Hostname: page-component-76fb5796d-5g6vh Total loading time: 0 Render date: 2024-04-26T20:47:00.684Z Has data issue: false hasContentIssue false

The utility of paired upper and lower respiratory tract sampling for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing in patients with artificial airways

Published online by Cambridge University Press:  10 May 2021

Eimear M. Kitt*
Affiliation:
Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Infection Prevention and Control, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
Daniela H. Davis
Affiliation:
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania Division of Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Caryn Kerman
Affiliation:
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Julia S. Sammons
Affiliation:
Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Infection Prevention and Control, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
Lori K. Handy
Affiliation:
Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Infection Prevention and Control, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
Elizabeth Gallagher
Affiliation:
Center for Healthcare Quality and Analytics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Kevin O’Callaghan
Affiliation:
Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Infection Prevention and Control, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
Rebecca M. Harris
Affiliation:
Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
Susan E. Coffin
Affiliation:
Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Infection Prevention and Control, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania Philadelphia Department of Health, Philadelphia, Pennsylvania
Louis M. Bell
Affiliation:
Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Kathleen Chiotos
Affiliation:
Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania Division of Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
*
Author for correspondence: Eimear M. Kitt, E-mail: kitte@chop.edu

Abstract

Early in the coronavirus disease 2019 (COVID-19) pandemic, the CDC recommended collection of a lower respiratory tract (LRT) specimen for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) testing in addition to the routinely recommended upper respiratory tract (URT) testing in mechanically ventilated patients. Significant operational challenges were noted at our institution using this approach. In this report, we describe our experience with routine collection of paired URT and LRT sample testing. Our results revealed a high concordance between the 2 sources, and that all children tested for SARS-CoV-2 were appropriately diagnosed with URT testing alone. There was no added benefit to LRT testing. Based on these findings, our institutional approach was therefore adjusted to sample the URT alone for most patients, with LRT sampling reserved for patients with ongoing clinical suspicion for SARS-CoV-2 after a negative URT test.

Type
Concise Communication
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Interim guidelines for collecting, handling, and testing clinical specimens from persons for coronavirus disease 2019 (COVID-19). Center for Disease Control and Prevention website. https://www.cdc.gov/coronavirus/2019-ncov/lab/guidelines-clinical-specimens.html. Published May 22, 2020. Accessed September 29, 2020.Google Scholar
Coronavirus 19 disease (COVID-19) testing and data. City of Philadelphia government website. https://www.phila.gov/programs/coronavirus-disease-2019-covid-19/testing-and-data/#/. Accessed February 15, 2021.Google Scholar
Feng, H, Liu, Y, Lv, M, Zhong, J. A case report of COVID-19 with false negative RT-PCR test: necessity of chest CT. Jpn J Radiol 2020;38:409410.CrossRefGoogle ScholarPubMed
Chen, L-D, Li, H, Ye, Y-M, et al. A COVID-19 patient with multiple negative results for PCR assays outside Wuhan, China: a case report. BMC Infect Dis 2020;20:517.CrossRefGoogle ScholarPubMed
Wang, W, Xu, Y, Gao, R, et al. Detection of SARS-CoV-2 in different types of clinical specimens. JAMA 2020;323:18431844.Google ScholarPubMed
Widders, A, Broom, A, Broom, J. SARS-CoV-2: the viral shedding vs infectivity dilemma. Infect Dis Health 2020;25:210215.Google ScholarPubMed
Geri, P, Salton, F, Zuccatosta, L, et al. Limited role for bronchoalveolar lavage to exclude COVID-19 after negative upper respiratory tract swabs: a multicentre study. Eur Respir J 2020. doi: 10.1183/13993003.01733-2020.CrossRefGoogle Scholar
Chiang, J, Amin, R. Respiratory care considerations for children with medical complexity. Child Basel Switz 2017;4(5). doi: 10.3390/children4050041.CrossRefGoogle Scholar
Zhu, H, Das, P, Roberson, DW, et al. Hospitalizations in children with preexisting tracheostomy: a national perspective: hospitalizations in children with preexisting tracheostomy. Laryngoscope 2015;125:462468.CrossRefGoogle ScholarPubMed
Testing for SARS-CoV2 Infection. COVID-19 treatment guidelines. National Institutes of Health website. https://www.covid19treatmentguidelines.nih.gov/overview/sars-cov-2-testing/. Published April 22, 2021. Accessed April 22, 2021.Google Scholar