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Comparative Study
. 2019 Mar;25(3):372-378.
doi: 10.1016/j.cmi.2018.06.009. Epub 2018 Jun 12.

Saliva as a diagnostic specimen for testing respiratory virus by a point-of-care molecular assay: a diagnostic validity study

K K W To  1 , C C Y Yip  2 , C Y W Lai  2 , C K H Wong  3 , D T Y Ho  4 , P K P Pang  4 , A C K Ng  4 , K-H Leung  5 , R W S Poon  2 , K-H Chan  4 , V C C Cheng  2 , I F N Hung  6 , K-Y Yuen  7
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Free article
Comparative Study

Saliva as a diagnostic specimen for testing respiratory virus by a point-of-care molecular assay: a diagnostic validity study

K K W To et al. Clin Microbiol Infect. 2019 Mar.
Free article

Abstract

Objectives: Automated point-of-care molecular assays have greatly shortened the turnaround time of respiratory virus testing. One of the major bottlenecks now lies at the specimen collection step, especially in a busy clinical setting. Saliva is a convenient specimen type that can be provided easily by adult patients. This study assessed the diagnostic validity, specimen collection time and cost associated with the use of saliva.

Methods: This was a prospective diagnostic validity study comparing the detection rate of respiratory viruses between saliva and nasopharyngeal aspirate (NPA) among adult hospitalized patients using Xpert® Xpress Flu/RSV. The cost and time associated with the collection of saliva and nasopharyngeal specimens were also estimated.

Results: Between July and October 2017, 214 patients were recruited. The overall agreement between saliva and NPA was 93.3% (196/210, κ 0.851, 95% CI 0.776-0.926). There was no significant difference in the detection rate of respiratory viruses between saliva and NPA (32.9% (69/210) versus 35.7% (75/210); p 0.146). The overall sensitivity and specificity were 90.8% (81.9%-96.2%) and 100% (97.3%-100%), respectively, for saliva, and were 96.1% (88.9%-99.2%) and 98.5% (94.7%-99.8%), respectively, for NPA. The time and cost associated with the collection of saliva were 2.26-fold and 2.59-fold lower, respectively, than those of NPA.

Conclusions: Saliva specimens have high sensitivity and specificity in the detection of respiratory viruses by an automated multiplex Clinical Laboratory Improvement Amendments-waived point-of-care molecular assay when compared with those of NPA. The use of saliva also reduces the time and cost associated with specimen collection.

Keywords: Automated; Cost; Influenza virus; Nasopharyngeal; Point-of-care testing; Respiratory syncytial virus; Saliva.

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