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Oropharyngeal swabs yield little benefit in pediatric respiratory virus detection
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The addition of an oropharyngeal swab to nasal swab practices may not be worth the minor increase in respiratory virus detection among pediatric patients, according to recent findings.
“Nasal swabs are the least invasive of all respiratory specimen techniques and require minimal technical skill for collection,” the researchers wrote. “In contrast, [oropharyngeal (OP)] specimen collection is more challenging in young children and may require restraining an uncooperative child and use of tongue depressors to obtain an adequate sample.”
Researchers examined the OP and nasal swabs of 703 hospitalized children participating in a multisite, prospective, randomized, placebo-controlled trial of Tamiflu (oseltamivir, Genentech) conducted in 2012-2013. Participants were aged younger than 10 years and had been hospitalized in the past week with respiratory illness, characterized by cough or sore throat.
OP and nasal swabs were taken at enrollment, before initiation of oseltamivir or placebo. All specimens were tested for respiratory syncytial virus (RSV), parainfluenza viruses (PIV) 1-3, adenovirus, human metapneumovirus (hMPV), rhinoviruses, and influenza viruses.
The viruses most frequently detected by either nasal or OP swab were RSV (49%) and rhinovirus (22%). Nasal swabs demonstrated sensitivity that was equal to or better than OP swabs for detection of all viruses except parainfluenza virus. OP swabs demonstrated the least sensitivity in detecting rhinovirus (83%; 95% CI, 75%-88%) and influenza viruses (83%; 95% CI, 65%-94%).
Adding an OP swab to a nasal swab alone yielded a 10% (95% CI, 3%-11%) increase in detection for rhinovirus, a 9% (95% CI, 3%-23%) increase for parainfluenza viruses and a 7% (95% CI, 0%-36%) increase for adenovirus. It did not lead to an increase in influenza virus detection since nasal swab sensitivity for influenza viruses was 100% (95% CI, 86%-100%).
According to the researchers, these results demonstrate that the addition of OP may not be worth the minor detection benefit.
“Our results suggest that collection of OP swabs in addition to nasal swabs in noncritically ill hospitalized children may have little added value considering the added burden of patient discomfort, staff time and swabbing supplies, particularly when infection with RSV, hMPV, or seasonal influenza viruses is suspected,” the researchers wrote. – by Jen Byrne
Disclosure: The researchers report no relevant financial disclosures.
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