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Home Microbiological Sampling in a Pediatric Cystic Fibrosis Population: Pandemic Implementation and Ongoing Use
Valerie Swanston1,2, Jeffrey N Bone2, Melissa Richmond3
1Undergraduate Medical Program, Faculty of Medicine, University of British Columbia (UBC), Vancouver, British Columbia, Canada.
Insights
Home airway sampling for cystic fibrosis (CF) patients is comparable to in-clinic methods, maintaining microbiological surveillance during the COVID-19 pandemic. This approach ensures continued patient care and pathogen detection when in-person visits are limited.
Area of Science:
- Medical Microbiology
- Pulmonology
- Infectious Disease Epidemiology
Background:
- The COVID-19 pandemic necessitated adaptations in healthcare delivery, impacting routine microbiological surveillance in cystic fibrosis (CF) care.
- Home-based airway sampling strategies emerged as a critical alternative to in-clinic procedures.
- The study addresses the need to review the validity and ongoing utility of these home-based sampling methods.
Purpose of the Study:
- To evaluate the frequency of home versus in-clinic airway sampling in CF patients.
- To compare the positivity rates of significant CF pathogens between home and in-clinic samples.
- To assess the impact of the COVID-19 pandemic on sampling practices.
Main Methods:
- A single-center, retrospective cohort study analyzed airway culture data from children with CF.
- Data spanned from January 2019 to May 2023, encompassing periods before, during, and after COVID-19 restrictions.
- Culture locations (home vs. clinic) were verified manually from patient records.
Main Results:
- A total of 2,638 cultures from 170 CF patients were analyzed.
- Home-collected samples showed a higher overall pathogen positivity rate (rate ratio: 1.46).
- Only other gram-negative bacilli demonstrated significantly higher positivity in home-collected samples (rate ratio: 1.69).
Conclusions:
- Home airway sampling demonstrates comparable positivity rates for clinically significant CF pathogens to in-clinic sampling.
- This suggests home-based methods are a viable alternative for microbiological surveillance.
- Further prospective research is recommended to definitively confirm the comparability of home and clinic sampling techniques.
Background:
During the coronavirus disease 2019 (COVID19) pandemic, restrictions on in-person care threatened to disrupt in-clinic airway sampling for microbiological surveillance, a vital aspect of cystic fibrosis (CF) care. In response, institutions developed home airway sampling strategies to allow continued guidelines-based microbiological surveillance. The validity of this sampling technique and its ongoing use has not been reviewed. Our aim is to characterize the frequency of home versus in-clinic airway sampling at our institution before, during, and after COVID19 and to compare the positivity rates of significant CF pathogens in both sampling methods.
Methods:
This single center, retrospective cohort study included children with CF with at least one airway culture between January 1st, 2019, and May 16th, 2023. Culture data were extracted from an electronic microbiological database and individual culture locations (home or clinic) were confirmed manually from patient charts.
Results:
Two thousand six hundred and thirty eight cultures were included from 170 patients (52.4% male, mean age 6.2 years). Of these, 2080 were collected by healthcare providers at BCCH and 558 were collected at home by parents or caregivers. Overall, the positivity rate of all pathogens was higher in home collected samples (rate ratio: 1.46, 95%CI: 1.32-1.61, p < 0.001) than in-clinic collected samples. However, on a species-by-species analysis, only the positivity rate of other gram-negative bacilli had significantly higher positivity in home-collected samples (rate ratio: 1.69, 95%CI: 1.16-2.46, p = 0.01).
Conclusion:
The similar positivity rates of clinically significant CF pathogens suggest that home sampling is comparable to clinic sampling, though future prospective studies are needed to confirm this hypothesis.
