Rapid Syndromic Molecular Detection in the ED and ICU:
a game-changer for the management of COVID-19 patients 14 January 2021
Questions for panelists and their responses
BioMérieux and BioFire
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response(s)
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Would you recommend regular PCR OP/NP swab for all patient for bronchoscopy? especially in patient planning for endobronchial biopsy/EBUS TBNA.
ResponseDr Chien-Chang Lee (Taiwan) responds:
Yes
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Aside from procalcitonin, will covid/bacterial coninfection channge the LDH, Ferritin, ddimer?
ResponseDr Chien-Chang Lee (Taiwan) responds:
There is insufficient evidence to show the three markers differentiate becaterial from non-bacterial infection.
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There is concern in using pneumonia panel, that detecting bacteria more sensitively may lead to more use of antibiotics, what is your opinion on this based on your experience?
ResponseDr Chien-Chang Lee (Taiwan) responds:
I suggest the pneumonia panel results should be interpreted in the context of clinincal presentation, quantitative PCR results. Procalcitonin level and pathogens.
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In your ER, which patient population do you test with FilmArray RP & PCT? All patients presenting with respiratory symptoms or suspected pneumonia patients?
ResponseDr Chien-Chang Lee (Taiwan) responds:
I currently use then in the elderly patients presenting with respiratory distress.
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How to treatment exacerbation COPD and ASTMA with COVID 19
ResponseDr Chien-Chang Lee (Taiwan) responds:
https://iris.paho.org/bitstream/handle/10665.2/52258/PAHONMHNVCOVID-19200023_eng.pdf?sequence=5&isAllowed=y
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Do you have any experience for patient management that has CAP / HAP with Congestive Heart Failure (by the raise of troponin)?
ResponseDr Chien-Chang Lee (Taiwan) responds:
CAP/HAP is a common cause to trigger acute decompensation of hert failure or even myocardial infarction. I suggest using a procalcitonin cut-off of 0.25 to start antibiotic treatment in patients with CHF. In addition, I suggest serial testing of troponins. in patients with dynamic rise and fall of troponin levels, serach for ECG or echocadiographic evidence for myocardial infarction.
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rapid test cost? specifity, sensitivity? is it practical? pcr versus rapid test: advantages disadvantages?
ResponseDr Chien-Chang Lee (Taiwan) responds:
Rapid molecular test cost around 400 USD with near perfect sensitivity and specificigy. The cost is higher than conventioal PCR, but it offers the advantage of short turn around time (45 minutes).
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How much would this Rapid Molecular test cost and how rapid is it? What countries are already capable of doing this test? Thank You.
ResponseDr Chien-Chang Lee (Taiwan) responds:
Rapid molecular test cost around 400 USD with near perfect sensitivity and specificigy. The turn around time around 45 minutes. The bioFire Asia-pacific team has the contry list.
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Do you see a possible, positive management of COVID using Rapid syndromic testing, in community clusters such as old folks homes, child care centers or schools, with relative cost-savings?
ResponseDr Chien-Chang Lee (Taiwan) responds:
Yes, the test is CLIA waived, which means low level of skill is needed to operate the machine, even outside the hospital settings. The use of rapid molecular test will early identify infection and take necessary action to prevent clustered infection.
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Is Molecular detection specific for diagnosis?
ResponseDr Chien-Chang Lee (Taiwan) responds:
Yes, the sensitivty and specificity for molecular test is greater than 98% in most pathogens of RP 2.1. It is a highly accurate test.
