Multicenter Evaluation of the Cepheid Xpert Xpress SARS-CoV-2 Test

Michael J. Loeffelholz, David Alland, Susan M. Butler-Wu, Utsav Pandey, Carlo Frederico Perno, Alice Nava, Karen C. Carroll, Heba Mostafa, Emma Davies, Ashley McEwan, Jennifer L. Rakeman, Randal C. Fowler, Jean Michel Pawlotsky, Slim Fourati, Sukalyani Banik, Padmapriya P. Banada, Shobha Swaminathan, Soumitesh Chakravorty, Robert W. Kwiatkowski, Victor C. ChuJo Ann Kop, Rajiv Gaur, Mandy L.Y. Sin, Duy Nguyen, Simranjit Singh, Na Zhang, David H. Persing

Research output: Contribution to journalArticle

Abstract

Background. Nucleic acid amplification tests (NAATs) are the primary means of identifying acute infections caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Accurate and fast test results may permit more efficient use of protective and isolation resources and allow for rapid therapeutic interventions.Methods. We evaluated the analytical and clinical performance characteristics of the Xpert® Xpress SARS-CoV-2 (Xpert) test, a rapid, automated molecular test for SARS-CoV-2. Analytical sensitivity and specificity/interference were assessed with infectious SARS-CoV-2, other infectious coronavirus species including SARS-CoV, and 85 nasopharyngeal swab specimens positive for other respiratory viruses including endemic human coronaviruses (hCoVs). Clinical performance was assessed using 483 remnant upper and lower respiratory specimens previously analyzed by standard of care (SOC) NAATs.Results. The limit of detection of the Xpert test was 0.01 plaque forming units (PFU)/mL. Other hCoVs, including Middle East Respiratory Syndrome coronavirus, were not detected by the Xpert test. SARS-CoV, a closely related species in the Sarbecovirus subgenus, was detected by a broad-range target (E) but was distinguished from SARS-CoV-2 (SARS-CoV-2-specific N2 target). Compared to SOC NAATs, the positive agreement of the Xpert test was 219/220 (99.5%) and the negative agreement was 250/261 (95.8%). A third tie-breaker NAAT resolved all but three of the discordant results in favor the Xpert test.Conclusions. The Xpert test provided sensitive and accurate detection of SARS-CoV-2 in a variety of upper and lower respiratory tract specimens. The high sensitivity and fast time to results of approximately 45 minutes may impact patient management.

Original languageEnglish (US)
JournalJournal of clinical microbiology
DOIs
StateAccepted/In press - May 4 2020

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)

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    Loeffelholz, M. J., Alland, D., Butler-Wu, S. M., Pandey, U., Perno, C. F., Nava, A., Carroll, K. C., Mostafa, H., Davies, E., McEwan, A., Rakeman, J. L., Fowler, R. C., Pawlotsky, J. M., Fourati, S., Banik, S., Banada, P. P., Swaminathan, S., Chakravorty, S., Kwiatkowski, R. W., ... Persing, D. H. (Accepted/In press). Multicenter Evaluation of the Cepheid Xpert Xpress SARS-CoV-2 Test. Journal of clinical microbiology. https://doi.org/10.1128/JCM.00926-20