title: Clinical evaluation of a multi-parameter customized respiratory TaqMan(®) array card compared to conventional methods in immunocompromised patients.
abstract: BACKGROUND
  Respiratory viral infections can cause significant morbidity and mortality in immunocompromised patients. Conventional tests routinely available at most institutions are limited by the number of detectable pathogens, by a poor sensitivity and/or a long turnaround time.
  
  
  OBJECTIVE
  To compare the performance of routine conventional testing with direct fluorescent antibody assays and viral culture to a customized TaqMan® array card (TAC) real-time PCR method, targeting 24 viruses, 8 bacteria and 2 fungi simultaneously.
  
  
  METHODS
  We collected 143 respiratory samples from 120 symptomatic immunocompromised patients. Samples for which conventional and TAC results were discordant underwent further verification testing.
  
  
  RESULTS
  The TAC assay identified viral pathogens in more samples than did conventional testing (77/143 versus 27/143; McNemar P<0.0001), even when TAC results for viruses that could not be detected by conventional testing were excluded from analysis (59/143 versus 26/143; P<0.0001). In addition, the TAC assay identified 18 samples with non-viral pathogens. Verification testing confirmed positive TAC results for 50 out of 55 samples for which conventional testing was negative. Two out of three samples with a positive conventional test but negative TAC result were confirmed positive. A viral and a total pathogen co-infection rate of 5.6% and 11.8% were found, respectively.
  
  
  CONCLUSIONS
  The customized TAC assay resulted in a significantly increased identification of respiratory viruses. This study provides a practical real-life assessment of the performance of the TAC assay in a population for whom rapid and accurate diagnosis of viral and atypical pathogens is crucial for appropriate clinical management.
authors.affiliation: Department of Clinical Microbiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium. Electronic address: deborah.steensels@erasme.ulb.ac.be.
authors.forename: Deborah
authors.initials: D
authors.lastname: Steensels
authors.affiliation: Department of Clinical Microbiology, AZ St-Jan Brugge-Oostende Hospital, Brugge, Belgium.
authors.forename: Marijke
authors.initials: M
authors.lastname: Reynders
authors.affiliation: Department of Clinical Microbiology, AZ St-Jan Brugge-Oostende Hospital, Brugge, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Descheemaeker
authors.affiliation: Public Health England, Clinical Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Cambridge, United Kingdom.
authors.forename: Martin D
authors.initials: MD
authors.lastname: Curran
authors.affiliation: Department of Infectious Diseases, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Frédérique
authors.initials: F
authors.lastname: Jacobs
authors.affiliation: Department of Clinical Microbiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Olivier
authors.initials: O
authors.lastname: Denis
authors.affiliation: Department of Clinical Microbiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Marie-Luce
authors.initials: ML
authors.lastname: Delforge
authors.affiliation: Department of Clinical Microbiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Isabel
authors.initials: I
authors.lastname: Montesinos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000175:diagnosis* / Q000382:microbiology; D005260:Female; D005658:Fungi; D006801:Humans; D016867:Immunocompromised Host; D008172:Lung Diseases, Fungal / Q000175:diagnosis* / Q000382:microbiology; D008297:Male; D008828:Microbiological Techniques / Q000379:methods*; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques / Q000379:methods*; D012141:Respiratory Tract Infections / Q000175:diagnosis*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014777:Virus Diseases / Q000175:diagnosis* / Q000821:virology; D055815:Young Adult
keywords: Conventional methods; Immunocompromised patients; Multi-pathogen molecular assay; Respiratory virus infections