1
|
Kahn M, Schuierer L, Bartenschlager C, Zellmer S, Frey R, Freitag M, Dhillon C, Heier M, Ebigbo A, Denzel C, Temizel S, Messmann H, Wehler M, Hoffmann R, Kling E, Römmele C. Performance of antigen testing for diagnosis of COVID-19: a direct comparison of a lateral flow device to nucleic acid amplification based tests. BMC Infect Dis 2021; 21:798. [PMID: 34376187 PMCID: PMC8354301 DOI: 10.1186/s12879-021-06524-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 07/31/2021] [Indexed: 02/08/2023] Open
Abstract
Objectives The gold standard for diagnosing an infection with SARS-CoV-2 is detection of viral RNA by nucleic acid amplification techniques. Test capacities, however, are limited. Therefore, numerous easy-to-use rapid antigen tests based on lateral flow technology have been developed. Manufacturer-reported performance data seem convincing, but real-world data are missing. Methods We retrospectively analysed all prospectively collected antigen tests results performed between 23.06.2020 and 26.11.2020, generated by non-laboratory personnel at the point-of-care from oro- or nasopharyngeal swab samples at the University Hospital Augsburg and compared them to concomitantly (within 24 h.) generated results from molecular tests. Results For a total of 3630 antigen tests, 3110 NAAT results were available. Overall, sensitivity, specificity, NPV and PPV of antigen testing were 59.4%, 99.0%, 98.7% and 64.8%, respectively. Sensitivity and PPV were lower in asymptomatic patients (47.6% and 44.4%, respectively) and only slightly higher in patients with clinical symptoms (66.7% and 85.0%, respectively). Some samples with very low Ct-values (minimum Ct 13) were not detected by antigen testing. 31 false positive results occurred. ROC curve analysis showed that reducing the COI cut-off from 1, as suggested by the manufacturer, to 0.9 is optimal, albeit with an AUC of only 0.66. Conclusion In real life, performance of lateral-flow-based antigen tests are well below the manufacturer's specifications, irrespective of patient’s symptoms. Their use for detection of individual patients infected with SARS-CoV2 should be discouraged. This does not preclude their usefulness in large-scale screening programs to reduce transmission events on a population-wide scale. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06524-7.
Collapse
Affiliation(s)
- Maria Kahn
- III. Medical Clinic-Gastroenterology, Infectious Diseases, University Hospital of Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany.
| | - Lukas Schuierer
- Laboratory Medicine and Microbiology, University Hospital of Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Christina Bartenschlager
- Chair of Health Care Operations/Health Information Management, University of Augsburg, Universitätsstraße 16, 86159, Augsburg, Germany
| | - Stephan Zellmer
- III. Medical Clinic-Gastroenterology, Infectious Diseases, University Hospital of Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Ramona Frey
- Chair of Health Care Operations/Health Information Management, University of Augsburg, Universitätsstraße 16, 86159, Augsburg, Germany
| | - Marie Freitag
- COVID-19 Task Force, University Hospital of Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Christine Dhillon
- COVID-19 Task Force, University Hospital of Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany.,General and Special Pathology, Faculty of Medicine, University of Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Margit Heier
- III. Medical Clinic-Gastroenterology, Infectious Diseases, University Hospital of Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Alanna Ebigbo
- III. Medical Clinic-Gastroenterology, Infectious Diseases, University Hospital of Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Christian Denzel
- IV. Medical Clinic-Emergency Department, University Hospital of Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Selin Temizel
- Department of Hygiene and Environmental Medicine, University Hospital of Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Helmut Messmann
- III. Medical Clinic-Gastroenterology, Infectious Diseases, University Hospital of Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Markus Wehler
- IV. Medical Clinic-Emergency Department, University Hospital of Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Reinhard Hoffmann
- Laboratory Medicine and Microbiology, University Hospital of Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Elisabeth Kling
- Laboratory Medicine and Microbiology, University Hospital of Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Christoph Römmele
- III. Medical Clinic-Gastroenterology, Infectious Diseases, University Hospital of Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany.,COVID-19 Task Force, University Hospital of Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| |
Collapse
|
2
|
Osmanodja B, Budde K, Zickler D, Naik MG, Hofmann J, Gertler M, Hülso C, Rössig H, Horn P, Seybold J, Lunow S, Bothmann M, Barrera-Pesek A, Mayrdorfer M. Accuracy of a Novel SARS-CoV-2 Antigen-Detecting Rapid Diagnostic Test from Standardized Self-Collected Anterior Nasal Swabs. J Clin Med 2021; 10:jcm10102099. [PMID: 34068236 PMCID: PMC8153114 DOI: 10.3390/jcm10102099] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 01/01/2023] Open
Abstract
Background Antigen-detecting rapid diagnostic tests (Ag-RDT) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) offer new opportunities for the quick and laboratory-independent identification of infected individuals for control of the SARS-CoV-2 pandemic. Despite the potential benefits, nasopharyngeal sample collection is frequently perceived as uncomfortable by patients and requires trained healthcare personnel with protective equipment. Therefore, anterior nasal self-sampling is increasingly recognized as a valuable alternative. Methods We performed a prospective, single-center, point of care validation of an Ag-RDT using a polypropylene absorbent collector for standardized self-collected anterior nasal swabs. Real-time polymerase chain reaction (RT-PCR) from combined oropharyngeal/nasopharyngeal swabs served as a comparator. Primary endpoint was sensitivity of the standardized Ag-RDT in symptomatic patients with medium or high viral concentration (≥1 million RNA copies on RT-PCR for SARS-CoV-2). Results Between 12 February and 22 March 2021, 388 participants were enrolled. After exclusion of 9 patients for which no PCR result could be obtained, the novel Ag-RDT was evaluated based on 379 participants, of whom 273 were symptomatic and 106 asymptomatic. In 61 samples from symptomatic patients with medium or high viral load (≥1 million RNA copies), the sensitivity of the standardized Ag-RDT was 96.7% (59/61; 95% confidence interval (CI): 88.7–99.6%) for the primary endpoint. In total, 62 positive Ag-RDT results were detected out of 70 RT-PCR positive individuals, yielding an overall sensitivity of 88.6% (95% CI: 78.7–94.9%). Specificity was 99.7% (95% CI: 98.2–100%) in 309 RT-PCR negative individuals. Conclusions Here, we present a validation of a novel Ag-RDT with a standardized sampling process for anterior nasal self-collection, which meets World Health Organisation (WHO) criteria of ≥80% sensitivity and ≥97% specificity. Although less sensitive than RT-PCR, this assay could be beneficial due to its rapid results, ease of use, and suitability for standardized self-testing.
Collapse
Affiliation(s)
- Bilgin Osmanodja
- Department of Nephrology and Medical Intensive Care, Charité–Universitätsmedizin Berlin, 10117 Berlin, Germany; (K.B.); (D.Z.); (M.G.N.); (M.M.)
- Correspondence: ; Tel.: + 49-30-450-614-368
| | - Klemens Budde
- Department of Nephrology and Medical Intensive Care, Charité–Universitätsmedizin Berlin, 10117 Berlin, Germany; (K.B.); (D.Z.); (M.G.N.); (M.M.)
| | - Daniel Zickler
- Department of Nephrology and Medical Intensive Care, Charité–Universitätsmedizin Berlin, 10117 Berlin, Germany; (K.B.); (D.Z.); (M.G.N.); (M.M.)
| | - Marcel G. Naik
- Department of Nephrology and Medical Intensive Care, Charité–Universitätsmedizin Berlin, 10117 Berlin, Germany; (K.B.); (D.Z.); (M.G.N.); (M.M.)
- Berlin Institute of Health, 10117 Berlin, Germany
| | - Jörg Hofmann
- Institute of Virology, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany;
- Labor Berlin–Charité Vivantes GmbH, 13353 Berlin, Germany
| | - Maximilian Gertler
- Institute of Tropical Medicine and International Health, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany; (M.G.); (C.H.); (S.L.); (M.B.); (A.B.-P.)
| | - Claudia Hülso
- Institute of Tropical Medicine and International Health, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany; (M.G.); (C.H.); (S.L.); (M.B.); (A.B.-P.)
| | - Heike Rössig
- Medical Directorate, Charité–Universitätsmedizin Berlin, 10117 Berlin, Germany; (H.R.); (P.H.); (J.S.)
| | - Philipp Horn
- Medical Directorate, Charité–Universitätsmedizin Berlin, 10117 Berlin, Germany; (H.R.); (P.H.); (J.S.)
| | - Joachim Seybold
- Medical Directorate, Charité–Universitätsmedizin Berlin, 10117 Berlin, Germany; (H.R.); (P.H.); (J.S.)
| | - Stephanie Lunow
- Institute of Tropical Medicine and International Health, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany; (M.G.); (C.H.); (S.L.); (M.B.); (A.B.-P.)
| | - Melanie Bothmann
- Institute of Tropical Medicine and International Health, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany; (M.G.); (C.H.); (S.L.); (M.B.); (A.B.-P.)
| | - Astrid Barrera-Pesek
- Institute of Tropical Medicine and International Health, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany; (M.G.); (C.H.); (S.L.); (M.B.); (A.B.-P.)
| | - Manuel Mayrdorfer
- Department of Nephrology and Medical Intensive Care, Charité–Universitätsmedizin Berlin, 10117 Berlin, Germany; (K.B.); (D.Z.); (M.G.N.); (M.M.)
| |
Collapse
|
3
|
Wang H, Hogan CA, Verghese M, Solis D, Sibai M, Huang C, Zehnder J, Sahoo MK, Pinsky BA. Ultra-sensitive Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Antigen Detection for the Diagnosis of Coronavirus Disease 2019 (COVID-19) in Upper Respiratory Samples. Clin Infect Dis 2021; 73:2326-2328. [PMID: 33830203 PMCID: PMC8083502 DOI: 10.1093/cid/ciab063] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Indexed: 12/23/2022] Open
Abstract
An ultra-sensitive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleocapsid antigen assay (S-PLEX, MesoScale Diagnostics) was evaluated in 250 retrospective and 200 prospective upper respiratory specimens. In samples with cycle threshold <35, there was 95%–98% positive and 93%–96% negative percent agreement with reverse transcription-polymerase chain reaction. S-PLEX may provide a high-throughput alternative to nucleic acid-based testing for coronavirus disease 2019 (COVID-19) diagnosis.
Collapse
Affiliation(s)
- Hannah Wang
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Catherine A Hogan
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Michelle Verghese
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Daniel Solis
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Mamdouh Sibai
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - ChunHong Huang
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - James Zehnder
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Malaya K Sahoo
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Benjamin A Pinsky
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.,Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
4
|
Dalal A, Sonika U, Kumar M, George R, Kumar A, Srivastava S, Sachdeva S, Sharma BC. COVID-19 Rapid Antigen Test: Role in Screening Prior to Gastrointestinal Endoscopy. Clin Endosc 2021; 54:522-525. [PMID: 33657784 PMCID: PMC8357579 DOI: 10.5946/ce.2020.295] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 12/23/2020] [Indexed: 01/27/2023] Open
Abstract
Background/Aims The severe acute respiratory syndrome coronavirus 2 pandemic has affected the gastrointestinal (GI) endoscopy units globally owing to the risk of transmission. We present our data on the use of rapid antigen test (RAT) as a screening tool prior to endoscopy to prevent the transmission of coronavirus disease (COVID-19).
Methods This study was a retrospective analysis of patients who underwent any GI endoscopic procedure from July 2020 to October 2020 at a tertiary referral center in New Delhi, India. All patients underwent screening for COVID-19 using RAT, and endoscopy was performed only when the RAT was negative. The data are presented as numbers and percentages.
Results A total of 3,002 endoscopic procedures were performed during the study period. Only one endoscopic procedure was performed in a COVID-19 positive patient. A total of 53 healthcare workers were involved in conducting these procedures. Only 2 healthcare workers (3.8%) were diagnosed COVID-19 positive, presumably due to community-acquired infection, during this period.
Conclusions The COVID-19 RAT is easily usable as a simple screening tool prior to GI endoscopy during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Ashok Dalal
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Ujjwal Sonika
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Manish Kumar
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Roshan George
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Ajay Kumar
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Siddharth Srivastava
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Sanjeev Sachdeva
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Barjesh Chander Sharma
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| |
Collapse
|