在气管切开术患者中使用基于 RT-PCR 的鼻咽拭子和留置气管插管检测 SAR-CoV-2 的比较研究

Sunicha Jiraboonsri, Nida Wright
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摘要

背景鼻咽拭子 RT-PCR 是检测 COVID-19 的标准程序。在气管切开术患者中,气道改变绕过了鼻咽部,不同部位样本的产量尚不清楚。这些信息对于制定气管切开术患者 COVID-19 RT-PCR 检测的样本采集方法至关重要。方法 这是一项横断面研究。研究人员从泰国巴吞他尼府 Thammasat 大学医院的 100 名非插入式气管造口术患者中采集了鼻咽拭子和气管分泌物(通过闭路分泌物抽吸)样本。参与者的年龄在 1-96 岁之间,目的是在大流行期间进行筛查。使用 McNemar 检验分析了每个地点的检测结果和周期阈值 (Ct),置信区间为 95%。结果 四名参与者检测结果呈阳性。其中一名患者的鼻咽拭子检测结果呈阳性,另一名患者的气管分泌物样本检测结果呈阳性。不一致组和一致组之间的差异无统计学意义(P = 1)。结论 在 100 名患者中的 4 个阳性病例中,我们发现了两个不一致的结果。一名患者的鼻咽拭子检测结果呈阳性,而另一名患者的气管样本检测结果呈阳性。吻合率为 98,卡帕系数为 65.64%(P <0.001)。根据上述结果,从鼻咽部或气管中采集一份样本就足以确定低风险患者的感染状况。对于高度可疑病例,应进行多部位采样。本研究显示,气管切开患者鼻咽拭子样本和气管分泌物样本的 COVID-19 RT-PCR 筛查结果不一致。建议对气管切开的高度可疑患者进行多部位采样。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A comparative study of SAR-CoV-2 detection using RT-PCR based testing from a nasopharyngeal swab versus indwelling tracheostomy in patients with a tracheostomy
Background Nasopharyngeal swab RT-PCR is the standard procedure for COVID-19 testing. In patients with tracheostomy with an altered airway that bypasses the nasopharynx, the yield of samples from different sites is unknown. This information will be essential for formulating a sample collection method for COVID-19 RT-PCR testing in patients undergoing tracheostomy. Methods This was a cross-sectional study. Nasopharyngeal swabs and tracheal secretion (via closed-circuit secretion suction) samples were collected from 100 patients with a non-plugging tracheostomy tube at Thammasat University Hospital, Pathum Thani, Thailand. The participants were aged between 1-96 years old for screening purposes during the pandemic. The detection results and cycle threshold (Ct) values from each site were analyzed using McNemar’s test with a 95% confidence interval. Results Four participants had positive results. One patient tested positive only for the nasopharyngeal swab, whereas the other tested positive only for the tracheal secretion sample. No statistically significant difference was found between the discordant and concordant groups (P = 1). Conclusions We found two discordant results among the four positive cases in the 100 patients. One patient tested positive only from the nasopharyngeal swab, whereas the other tested positive only from the tracheal sample. The percentage of agreement was 98, and the kappa coefficient value was 65.64% (p <0.001). According to these results, one sample from the nasopharynx or tracheal tube should be sufficient to determine the infection status of low-risk patients. For highly suspicious cases, multisite sampling should be performed. This study showed discordance in COVID-19 RT-PCR screening results using samples from nasopharyngeal swabs and tracheal secretions in tracheotomized patients. A multiple-site sample is suggested for highly suspicious patients with tracheostomy.
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