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Article

Sensitivity of Rapid Antigen Testing and RT-PCR Performed on Nasopharyngeal Swabs versus Saliva Samples in COVID-19 Hospitalized Patients: Results of a Prospective Comparative Trial (RESTART)

1
Institute of Microbiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
2
Intensive Care Unit, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
3
Service of Internal Medicine, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
*
Authors to whom correspondence should be addressed.
These authors contribute equally to this work.
Academic Editor: Raffaele Bruno
Microorganisms 2021, 9(9), 1910; https://doi.org/10.3390/microorganisms9091910
Received: 13 August 2021 / Revised: 31 August 2021 / Accepted: 7 September 2021 / Published: 9 September 2021
(This article belongs to the Special Issue COVID-19: Focusing on Epidemiologic, Virologic, and Clinical Studies)
Saliva sampling could serve as an alternative non-invasive sample for SARS-CoV-2 diagnosis while rapid antigen tests (RATs) might help to mitigate the shortage of reagents sporadically encountered with RT-PCR. Thus, in the RESTART study we compared antigen and RT-PCR testing methods on nasopharyngeal (NP) swabs and salivary samples. We conducted a prospective observational study among COVID-19 hospitalized patients between 10 December 2020 and 1 February 2021. Paired saliva and NP samples were investigated by RT-PCR (Cobas 6800, Roche-Switzerland, Basel, Switzerland) and by two rapid antigen tests: One Step Immunoassay Exdia® COVID-19 Ag (Precision Biosensor, Daejeon, Korea) and Standard Q® COVID-19 Rapid Antigen Test (Roche-Switzerland). A total of 58 paired NP-saliva specimens were collected. A total of 32 of 58 (55%) patients were hospitalized in the intensive care unit, and the median duration of symptoms was 11 days (IQR 5-19). NP and salivary RT-PCR exhibited sensitivity of 98% and 69% respectively, whereas the specificity of these RT-PCRs assays was 100%. The NP RATs exhibited much lower diagnostic performance, with sensitivities of 35% and 41% for the Standard Q® and Exdia® assays, respectively, when a wet-swab approach was used (i.e., when the swab was diluted in the viral transport medium (VTM) before testing). The sensitivity of the dry-swab approach was slightly better (47%). These antigen tests exhibited very low sensitivity (4% and 8%) when applied to salivary swabs. Nasopharyngeal RT-PCR is the most accurate test for COVID-19 diagnosis in hospitalized patients. RT-PCR on salivary samples may be used when nasopharyngeal swabs are contraindicated. RATs are not appropriate for hospitalized patients. View Full-Text
Keywords: SARS-CoV-2 diagnosis; RT-PCR; rapid antigen testing; saliva; viral transport medium SARS-CoV-2 diagnosis; RT-PCR; rapid antigen testing; saliva; viral transport medium
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MDPI and ACS Style

Kritikos, A.; Caruana, G.; Brouillet, R.; Miroz, J.-P.; Abed-Maillard, S.; Stieger, G.; Opota, O.; Croxatto, A.; Vollenweider, P.; Bart, P.-A.; Chiche, J.-D.; Greub, G. Sensitivity of Rapid Antigen Testing and RT-PCR Performed on Nasopharyngeal Swabs versus Saliva Samples in COVID-19 Hospitalized Patients: Results of a Prospective Comparative Trial (RESTART). Microorganisms 2021, 9, 1910. https://doi.org/10.3390/microorganisms9091910

AMA Style

Kritikos A, Caruana G, Brouillet R, Miroz J-P, Abed-Maillard S, Stieger G, Opota O, Croxatto A, Vollenweider P, Bart P-A, Chiche J-D, Greub G. Sensitivity of Rapid Antigen Testing and RT-PCR Performed on Nasopharyngeal Swabs versus Saliva Samples in COVID-19 Hospitalized Patients: Results of a Prospective Comparative Trial (RESTART). Microorganisms. 2021; 9(9):1910. https://doi.org/10.3390/microorganisms9091910

Chicago/Turabian Style

Kritikos, Antonios, Giorgia Caruana, René Brouillet, John-Paul Miroz, Samia Abed-Maillard, Geraldine Stieger, Onya Opota, Antony Croxatto, Peter Vollenweider, Pierre-Alexandre Bart, Jean-Daniel Chiche, and Gilbert Greub. 2021. "Sensitivity of Rapid Antigen Testing and RT-PCR Performed on Nasopharyngeal Swabs versus Saliva Samples in COVID-19 Hospitalized Patients: Results of a Prospective Comparative Trial (RESTART)" Microorganisms 9, no. 9: 1910. https://doi.org/10.3390/microorganisms9091910

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