Detection of bacterial pathogens using home oropharyngeal swab collection in children with cystic fibrosis

Abstract

Background Collection of respiratory cultures for airway microbiology surveillance is an essential component of routine clinical care in cystic fibrosis (CF). The COVID‐19 global pandemic has necessitated increased use of telehealth, but one limitation of telehealth is the inability to collect respiratory specimens. We initiated a protocol for at‐home collection of oropharyngeal (OP) swabs from children with CF. Methods Home respiratory specimen collection was offered during telehealth encounters. Home OP swab kits were sent to participating families via mail with instructions for collection and return. Specimens were returned by overnight shipping or dropped off at a hospital lab for processing and culture. We evaluated demographic data and compared culture results from the home‐collected specimen to the most recent specimen collected in clinic. We also tracked the frequency of newly identified Pseudomonas aeruginosa. Results Home OP swab kits were sent to families of 33 children with CF (range 1.5–19 years). OP swab kits were successfully returned from 19 children (range 1.5–19 years). One or more CF pathogens grew from 79% of the specimens. For four individuals, the home collected specimen demonstrated the new growth of P. aeruginosa. Conclusions Home collection of OP swabs for bacterial culture is feasible in children with CF across a range of ages. Most home‐collected specimens demonstrated growth of one or more CF pathogens and results were similar to recent in‐clinic specimens, suggesting acceptable sample collection technique. Anti‐pseudomonal therapy was initiated for four children based on the growth of P. aeruginosa from the home respiratory specimen.

Cystic Fibrosis Respiratory Microbiology Monitoring during a Global Pandemic: Lessons Learned from a Shift to Telehealth

“…Without appropriate adjustments to remote care models, reduced frequency of sputum monitoring may lead to missed or delayed opportunities to detect new pathogens that may require timely eradication, such as Pseudomonas . Home-performed cough swabs may be an option for monitoring younger patients and those not producing sputum regularly ( 6 ), whereas induced sputum production should be encouraged for those patients already established on nebulized saline. Specialist centers should be aware of the transport requirements for each sample type and plan service modifications to ensure adequate microbiology monitoring is maintained during the shift to telehealth care ( 7 ).…”

Short and Long-Term Impact of COVID-19 Infection on Previous Respiratory Diseases

“…Procedures such as respiratory function tests have been drastically reduced and remote attention such as telehealth, 120 , 121 , 122 , 123 home spirometry, 108 home collection of sputum samples, 124 home delivery of medication from the hospital pharmacy, and long-distance electronic monitoring 123 were required. This provided an opportunity to take new approaches to improving CF patients care with new and effective models, with durable changes in the future CF health care ( Fig.…”

Changes in Care during the COVID-19 Pandemic for People with Cystic Fibrosis

“…The CFF purchased and helped distribute devices to monitor pulmonary function at home. In addition, efforts have been made to allow for home collection of cultures of respiratory secretions ( 26 ). Although we did not detect differences in in-person clinic visits according to potential barriers to telehealth services, heightened efforts to address disparities in access to care are needed given the poorer outcomes among pwCF with disparities in social determinants of health ( 27 ), as well as poorer outcomes of COVID-19 infections among people with disparities in social determinant of health ( 28 ).…”