scholarly journals Real-world evaluation of a computed tomography-first triage strategy for suspected coronavirus disease 2019 in emergency outpatients in Japan: an observational cohort study

2020 ◽  
Author(s):  
Shigeta Miyake ◽  
Takuma Higurashi ◽  
Takashi Jono ◽  
Taisuke Akimoto ◽  
Fumihiro Ogawa ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Polymerase Chain Reaction ◽  
Cohort Study ◽  
Real World ◽  
Clinical History ◽  
University Hospital ◽  
Diagnostic Systems ◽  
Chain Reaction ◽  
Triage Protocol ◽  
Polymerase Chain

Abstract Background: Coronavirus disease 2019 (COVID-19) continues to spread worldwide. Because of the absence of reliable rapid diagnostic systems, patients with COVID-19 symptoms are suspected of disease. Computed tomography (CT) in patients with suspected COVID-19 may be reasonable for triaging, and CT-first triage strategies have been proposed. However, clinical evaluation of a CT-first triage protocol is lacking. The aim of this study is to investigate the real-world efficacy and limitations of a CT-first triage strategy in patients with suspected COVID-19.Methods: This was a single-center cohort study evaluating outpatients with suspected COVID-19 who underwent a medical examination at Yokohama City University Hospital and who were prospectively registered between 9 February and 5 May 2020. We treated patients according to the CT-first triage protocol. CT findings were classified into five categories according to the COVID-19 Reporting and Data System (CO-RADS). With the CT-first triage protocol, patients with a suspicious clinical history, symptoms, or suspicious findings on chest CT were allocated to the COVID-19 suspected group. The primary outcome was efficacy of the CT-first triage protocol for outpatients with suspected COVID-19. We conducted additional analyses of the isolation time of outpatients with suspected COVID-19 and reached final diagnoses.Results: In total, 108 outpatients with suspected COVID-19 were examined at our hospital. Forty-eight patients (44.9%) were categorized as CO-RADS 1, 26 patients (24.3%) as CO-RADS 2, 14 patients (13.1%) as CO-RADS 3, 6 patients (5.6%) as CO-RADS 4, and 13 patients (12.1%) as CO-RADS 5. One patient was excluded because of pregnancy. Using the CT-first triage protocol, 48 (44.9%) patients were suspected of having COVID-19. Nine patients (18.8%) in this group were positive for severe acute respiratory syndrome coronavirus 2 using polymerase chain reaction; no patients in the group not suspected of having COVID-19 were diagnosed with COVID-19 during follow up. The protocol significantly shortened the duration of isolation for the not-suspected versus the suspected group (70.5 vs. 1037.0 minutes, P < .001). Conclusions: Our CT-first triage protocol was acceptable for triaging outpatients with suspected COVID-19. This protocol will be helpful for appropriate triage, especially in areas where polymerase chain reaction is limited.

scholarly journals Real-world evaluation of a computed tomography-first triage strategy for suspected Coronavirus disease 2019 in outpatients with fever in Japan: an observational cohort study

2020 ◽  
Author(s):  
Shigeta Miyake ◽  
Takuma Higurashi ◽  
Takashi Jono ◽  
Taisuke Akimoto ◽  
Fumihiro Ogawa ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Polymerase Chain Reaction ◽  
Cohort Study ◽  
Positive Predictive Value ◽  
Real World ◽  
Predictive Value ◽  
Chain Reaction ◽  
Triage Protocol ◽  
Polymerase Chain ◽  
Sensitivity Specificity

Abstract Background: The Coronavirus disease 2019 pandemic continues to spread worldwide. Because of the absence of reliable rapid diagnostic systems, patients with symptoms of Coronavirus disease 2019 are treated as suspected of the disease. Use of computed tomography findings in Coronavirus disease 2019 are expected to be a reasonable method for triaging patients, and computed tomography-first triage strategies have been proposed. However, clinical evaluation of a computed tomography-first triage protocol is lacking.The aim of this study is to investigate the real-world efficacy and limitations of a computed tomography-first triage strategy in patients with suspected Coronavirus disease 2019.Methods: This was a single-center cohort study evaluating outpatients with fever who received medical examination at Yokohama City University Hospital, prospectively registered between 9 February and 5 May 2020. We treated according to the computed tomography-first triage protocol. The primary outcome was efficacy of the computed tomography-first triage protocol for patients with fever in an outpatient clinic. Efficacy of the computed tomography-first triage protocol for outpatients with fever was evaluated using sensitivity, specificity, positive predictive value, and negative predictive value. We conducted additional analyses of the isolation time of feverish outpatients and final diagnoses.Results: In total, 108 consecutive outpatients with fever were examined at our hospital. Using the computed tomography-first triage protocol, 48 (44.9%) patients were classified as suspected Coronavirus disease 2019. Nine patients (18.8%) in this group were positive for severe acute respiratory syndrome coronavirus 2 using polymerase chain reaction; no patients in the group considered less likely to have Coronavirus disease 2019 tested positive for the virus. The sensitivity, specificity, positive predictive value, and negative predictive value of our computed tomography-first triage protocol for Coronavirus disease 2019 were 100%, 60.2%, 18.8%, and 100%, respectively. The protocol significantly shortened the duration of isolation for the not-suspected versus the suspected group (70.5 vs. 1037.0 minutes, P < .001). Conclusions: Our computed tomography-first triage protocol was acceptable for screening patients with suspected Coronavirus disease 2019. This protocol will be helpful for appropriate triage, especially in areas where polymerase chain reaction is inadequate.

scholarly journals A Real-World Comparison of SARS-CoV-2 Rapid Antigen vs. Polymerase Chain Reaction Testing in Florida

2021 ◽  
Author(s):  
Lao-Tzu Allan-Blitz ◽  
Jeffrey D. Klausner
Keyword(s):  
Polymerase Chain Reaction ◽  
Real World ◽  
Threshold Value ◽  
Test Results ◽  
Chain Reaction ◽  
Cycle Threshold ◽  
Large Populations ◽  
Symptom Status ◽  
Polymerase Chain ◽  
Antigen Tests

Background The reported sensitivity of rapid, antigen-based diagnostics for SARS-CoV-2 infection varies. Few studies have evaluated rapid antigen tests in real-world settings or among large populations. Methods Beginning October 2020, Florida offered individuals presenting for SARS-CoV-2 testing polymerase chain reaction (PCR) testing if they tested positive by the Abbott BinaxNOW TM COVID-19 Ag Card, were symptomatic, or required or requested PCR testing. We compared test results among individuals who received both types of tests at four publicly-accessible testing sites across Florida. We calculated the positive percent agreement (PPA) between the two test types by symptom status. Subsequently, we evaluated the PPA among individuals regardless of symptoms with lower cycle threshold values (<30). Results Overall, 18,457 individuals were tested via both methods, of which 3,153 (17.1%) were positive by PCR. The PPA for the Abbott BinaxNOW TM COVID-19 Ag Card using the PCR comparator was 49.2% (95% CI 47.4%-50.9%). That performance was moderately improved among symptomatic individuals (51.9%; 95% CI 49.7%-54.0%). When restricted to positive PCR tests with a cycle threshold value <30, regardless of symptom status, the PPA was 75.3% (95% CI 72.8%-77.6%). Conclusion The PPA of the Abbott BinaxNOW TM COVID-19 Ag Card with PCR was lower than among previous reports. Our findings may reflect the performance of the BinaxNOW TM antigen test in real-world settings.

scholarly journals The Inc FII Plasmid and its Contribution in the Transmission of blaNDM-1 and blaKPC-2 in Klebsiella pneumoniae in Egypt

Antibiotics ◽  
2019 ◽  
Vol 8 (4) ◽  
pp. 266 ◽  
Author(s):  
Eman Ramadan Mohamed ◽  
Mamdouh Yones Ali ◽  
Nancy G F M Waly ◽  
Hamada Mohamed Halby ◽  
Rehab Mahmoud Abd El-Baky
Keyword(s):  
Polymerase Chain Reaction ◽  
Klebsiella Pneumoniae ◽  
Molecular Typing ◽  
University Hospital ◽  
Chain Reaction ◽  
Great Problem ◽  
E Coli ◽  
String Test ◽  
Resistance Patterns ◽  
Polymerase Chain

The emergence of blaKPC-2 and blaNDM-1 producing Klebsiella pneumoniae represents a great problem in many Egyptian hospitals. One hundred and twenty-six K. pneumoniae isolates from patients admitted to Assiut University Hospital were identified by an API20E kit. Carbapenemase-producing K. pneumoniae (CPKP) was detected by the modified carbapenem inactivation method (mCIM), the EDTA-modified carbapenem inactivation method (eCIM), and an E-test. Based on the polymerase chain reaction, all isolates were negative for bla-VIM-1 and bla-IMP-1, fifteen of these isolates were positive for both blaKPC-2 and blaNDM-1, two isolates were positive for blaKPC-2 only, and twenty-eight isolates were positive for bla-NDM-1 only. Although one isolate was positive for the string test, all CPKP isolates were negative for capsular genes. Only 71.1% of CPKP transferred their plasmids to their corresponding transconjugants (E. coli J53). The resistance patterns of the clinical isolates and their transconjugates were similar, except for 12 isolates, which showed differences with their transconjugates in the resistance profile of four antibiotics. Molecular typing of the plasmids based on replicon typing showed that Inc FIIK and FII plasmids predominated in isolates and their transconjugants carrying blaKPC-2 and/or blaNDM-1. Conjugative Inc FII plasmids play an important role in the spread of CPKP, and their recognition is essential to limit their spread.

An Epidemiologic Survey of Methicillin-ResistantStaphylococcus Aureusby Combined Use ofMec-HVR Genotyping and Toxin Genotyping in a University Hospital in Japan

2002 ◽  
Vol 23 (9) ◽  
pp. 506-510 ◽  
Author(s):  
Junichiro Nishi ◽  
Masao Yoshinaga ◽  
Hiroaki Miyanohara ◽  
Motoshi Kawahara ◽  
Masaharu Kawabata ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Hypervariable Region ◽  
Polymerase Chain Reaction Method ◽  
University Hospital ◽  
Chain Reaction ◽  
Discriminatory Ability ◽  
Epidemiologic Survey ◽  
Combined Use ◽  
Polymerase Chain ◽  
Hospital Wards

Objective:To evaluate the usefulness of an assay using two polymerase chain reaction-based genotyping methods in the practical surveillance of methicillin-resistantStaphylococcus aureus(MRSA).Methods:Nosocomial infection and colonization were surveyed monthly in a university hospital in Japan for 20 months. Genotyping withmec-HVR is based on the size of themec-associated hypervariable region amplified by polymerase chain reaction. Toxin genotyping uses a multiplex polymerase chain reaction method to amplify eight staphylococcal toxin genes.Results:Eight hundred nine MRSA isolates were classified into 49 genotypes. We observed differing prevalences of genotypes for different hospital wards, and could rapidly demonstrate the similarity of genotype for outbreak isolates. The incidence of genotype D: SEC/TSST1 was significantly higher in isolates causing nosocomial infections (49.5%; 48 of 97) than in nasal isolates (31.4%; 54 of 172) (P= .004), suggesting that this genotype may represent the nosocomial strains.Conclusion:The combined use of these two genotyping methods resulted in improved discriminatory ability and should be further investigated.

scholarly journals Efficacy of rapid multiplex polymerase chain reaction for early diagnosis and treatment of pertussis

2019 ◽  
Author(s):  
Se Chang Oh ◽  
Soo Min Park ◽  
Jian Hur ◽  
Eun Young Choi ◽  
Hyun Jung Jin ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Early Diagnosis ◽  
Multiplex Pcr ◽  
Bordetella Pertussis ◽  
Turnaround Time ◽  
University Hospital ◽  
Diagnosis And Treatment ◽  
Chain Reaction ◽  
Polymerase Chain ◽  
Pcr Test

Abstract Background Pertussis, a highly infectious respiratory disease caused by Bordetella pertussis, causes airway inflammation and severe, persistent (lasting 2 weeks or more) characteristic whooping cough. In severe cases, complications such as atelectasis and bronchopneumonia may occur. Recently, the prevalence of pertussis has increased in South Korea due to reduced effect of the DTaP vaccination in infants as their age increased. Although culture is the gold standard test for diagnosis, polymerase chain reaction (PCR) method is most commonly used for diagnosis of pertussis due to the low sensitivity and long turnaround time of the culture method. Recently, a rapid multiplex PCR test has been introduced for comprehensive detection of respiratory pathogens (17 viruses and 3 bacteria), including Bordetella pertussis, with a turnaround time of 1 hour. This study aimed to investigate the efficacy of multiplex PCR for early diagnosis and treatment of pertussis. Methods We performed a retrospective study on patients with pertussis diagnosed from May 2017 to June 2019 at Yeungnam University Hospital. Nasopharyngeal swab specimens were tested using multiplex PCR. Medical records collected included data on age, sex, symptoms at the time of diagnosis, admission, hospitalization, isolation, vaccination history, past medical history, and accompanying diseases. Results A total of 27 patients were diagnosed with pertussis, nine (33.3%) of whom were men, with a median age of 48.9 years (3.3–82.2). Eleven (40.7%) had fever, 12 (44.4%) had dyspnea, 3 (11.1%) had paroxysmal cough, and 9 (33.3%) had inspiratory whooping. Seventeen (62.9%) and 24 (88.8%) patients had coughing for <8 days and ≤14 days, respectively. Median time from first symptom to diagnosis was 9.0 (1–31) days. Twenty-four patients (81.5%) were diagnosed within 2 weeks. All but one patient was prescribed macrolide antibiotics; all patients were isolated, with 22 (81.5%) requiring hospitalization. Three patients (11.1%) received ICU care for ventilation. All patients survived. Conclusion A rapid multiplex PCR test can ensure early diagnosis, isolation, and treatment of pertussis. Testing of patients with respiratory symptom with multiplex PCR can led to early diagnosis of pertussis, proper treatment, and may help in outbreak control.

Sign in / Sign up

Export Citation Format

Share Document