitalized at eight clinics and hospitals with influenza-like illnesses between December 2019 and March 2020 participated in this study. We collected nasopharyngeal swabs from all patients and gargle samples from patients whom the physician judged fit to perform gargling. The result of TRCsatFLU was compared to a conventional reverse transcription-polymerase chain reaction (RT-PCR). If the results of TRCsatFLU and conventional RT-PCR were different, the samples were analyzed by sequencing. RESULTS We evaluated 233 nasopharyngeal swabs and 213 gargle samples from 244 patients. The average age of the patients was 39.3 ± 21.2. Of the patients, 68.9% visited a hospital within 24 h of symptom onset. The most common symptoms were fever (93.0%), fatigue (79.5%), and nasal discharge (64.8%). All patients in whom the gargle sample was not collected were children. Influenza A or B was detected in 98 and 99 patients in nasopharyngeal swabs and gargle samples using TRCsatFLU, respectively. Four and five patients in nasopharyngeal swabs and gargle samples, respectively, with different TRCsatFLU and conventional RT-PCR results. Influenza A or B was detected using sequencing in all samples with different results. Based on the combined conventional RT-PCR and sequencing results, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of TRCsatFLU for influenza detection in nasopharyngeal swabs were 0.990, 1.000, 1.000, and 0.993, respectively. In the gargle samples, the sensitivity, specificity, PPV, and NPV of the TRCsatFLU for detecting influenza were 0.971, 1.000, 1.000, and 0.974, respectively. CONCLUSIONS The TRCsatFLU showed great sensitivity and specificity for the detection of influenza in nasopharyngeal swabs and gargle samples. TRIAL REGISTRATION This study was registered in the UMIN Clinical Trials Registry (reference number: UMIN000038276) on October 11, 2019. Before sample collection, written informed consent for the participation and publication of this study was obtained from all participants.
Collapse
Affiliation(s)
- Norihito Kaku
- Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan. .,Department of Laboratory Medicine, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan. .,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, 4438 BSRB, 109 Zina Pitcher Pl, Ann Arbor, MI, 48109, USA.
| | - Tomohito Urabe
- Urabe Otorhinolaryngology Clinic, Nagasaki City, Nagasaki, Japan
| | - Tetsuya Iida
- Iida Naika Syounika Clinic, Nagasaki City, Nagasaki, Japan
| | - Chyuns Yun
- Ohisama Pediatric Clinic, Nagayo-cho, Nagasaki, Japan
| | - Yoshiyuki Nishida
- Nishida Gastrointestinal Internal Medicine Clinic, Nagasaki City, Nagasaki, Japan
| | | | - Kohji Hashiguchi
- Department of Respiratory Medicine, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki City, Nagasaki, Japan
| | | | | | - Koichi Izumikawa
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki City, Nagasaki, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki City, Nagasaki, Japan
| | - Katsunori Yanagihara
- Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan.,Department of Laboratory Medicine, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
| |
Collapse
|
2
|
Moon SH, Kim SC, Kim BW, Park GJ, Chai HS, Kim YM, Kim HS, Park HS. SARS-CoV-2 molecular diagnostic point-of-care testing based on loop-mediated isothermal amplification: A prospective, single-center validation study. Heliyon 2023; 9:e14564. [PMID: 36942218 PMCID: PMC10014123 DOI: 10.1016/j.heliyon.2023.e14564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/04/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023] Open
Abstract
Objectives Rapid and accurate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnostic tests are crucial for controlling the spread of infections in emergency settings. This study evaluated the diagnostic accuracy of a point-of-care (POC) test based on loop-mediated isothermal amplification (LAMP) that produces rapid results within 30 min. Methods We prospectively included adult patients (age >19 years) who were diagnosed with SARS-CoV-2 infection within the last 3 days and symptomatic patients who had visited the emergency room. Posterior nasopharyngeal (PNP) swabs and throat swabs collected by physicians were used to test the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and Cohen's Kappa coefficient (k) of the POC index and reference reverse transcription quantitative polymerase chain reaction (RT-qPCR) test devices. Results Of the 352 participants, 102 (29.0%) tested positive via the RT-PCR-based reference test device; the RT-LAMP-based POC test had a sensitivity of 70.6% and specificity of 98.0%, with 93.5% PPV, 89.1% NPV, 35.5% PLR, and 3.4% NLR. Cohen's k correlation of results from the two devices was 0.74. The cycle threshold value between the positive and negative POC test results differed (17.6 vs. 24.6, p < 0.001). Conclusions The RT-LAMP POC test in the emergency medical setting has a fair predictive value in high viral load cases in terms of infectivity.
Collapse
Affiliation(s)
- Sung Hun Moon
- Department of Emergency Medicine, Chungbuk National University Hospital, 776, 1st Sunhwan-ro, Seowon-gu, Cheongju-si, Chungcheongbuk-do 28646, Republic of Korea
| | - Sang-Chul Kim
- Department of Emergency Medicine, Chungbuk National University Hospital, 776, 1st Sunhwan-ro, Seowon-gu, Cheongju-si, Chungcheongbuk-do 28646, Republic of Korea
- Department of Emergency Medicine, College of Medicine, Chungbuk National University, 1 Chungdae-ro, Seowongu, Cheongju-si, Chungcheongbuk-do 28646, Republic of Korea
| | - Byung Woo Kim
- Department of Paramedic Science, Korea National University of Transportation, 61, Daehak-ro, Jeungpyeong-gun, Chungcheongbuk-do, 27909, Republic of Korea
| | - Gwan-Jin Park
- Department of Emergency Medicine, Chungbuk National University Hospital, 776, 1st Sunhwan-ro, Seowon-gu, Cheongju-si, Chungcheongbuk-do 28646, Republic of Korea
| | - Hyun-Seok Chai
- Department of Emergency Medicine, Chungbuk National University Hospital, 776, 1st Sunhwan-ro, Seowon-gu, Cheongju-si, Chungcheongbuk-do 28646, Republic of Korea
| | - Young Min Kim
- Department of Emergency Medicine, Chungbuk National University Hospital, 776, 1st Sunhwan-ro, Seowon-gu, Cheongju-si, Chungcheongbuk-do 28646, Republic of Korea
| | - Hee Sung Kim
- Department of Internal Medicine, Chungbuk National University Hospital, 776, 1st Sunhwan-ro, Seowon-gu, Cheongju-si, Chungcheongbuk-do 28646, Republic of Korea
- College of Medicine and Medical Research Institute, Chungbuk National University, 1 Chungdae-ro, Seowongu, Cheongju-si, Chungcheongbuk-do 28646, Republic of Korea
| | - Hee Sue Park
- Department of Laboratory Medicine, Chungbuk National University Hospital, 776, 1st Sunhwan-ro, Seowon-gu, Cheongju-si, Chungcheongbuk-do 28646, Republic of Korea
- Department of Laboratory Medicine, College of Medicine, Chungbuk National University, 1 Chungdae-ro, Seowongu, Cheongju-si, Chungcheongbuk-do 28646, Republic of Korea
| |
Collapse
|
3
|
Relich RF, Abbott AN. Syndromic and Point-of-Care Molecular Testing. Clin Lab Med 2022; 42:507-531. [PMID: 36368779 DOI: 10.1016/j.cll.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ryan F Relich
- Division of Clinical Microbiology, Indiana University Health Pathology Laboratory, Indiana University Health and Indiana University School of Medicine, Suite 6027E, 350 West 11th Street, Indianapolis, IN 46202, USA.
| | - April N Abbott
- Department of Laboratory Medicine, Deaconess Hospital, 600 Mary Street, Evansville, IN 47747, USA
| |
Collapse
|
4
|
de Courville C, Cadarette SM, Wissinger E, Alvarez FP. The economic burden of influenza among adults aged 18 to 64: A systematic literature review. Influenza Other Respir Viruses 2022; 16:376-385. [PMID: 35122389 PMCID: PMC8983919 DOI: 10.1111/irv.12963] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 12/22/2021] [Indexed: 11/28/2022] Open
Abstract
While the economic burden of influenza infection is well described among adults aged 65 and older, less is known about younger adults. A systematic literature review was conducted to describe the economic burden of seasonal influenza in adults aged 18 to 64 years, to identify the main determinants of direct and indirect costs, and to highlight any gaps in the existing published evidence. MEDLINE and Embase were searched from 2007 to February 7, 2020, for studies reporting primary influenza-related cost data (direct or indirect) or absenteeism data. Of the 2613 publications screened, 51 studies were included in this review. Half of them were conducted in the United States, and 71% of them described patients with influenza-like illness rather than laboratory-confirmed disease. Only 12 studies reported cost data specifically for at-risk populations. Extracted data highlighted that within the 18- to 64-year-old group, up to 88% of the economic burden of influenza was attributable to indirect costs, and up to 75% of overall direct costs were attributable to hospitalizations. Furthermore, within the 18- to 64-year-old group, influenza-related costs increased with age and underlying medical conditions. The reported cost of influenza-related hospitalizations was found to be up to 2.5 times higher among at-risk populations compared with not-at-risk populations. This review documents the considerable economic impact of influenza among adults aged 18 to 64. In this age group, most of the influenza costs are indirect, which are generally not recognized by decision makers. Future studies should focus on at-risk subgroups, lab-confirmed cases, and European countries.
Collapse
Affiliation(s)
| | | | - Erika Wissinger
- Evidence Synthesis & ModelingXcenda, L.L.C.CarrolltonTexasUSA
| | - Fabián P. Alvarez
- Global Health Economics and Value AssessmentSanofi PasteurLyonFrance
| |
Collapse
|
5
|
Point of Care Nucleic Acid Testing for SARS-CoV-2 in Hospitalized Patients: A Clinical Validation Trial and Implementation Study. Cell Rep Med 2020; 1:100062. [PMID: 32838340 PMCID: PMC7362826 DOI: 10.1016/j.xcrm.2020.100062] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/26/2020] [Accepted: 07/08/2020] [Indexed: 01/18/2023]
Abstract
There is an urgent need for rapid SARS-CoV-2 testing in hospitals to limit nosocomial spread. We report an evaluation of point of care (POC) nucleic acid amplification testing (NAAT) in 149 participants with parallel combined nasal and throat swabbing for POC versus standard lab RT-PCR testing. Median time to result is 2.6 (IQR 2.3-4.8) versus 26.4 h (IQR 21.4-31.4, p < 0.001), with 32 (21.5%) positive and 117 (78.5%) negative. Cohen's κ correlation between tests is 0.96 (95% CI 0.91-1.00). When comparing nearly 1,000 tests pre- and post-implementation, the median time to definitive bed placement from admission is 23.4 (8.6-41.9) versus 17.1 h (9.0-28.8), p = 0.02. Mean length of stay on COVID-19 "holding" wards is 58.5 versus 29.9 h (p < 0.001). POC testing increases isolation room availability, avoids bed closures, allows discharge to care homes, and expedites access to hospital procedures. POC testing could mitigate the impact of COVID-19 on hospital systems.
Collapse
|
6
|
Cost evaluation of point-of-care testing for community-acquired influenza in adults presenting to the emergency department. J Clin Virol 2020; 129:104533. [PMID: 32659711 DOI: 10.1016/j.jcv.2020.104533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Rapid molecular point-of-care tests (POCTs) for influenza have potential to produce cost savings in emergency departments (EDs) and acute care settings. To date, published projected savings have been based on estimated costs. OBJECTIVES This study aimed to describe the cost implications of a rapid influenza POCT using accurate real-world patient level costing data. 204 adult patients receiving point-of-care (POC) influenza testing in the ED as part of a routine clinical service were identified retrospectively, alongside a control cohort of 104 patients from the same influenza season. Costs for all were calculated at the individual patient level. Cost comparison was performed using an instrumental variable (IV) regression to overcome potential bias within the observational dataset. RESULTS Patients who had a POCT on average cost 67 % less than those who did not (average cost reduction: £2066: 95 % CI: £624 and £2665). Moderate to high NEWS score at arrival, presence of ≥1 comorbidity, and age ≥70 years increased overall costs across both groups (p < 0.05). CONCLUSIONS Savings from POC testing can be attributed to more targeted treatments, fewer admissions and reduced lengths of stay. The IV regression results are supported by a second method (ordinary least square against baseline characteristics). They are also in line with existing work that use estimated costs but indicate greater savings than predicted previously. In conclusion, POC influenza testing in the emergency department produces significant cost savings, this is demonstrated here through an analysis using individual real-world patient level costing data.
Collapse
|
7
|
Berry L, Lansbury L, Gale L, Carroll AM, Lim WS. Point of care testing of Influenza A/B and RSV in an adult respiratory assessment unit is associated with improvement in isolation practices and reduction in hospital length of stay. J Med Microbiol 2020; 69:697-704. [PMID: 32250239 PMCID: PMC7451037 DOI: 10.1099/jmm.0.001187] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/14/2020] [Indexed: 12/31/2022] Open
Abstract
Introduction. Every winter seasonal influenza and other viral respiratory infections increase pressure on the health services and are associated with nosocomial infection and morbidity.Aim. To compare provision of point-of-care (POC) testing with laboratory-based testing for influenza and RSV detection on an adult respiratory assessment unit to assess the impact on isolation practices and length of stay (LOS).Methodology. Prospective interrupted 'on-off' study in adults admitted to the respiratory unit between December 2018 and April 2019 with a suspected respiratory tract infection. Nasopharyngeal samples were tested using either the GeneXpert rapid POC test for influenza and RSV (on-period), or were sent to the laboratory for multiplex PCR testing against a panel of 12 respiratory viruses (off-period). Outcome measures were time to patient isolation for infection control, LOS and turnaround time from admission to test results.Results. Of 1145 patients evaluated, 755 were tested with POC and 390 with laboratory multiplex; a respiratory virus was identified in 164 (21.7 %) and 138 (35.4 %) patients respectively. A positive POC test was associated with a shorter time to isolation (mean difference 16.9 h, P<0.001), shorter LOS (mean difference 15.5 h, P=0.05,) and shorter turnaround time (mean difference 28.3 h, P<0.001), compared to laboratory testing.Conclusion. Use of GeneXpert POC testing for Flu/RSV is associated with rapid reporting of results with significant improvements in isolation practices and reductions in LOS.
Collapse
Affiliation(s)
- Louise Berry
- Department of Microbiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Louise Lansbury
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Lydia Gale
- Department of Microbiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Ann Marie Carroll
- Department of Microbiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Wei Shen Lim
- Department of Respiratory Medicine, Nottingham University Hospitals Trust, Nottingham, UK
| |
Collapse
|
8
|
Farfour E, Roux A, Ballester M, Gagneur L, Renaux C, Jolly E, Vasse M. Improved performances of the second generation of the ID NOW influenza A&B 2® and comparison with the GeneXpert®. Eur J Clin Microbiol Infect Dis 2020; 39:1681-1686. [DOI: 10.1007/s10096-020-03905-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/07/2020] [Indexed: 11/30/2022]
|
9
|
Zidovec Lepej S, Poljak M. Portable molecular diagnostic instruments in microbiology: current status. Clin Microbiol Infect 2020; 26:411-420. [DOI: 10.1016/j.cmi.2019.09.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 12/25/2022]
|
10
|
Bouzid D, Zanella MC, Kerneis S, Visseaux B, May L, Schrenzel J, Cattoir V. Rapid diagnostic tests for infectious diseases in the emergency department. Clin Microbiol Infect 2020; 27:182-191. [PMID: 32120036 PMCID: PMC7129254 DOI: 10.1016/j.cmi.2020.02.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 02/12/2020] [Accepted: 02/17/2020] [Indexed: 12/23/2022]
Abstract
Background Rapid diagnostic tests (RDTs) for infectious diseases, with a turnaround time of less than 2 hours, are promising tools that could improve patient care, antimicrobial stewardship and infection prevention in the emergency department (ED) setting. Numerous RDTs have been developed, although not necessarily for the ED environment. Their successful implementation in the ED relies on their performance and impact on patient management. Objectives The aim of this narrative review was to provide an overview of currently available RDTs for infectious diseases in the ED. Sources PubMed was searched through August 2019 for available studies on RDTs for infectious diseases. Inclusion criteria included: commercial tests approved by the US Food and Drug Administration (FDA) or Conformité Européenne (CE) in vitro diagnostic devices with data on clinical samples, ability to run on fully automated systems and result delivery within 2 hours. Content A nonexhaustive list of representative commercially available FDA- or CE-approved assays was categorized by clinical syndrome: pharyngitis and upper respiratory tract infection, lower respiratory tract infection, gastrointestinal infection, meningitis and encephalitis, fever in returning travellers and sexually transmitted infection, including HIV. The performance of tests was described on the basis of clinical validation studies. Further, their impact on clinical outcomes and anti-infective use was discussed with a focus on ED-based studies. Implications Clinicians should be familiar with the distinctive features of each RDT and individual performance characteristics for each target. Their integration into ED work flow should be preplanned considering local constraints of given settings. Additional clinical studies are needed to further evaluate their clinical effectiveness and cost-effectiveness.
Collapse
Affiliation(s)
- D Bouzid
- Emergency Department, AP-HP, Bichat Claude Bernard Hospital, Paris, France; University of Paris, IAME, INSERM, Paris, France
| | - M-C Zanella
- Laboratory of Bacteriology, Division of Laboratory Medicine and Division of Infectious Diseases, University of Geneva Hospitals, Geneva, Switzerland; University of Geneva Medical School, Geneva, Switzerland
| | - S Kerneis
- University of Paris, IAME, INSERM, Paris, France; AP-HP, Antimicrobial Stewardship Team, Hôpitaux Universitaires Paris Centre-Cochin, Paris, France; Pharmacoepidémiology and Infectious Diseases (Phemi), Pasteur Institute, Paris, France
| | - B Visseaux
- University of Paris, IAME, INSERM, Paris, France; AP-HP, Bichat Claude Bernard Hospital, Virology, Paris, France
| | - L May
- Department of Emergency Medicine, University of California-Davis, Sacramento, CA, USA
| | - J Schrenzel
- Laboratory of Bacteriology, Division of Laboratory Medicine and Division of Infectious Diseases, University of Geneva Hospitals, Geneva, Switzerland; University of Geneva Medical School, Geneva, Switzerland; Genomic Research Laboratory, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - V Cattoir
- Service de Bactériologie-Hygiène Hospitalière, CHU de Rennes, Rennes, France; CNR de `la Résistance aux Antibiotiques (laboratoire associé'Entérocoques), Rennes, France; Unité Inserm U1230, Université de Rennes 1, Rennes, France.
| |
Collapse
|
11
|
Brooke-Pearce F, Demertzi E. Introduction of Cobas Liat Influenza A/B for rapid point-of-care diagnosis of influenza infection in an acute trust. J Infect Prev 2019; 20:297-300. [PMID: 31762792 DOI: 10.1177/1757177419853342] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 04/14/2019] [Indexed: 11/17/2022] Open
Abstract
Background We aimed to evaluate the impact of a new molecular point-of-care test (POCT), the Cobas Liat Influenza A/B for rapid diagnosis of influenza within 20 min, on the operational workflow of the Trust, accurate diagnosis and potential cost savings during the winter of 2017-2018. Methods A retrospective cohort study was conducted on all patients aged > 18 years tested for flu A/B by laboratory PCR in January 2017 and by POCT in January 2018. Results From 21 December 2017 to 30 April 2018, a total of 1375 POCTs were performed with a total of 479 (35%) influenza-positive cases. Results demonstrated that 1046 (76%) suspected cases did not require isolation or were able to be discharged from Emergency Department (ED), once other risks had been ruled out. We particularly looked into the differences between the month of January 2017 (before POCT) and the month of January 2018. Discussion Results demonstrate that influenza POCT had a positive impact on the Trust regarding prompt patient diagnosis and treatment, discharge decisions, improvement of patient bed management by avoiding unnecessary patient isolation and reducing bay closures, and significant reduction in length of stay in both positive and negative cases. Estimated cost savings were significant.
Collapse
Affiliation(s)
- Fran Brooke-Pearce
- Kingston Hospital NHS Foundation Trust, Kingston Upon Thames, Surrey, UK
| | - Elli Demertzi
- Kingston Hospital NHS Foundation Trust, Kingston Upon Thames, Surrey, UK
| |
Collapse
|
12
|
Simpson CR, Beever D, Challen K, De Angelis D, Fragaszy E, Goodacre S, Hayward A, Lim WS, Rubin GJ, Semple MG, Knight M. The UK's pandemic influenza research portfolio: a model for future research on emerging infections. THE LANCET. INFECTIOUS DISEASES 2019; 19:e295-e300. [PMID: 31006605 DOI: 10.1016/s1473-3099(18)30786-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 11/30/2018] [Accepted: 12/11/2018] [Indexed: 12/15/2022]
Abstract
The 2009 influenza A H1N1 pandemic was responsible for considerable global morbidity and mortality. In 2009, several research studies in the UK were rapidly funded and activated for clinical and public health actions. However, some studies were too late for their results to have an early and substantial effect on clinical care, because of the time required to call for research proposals, assess, fund, and set up the projects. In recognition of these inherent delays, a portfolio of projects was funded by the National Institute for Health Research in 2012. These studies have now been set up (ie, with relevant permissions and arrangements made for data collection) and pilot tested where relevant. All studies are now on standby awaiting activation in the event of a pandemic being declared. In this Personal View, we describe the projects that were set up, the challenges of putting these projects into a maintenance-only state, and ongoing activities to maintain readiness for activation, and discuss how to plan research for a range of major incidents.
Collapse
Affiliation(s)
- Colin R Simpson
- School of Health, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand; Usher Institute, The University of Edinburgh, Edinburgh, UK.
| | - Dan Beever
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, UK
| | - Kirsty Challen
- Lancashire Teaching Hospitals National Health Service Trust, Preston, UK
| | - Daniela De Angelis
- Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Ellen Fragaszy
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Steve Goodacre
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, UK
| | - Andrew Hayward
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK; Institute of Epidemiology and Health Care, University College London, London, UK
| | - Wei Shen Lim
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - G James Rubin
- Department of Psychological Medicine, Weston Education Centre, King's College London, London, UK
| | - Malcolm G Semple
- Institute of Translational Medicine, University of Liverpool, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | | |
Collapse
|
13
|
Rahamat‐Langendoen J, Groenewoud H, Kuijpers J, Melchers WJ, van der Wilt GJ. Impact of molecular point-of-care testing on clinical management and in-hospital costs of patients suspected of influenza or RSV infection: a modeling study. J Med Virol 2019; 91:1408-1414. [PMID: 30950066 PMCID: PMC7166495 DOI: 10.1002/jmv.25479] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/22/2019] [Accepted: 03/19/2019] [Indexed: 01/25/2023]
Abstract
Background At hospital admission, patients suspected of infection with influenza or respiratory syncytial virus (RSV) are placed in isolation, pending the outcome of diagnostics. In a significant number, isolated care proves unnecessary. We investigated the potential impact of molecular point‐of‐care (POC) diagnostics on patient management and in‐hospital costs. Method Prospective collection of data on resource utilization within the hospital from consecutive patients 18 years or older presenting at our university medical center with symptoms of respiratory tract infection from December 2016 to April 2017. A cost analysis was conducted using Markov modeling comparing the actual course of events (on the basis of routine diagnostic tests) with two hypothetical scenarios: when POC would impact time to diagnosis only (scenario 1) or on discharge from the hospital, too (scenario 2). Results A total of 283 patients were included, of whom 217 (76.7%) were admitted. Influenza and RSV were detected in 31% and 7% of the patients, respectively. Fifty‐four percent of patients tested negative, of which 79% were kept in isolated care waiting for test results, with a median duration of 24 hours. Median length of stay was 6.0 days. Mean total in‐hospital costs per patient were € 5243. Introducing POC would lower mean costs per patient to € 4904 (scenario 1) and € 4206 (scenario 2). At the hospital level, this would result in a total cost reduction of € 95 937 to € 293 471 in a single influenza season. Conclusions Introducing POC testing for patients presenting with symptoms of viral respiratory tract infection can reduce time‐to‐diagnosis, hospital stay and, thereby, in‐hospital costs.
Collapse
Affiliation(s)
| | - Hans Groenewoud
- Department of Health EvidenceRadboud University Medical CenterNijmegenThe Netherlands
| | - Judith Kuijpers
- Department of Medical MicrobiologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Willem J.G. Melchers
- Department of Medical MicrobiologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Gert Jan van der Wilt
- Department of Health EvidenceRadboud University Medical CenterNijmegenThe Netherlands
| |
Collapse
|
14
|
Goldstein E, Gunson R. In-house validation of the cobas Liat influenza A/B and RSV assay for use with gargles, sputa and endotracheal secretions. J Hosp Infect 2019; 101:289-291. [DOI: 10.1016/j.jhin.2018.10.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 10/31/2018] [Indexed: 11/24/2022]
|
15
|
Bazarragchaa E, Okamatsu M, Ulaankhuu A, Twabela AT, Matsuno K, Kida H, Sakoda Y. Evaluation of a rapid isothermal nucleic acid amplification kit, Alere™ i Influenza A&B, for the detection of avian influenza viruses. J Virol Methods 2019; 265:121-125. [PMID: 30633948 DOI: 10.1016/j.jviromet.2019.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 12/27/2018] [Accepted: 01/08/2019] [Indexed: 11/16/2022]
Abstract
Rapid and accurate diagnosis of influenza virus infection is essential for quick responses for both human and animal health. The Alere™ i Influenza A&B is a novel isothermal nucleic acid amplification kit that can detect and differentiate between influenza A and B viruses in human specimens in approximately 15 min. In the present study, the performance of the Alere™ i Influenza A&B kit was evaluated for its ability to detect avian influenza virus in chickens. The kit was able to detect representative avian influenza virus strains (hemagglutinin subtypes H1-H16, including the recently isolated H5 and H7 highly pathogenic avian influenza viruses), and the detection limit of the kit for these viruses varied between 10-1.4-102.1 50% egg-infective dose per test, which is higher than the analytical sensitivity of the antigen detection immunochromatography kit ESPLINE® A INFLUENZA. In experimentally infected chickens inoculated with a highly pathogenic avian influenza virus strain A/chicken/Hokkaido/002/2016 (H5N6), viral RNA was detected in the tracheal and cloacal swabs. These results indicate that this kit has the potential to be used as a rapid screening test of influenza A virus infection in chickens.
Collapse
Affiliation(s)
- Enkhbold Bazarragchaa
- Laboratory of Microbiology, Department of Disease Control, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido 060-0818, Japan; Division of Transboundary Animal Diseases Diagnosis and Surveillance, State Central Veterinary Laboratory, Ulaanbaatar 17024, Mongolia
| | - Masatoshi Okamatsu
- Laboratory of Microbiology, Department of Disease Control, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido 060-0818, Japan
| | - Ankhanbaatar Ulaankhuu
- Division of Transboundary Animal Diseases Diagnosis and Surveillance, State Central Veterinary Laboratory, Ulaanbaatar 17024, Mongolia
| | - Augustin Tshibwabwa Twabela
- Laboratory of Microbiology, Department of Disease Control, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido 060-0818, Japan
| | - Keita Matsuno
- Laboratory of Microbiology, Department of Disease Control, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido 060-0818, Japan; Global Station of Zoonosis Control, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Hokkaido 001-0020, Japan
| | - Hiroshi Kida
- Global Station of Zoonosis Control, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Hokkaido 001-0020, Japan; Research Center for Zoonosis Control, Hokkaido University, Sapporo, Hokkaido 001-0020, Japan
| | - Yoshihiro Sakoda
- Laboratory of Microbiology, Department of Disease Control, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido 060-0818, Japan; Global Station of Zoonosis Control, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Hokkaido 001-0020, Japan.
| |
Collapse
|
16
|
Das S, Dunbar S, Tang YW. Laboratory Diagnosis of Respiratory Tract Infections in Children - the State of the Art. Front Microbiol 2018; 9:2478. [PMID: 30405553 PMCID: PMC6200861 DOI: 10.3389/fmicb.2018.02478] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 09/28/2018] [Indexed: 12/13/2022] Open
Abstract
In the pediatric population, respiratory infections are the most common cause of physician visits. Although many respiratory illnesses are self-limiting viral infections that resolve with time and supportive care, it can be critical to identify the causative pathogen at an early stage of the disease in order to implement effective antimicrobial therapy and infection control. Over the last few years, diagnostics for respiratory infections have evolved substantially, with the development of novel assays and the availability of updated tests for newer strains of pathogens. Newer laboratory methods are rapid, highly sensitive and specific, and are gradually replacing the conventional gold standards, although the clinical utility of these assays is still under evaluation. This article reviews the current laboratory methods available for testing for respiratory pathogens and discusses the advantages and disadvantages of each approach.
Collapse
Affiliation(s)
- Shubhagata Das
- Global Scientific Affairs, Luminex Corporation, Austin, TX, United States
| | - Sherry Dunbar
- Global Scientific Affairs, Luminex Corporation, Austin, TX, United States
| | - Yi-Wei Tang
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, Weill Medical College of Cornell University, New York, NY, United States.,Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, Weill Medical College of Cornell University, New York, NY, United States
| |
Collapse
|
17
|
Detection of Influenza A and B Viruses and Respiratory Syncytial Virus by Use of Clinical Laboratory Improvement Amendments of 1988 (CLIA)-Waived Point-of-Care Assays: a Paradigm Shift to Molecular Tests. J Clin Microbiol 2018; 56:JCM.00367-18. [PMID: 29695519 DOI: 10.1128/jcm.00367-18] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
An accurate laboratory diagnosis of influenza, respiratory syncytial virus (RSV), and other respiratory viruses can help to guide patient management, antiviral therapy, infection prevention strategies, and epidemiologic monitoring. Influenza has been the primary driver of rapid laboratory testing due to its morbidity and mortality across all ages, the availability of antiviral therapy, which must be given early to have an effect, and the constant threat of new pandemic strains. Over the past 30 years, there has been an evolution in viral diagnostic testing, from viral culture to rapid antigen detection, and more recently, to highly sensitive nucleic acid amplification tests (NAAT), as well as a trend to testing at the point of care (POC). Simple rapid antigen immunoassays have long been the mainstay for POC testing for influenza A and B viruses and respiratory syncytial virus (RSV) but have been faulted for low sensitivity. In 2015, the first POC NAAT for the detection of influenza was approved by the Food and Drug Administration (FDA), ushering in a new era. In 2017, the FDA reclassified rapid influenza diagnostic tests (RIDTs) from class I to class II devices with new minimum performance standards and a requirement for annual reactivity testing. Consequently, many previously available RIDTs can no longer be purchased in the United States. In this review, recent developments in Clinical Laboratory Improvement Amendments of 1988 (CLIA)-waived testing for respiratory virus infections will be presented, with the focus on currently available FDA-cleared rapid antigen and molecular tests primarily for influenza A and B viruses and RSV.
Collapse
|
18
|
Paying for Point-of-Care Nucleic Acid Amplification Tests: a Micro-Comic Strip. J Clin Microbiol 2018; 56:56/6/e00526-18. [DOI: 10.1128/jcm.00526-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
19
|
Wang H, Deng J, Tang YW. Profile of the Alere i Influenza A & B assay: a pioneering molecular point-of-care test. Expert Rev Mol Diagn 2018; 18:403-409. [PMID: 29688086 PMCID: PMC6153442 DOI: 10.1080/14737159.2018.1466703] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The Alere i Influenza A & B assay incorporates the Nicking Enzyme Amplification Reaction technique on the Alere i instrument to detect and differentiate influenza virus (Flu) A and B nucleic acids in specific specimens. Areas covered: The Alere i Influenza A & B assay was cleared by the US Food and Drug Administration for use with nasal swabs (NS) and nasopharyngeal swabs, either directly or in viral transport medium. Notably, direct use on NS was the first ever CLIA-waived nucleic acid-based test. Previously published evaluations have reported sensitivities and specificities of 55.2-100% and 62.5-100% for Flu A and 45.2-100% and 53.6-100% for Flu B, respectively. Expert commentary: The Alere i Influenza A & B assay provides a rapid and simple platform for detection and differentiation of Flu A and B. Efforts are expected to further improve sensitivity and user-friendliness for effective and widespread use in the true point-of-care setting.
Collapse
Affiliation(s)
- Hongmei Wang
- Division of Infectious Diseases, Shenzhen Children Hospital, Shenzhen, China
- Departments of Laboratory Medicine and Internal Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Jikui Deng
- Division of Infectious Diseases, Shenzhen Children Hospital, Shenzhen, China
| | - Yi-Wei Tang
- Departments of Laboratory Medicine and Internal Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
- Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University, New York, NY, USA
| |
Collapse
|
20
|
Allen AJ, O’Leary RA, Davis S, Graziadio S, Jones WS, Simpson AJ, Price DA, Vale L, Power M. Cost implications for the NHS of using the Alere™ i Influenza A & B near patient test with nasal swabs. Diagn Progn Res 2018; 2:15. [PMID: 31093564 PMCID: PMC6460782 DOI: 10.1186/s41512-018-0031-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 05/18/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Influenza is an acute viral infection of the respiratory tract. A rapid confirmatory diagnosis of influenza is important, since it is highly transmissible and outbreaks of influenza within the hospital setting increase morbidity and mortality. The objective of this study was to evaluate the cost implications, from the perspective of the UK NHS, of using on-label nasal swabs with the Alere™ i Influenza A & B test in a near patient setting. METHODS A cost consequence model was developed. The time horizon of the model was from hospital admission on suspicion of influenza until the end of treatment (following a diagnosis of influenza or discharge from hospital). Data on the prevalence of influenza and the sensitivity and specificity of the Alere™ i Influenza A & B test came from two prospective observational diagnostic accuracy studies. Costs were obtained from published resources. Uncertainties in the model data were investigated using deterministic, one-way sensitivity analyses. RESULTS Using the Alere™ i Influenza A & B point of care test with nasal swabs (on label) in NHS medical assessment units and emergency departments could save approximately £242,730 per 1000 adults presenting with influenza-like symptoms. The main cause for this was reduced times to availability of the result compared with the laboratory RT-PCR test. Other key drivers of savings were the cost of isolation, the prevalence of influenza, the specificity of the test, and the availability of isolation resources. CONCLUSIONS The Alere™ i Influenza A & B point of care test would have greatest impact in hospitals that have extensive delays in the time to receive a result. Sensitivity analyses identified the model parameters which would have greatest effect on the result and confirmed that assumptions were conservative, i.e. did not change key results.
Collapse
Affiliation(s)
- A. J. Allen
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle upon Tyne, UK
- 0000 0001 0462 7212grid.1006.7Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - R. A. O’Leary
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle upon Tyne, UK
- 0000 0004 0444 2244grid.420004.2Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - S. Davis
- 0000 0000 9422 8284grid.31410.37Department of Virology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S. Graziadio
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle upon Tyne, UK
- 0000 0004 0444 2244grid.420004.2Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - W. S. Jones
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle upon Tyne, UK
- 0000 0001 0462 7212grid.1006.7Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - A. J. Simpson
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle upon Tyne, UK
- 0000 0001 0462 7212grid.1006.7Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - D. A. Price
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle upon Tyne, UK
- 0000 0004 0641 3236grid.419334.8Department of Infectious Diseases, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - L. Vale
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle upon Tyne, UK
- 0000 0001 0462 7212grid.1006.7Health Economics Group, Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, UK
| | - M. Power
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle upon Tyne, UK
- 0000 0004 0444 2244grid.420004.2Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| |
Collapse
|
21
|
Antoniol S, Fidouh N, Ghazali A, Ichou H, Bouzid D, Kenway P, Choquet C, Visseaux B, Casalino E. Diagnostic performances of the Xpert ® Flu PCR test and the OSOM ® immunochromatographic rapid test for influenza A and B virus among adult patients in the Emergency Department. J Clin Virol 2017; 99-100:5-9. [PMID: 29257982 DOI: 10.1016/j.jcv.2017.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/08/2017] [Accepted: 12/12/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND New rapid influenza diagnostic tests (RIDT) are available but their clinical utility in adults has not been validated. OBJECTIVES To evaluate the diagnostic performances of OSOM® Ultra Flu A&B a RIDT on viral strains of influenza A/B from the last epidemic season, and its feasibility by Emergency Department (ED) physicians and nurses. STUDY DESIGN Of the 1099 patients admitted to the ED with suspected influenza, all having a nasopharyngeal swab tested by the Xpert® Flu PCR and then stored at -20 °C; 500 were selected at random and their samples were tested using the RIDT. Two experts reviewed ED and hospital medical records and all virological data to define influenza cases. Intra- and inter-observer variability were calculated. RESULTS Of the 500 patients included 45% were ≥75 years, 122 (24.4%) presented with influenza based on clinical and virological criteria. PCR test performances (%) were Se 98.4 (95% CI 93.6-99.7), Spe 99.7 (98.3-100), PPV 99.2 (94.8-100) and NPV 99.5 (97.9-100); and RIDT performances were Se 95.1 (89.2-97.9), Spe 98.4 (96.4-99.4), PPV 95.1 (87.2-99.9) and NPV 98.4 (96.4-98). There was no difference in test performance between influenza A and B virus nor between the influenza A subtypes. Intra- and inter-observer variability of RIDT were 0.94 (0.89-0.99) and 0.96 (0.92-1). CONCLUSION Our results show that the Xpert® Flu PCR and the OSOM® Ultra Flu A&B Test perform very well in diagnosing strains of circulating virus in adults and elderly. Our results also confirm the feasibility of this RIDT at point-of-care by ED staff.
Collapse
Affiliation(s)
- Stephanie Antoniol
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Universitaire Paris Nord Val de Seine, Emergency Department, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, EA 7334, Recherche clinique coordonnée ville-hôpital, Méthodologies et Société (REMES), Paris, France; Study Group for Efficiency and Quality of Emergency Departments and Non-Scheduled Activities Departments, Paris, France
| | - Nadhira Fidouh
- IAME (Infection, Antimicrobials, Modelling, Evolution), Université Paris Diderot, Sorbonne Paris Cité, UMR 1137, INSERM, Paris, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Universitaire Paris Nord Val de Seine, Laboratoire de Virologie, Hôpital Bichat, AP-HP, Paris, France
| | - Aiham Ghazali
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Universitaire Paris Nord Val de Seine, Emergency Department, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, EA 7334, Recherche clinique coordonnée ville-hôpital, Méthodologies et Société (REMES), Paris, France; Study Group for Efficiency and Quality of Emergency Departments and Non-Scheduled Activities Departments, Paris, France
| | - Houria Ichou
- IAME (Infection, Antimicrobials, Modelling, Evolution), Université Paris Diderot, Sorbonne Paris Cité, UMR 1137, INSERM, Paris, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Universitaire Paris Nord Val de Seine, Laboratoire de Virologie, Hôpital Bichat, AP-HP, Paris, France
| | - Donia Bouzid
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Universitaire Paris Nord Val de Seine, Emergency Department, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, EA 7334, Recherche clinique coordonnée ville-hôpital, Méthodologies et Société (REMES), Paris, France; Study Group for Efficiency and Quality of Emergency Departments and Non-Scheduled Activities Departments, Paris, France
| | - Philippe Kenway
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Universitaire Paris Nord Val de Seine, Emergency Department, Paris, France; Study Group for Efficiency and Quality of Emergency Departments and Non-Scheduled Activities Departments, Paris, France
| | - Christophe Choquet
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Universitaire Paris Nord Val de Seine, Emergency Department, Paris, France; Study Group for Efficiency and Quality of Emergency Departments and Non-Scheduled Activities Departments, Paris, France
| | - Benoit Visseaux
- IAME (Infection, Antimicrobials, Modelling, Evolution), Université Paris Diderot, Sorbonne Paris Cité, UMR 1137, INSERM, Paris, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Universitaire Paris Nord Val de Seine, Laboratoire de Virologie, Hôpital Bichat, AP-HP, Paris, France
| | - Enrique Casalino
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Universitaire Paris Nord Val de Seine, Emergency Department, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, EA 7334, Recherche clinique coordonnée ville-hôpital, Méthodologies et Société (REMES), Paris, France; Study Group for Efficiency and Quality of Emergency Departments and Non-Scheduled Activities Departments, Paris, France.
| | | |
Collapse
|