title: Evaluation of a clinical scoring system and directed laboratory testing for respiratory virus infection in hematopoietic stem cell transplant recipients.
abstract: A simple clinical screening (CS) tool for respiratory virus (RV) infection was introduced and evaluated in a single hematology ward, as part of a strategy to reduce nosocomial RV infection. Up to 6 clinical symptoms or signs were scored and a predefined threshold score of ≥ 2 prompted paired nose/throat swab (NTS) collection for RV testing. The criterion standard for RV infection was positive immunofluorescence (IF) or polymerase chain reaction (PCR) for 7 and 15 viruses, respectively. The tool was shown to be most beneficial at excluding infection at a threshold score of 1 (negative predictive value [NPV] 89%, [95% confidence interval 78-96%], sensitivity 85% [70-94%], specificity 35% [27-43%]), compared with a score of 2 (NPV 85% [76-91%], sensitivity 63% [46-77%], specificity 57% [48-65%]) at a prevalence of 22%. The tool's ability to diagnose infection was limited (positive predictive value 27% and 29% at thresholds 1 and 2). The sensitivity of IF compared with PCR was 45% for the 7 viruses common to both, and 23% for the extended virus panel detected by PCR. An algorithm incorporating CS, paired NTS collection at a threshold of 1 symptom or sign, and sensitive testing including PCR can guide infection control measures in hospitalized hematopoietic stem cell transplant recipients.
authors.affiliation: Centre for Infectious Diseases and Microbiology, and NHMRC Clinical Centre for Research Excellence in Infection, Bioethics and Haematological Malignancies, Westmead Hospital, University of Sydney, Westmead, New South Wales, Australia. patricia.ferguson@swahs.health.nsw.gov.au
authors.forename: P E
authors.initials: PE
authors.lastname: Ferguson
authors.forename: N M
authors.initials: NM
authors.lastname: Gilroy
authors.forename: T P
authors.initials: TP
authors.lastname: Sloots
authors.forename: M D
authors.initials: MD
authors.lastname: Nissen
authors.forename: D E
authors.initials: DE
authors.lastname: Dwyer
authors.forename: T C
authors.initials: TC
authors.lastname: Sorrell
mesh_terms: D005455:Fluorescent Antibody Technique; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D009296:Nasal Cavity / Q000821:virology; D016133:Polymerase Chain Reaction / Q000379:methods; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000821:virology*; D012680:Sensitivity and Specificity; D014776:Virus Cultivation / Q000379:methods