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Impact of Rapid On-demand Molecular Diagnosis of Pediatric Seasonal Influenza on Laboratory Workflow and Testing Costs

A Retrospective Study

Brotons, Pedro, MSc*,†; Nogueras, Maria-Mercedes, PhD*,†; Valls, Ana, MD; Larrauri, Amparo, MD, PhD†,§; Dominguez, Angela, MD, PhD†,¶; Launes, Cristian, MD, PhD*,†; Luaces-Cubells, Carlos, MD, PhD; Muñoz-Almagro, Carmen, MD, PhD*,†,**

The Pediatric Infectious Disease Journal: June 2019 - Volume 38 - Issue 6 - p 559–563
doi: 10.1097/INF.0000000000002224
Original Studies
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Background: Seasonal influenza imposes a considerable burden worldwide. We aimed to evaluate impact of rapid pediatric seasonal influenza diagnosis on laboratory workflow and cost using a rapid antigen detection-based test combined with either a reverse transcriptase polymerase chain reaction (RT-PCR) or the Alere i Influenza A and B (Alere i) assay for confirmation of negative results as well as single Alere i testing on nasopharyngeal aspirates. A secondary objective was assessing performance of Alere i against RT-PCR.

Methods: Effects of implementing the 3 diagnostic algorithms were assessed in the Emergency Department of Hospital Sant Joan de Déu (Barcelona, Spain) across the 2014–2015, 2015–2016 and 2016–2017 influenza seasons. Alere i performance against RT-PCR was determined during the 2015–2016 epidemic period.

Results: Median time to result decreased when using Alere i as a confirmatory test of previous antigen detection and RT-PCR results or alone (9.7vs. 3.5/2.0 and 0.7 hours, P < 0.001) along with mean testing costs (€87.3 vs. €38.2 and €25.0, P < 0.001). Results available before patient discharge from the emergency department increased from 42.7% for sequential testing by antigen detection and RT-PCR to 80.0% when Alere i was utilized as a stand-alone test. Alere i sensitivity and specificity values were 96.6% (95% confidence interval: 82.8%–99.4%) and 94.4% (95% confidence interval: 86.6%–97.8%), respectively.

Conclusions: Rapid Alere i testing facilitated efficient laboratory workflow near the patient during influenza epidemics while contributing cost savings when compared with serial testing by antigen and RT-PCR assays.

From the *Institut de Recerca Sant Joan de Deu, Hospital Sant Joan de Deu, Spain

Centro de Investigacion Biomedica en Red de Epidemiology y Salud Publica (CIBERESP), Instituto de Salud Carlos III, Spain

Clinical Laboratory, Hospital Sant Joan de Déu, Spain

§Centro Nacional de Epidemiología (CNE), Instituto de Salud Carlos III, Spain

Departament de Medicina, Universitat de Barcelona, Barcelona, Spain

Emergency Department, Hospital Sant Joan de Déu, Spain

**Universitat Internacional de Catalunya, Spain

Accepted for publication October 23, 2018.

This work was partially supported by funds from CIBER of Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III. Abbott supplied Alere i Influenza A and B reagents free of charge to perform 101 determinations for assessment of agreement of Alere i Influenza A and B test with RealStar Influenza S and t test. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. C.M.-A. reports a conflict of interest regarding support in kind to the study by Abbott. The other authors have no conflicts of interest to disclose.

Address for correspondence: Carmen Muñoz-Almagro, MD, PhD, Molecular Microbiology Department, Hospital Sant Joan de Déu, Passeig de Sant Joan de Deu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain. E-mail: cma@sjdhospitalbarcelona.org.

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