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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

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References

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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
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