The study used NP swabs for testing in children aged 2–12 years (mean age 5.6, SD 2.7 years) with acute sinusitis, diagnosed according to American Academy of Pediatrics guidelines. Eligible subjects had either 1) 11–29 days of non-improving daytime cough and/or rhinorrhea, or (2) 6-10 days of worsening nasal symptoms, or fever after improvement period. Excluded from the sample were children 1) with severe AS 2) who received antibiotic treatment within 15 days of the study 3) with possible other infection, with immune deficiency, cystic fibrosis, ciliary dyskinesis, or major developmental delay, and with asthma or allergic rhinitis. 174 children enrolled in the study, but due to cost restrictions, RNA-sequencing was performed on only 25 children.

Sample for Study of Multiple Testing with NP Swabs

- Bacterial culture

- Viral detection (using PCR)

- Cytokine measurement (using quantitative PCR)

- RNA-sequencing 

- 16S ribosomal RNA gene sequencing

Multiple Tests that can be Performed with NP Swab

In the study of multiple testing, the NP swabs used were ESwab, with 1 ml liquid amies, and FLOQswab. The thin, flexible, sterile, flocked swab was gently inserted in one nostril, swept the nasal cavity, and brought into contact with the pharyngeal wall. Swabs were refrigerated at 2–8 °C until transported to the laboratory on ice for testing.


Method for Using NP Swab in Study of Multiple Testing

Chi-squared (χ2) test was used to compare distributions, and paired t test as well as analysis of variance were used to compare mean values.

Statistical Method For Multiple Testing with NP Swabs

As a less-invasive measure, mid-turbinate sampling is often employed as an alternative to NP swabs and is similarly sensitive to most viral and bacterial pathogens. Further research is needed to determine whether the protocol described in this study could potentially be performed using a mid-turbinate swab.

Mid-Turbinate Sampling as Alternative to Using NP Swab for Multiple Testing

In clinical research, the collection of multiple biological samples from a single patient, especially a child, is often difficult. To study the effectiveness of multiple testing with a single NP swab, one study used NP swabs to test for bacterial culture, viral detection using PCR, cytokine measurement by quantitative PCR, RNA-sequencing (RNA-seq), and 16S ribosomal RNA gene sequencing in children with diagnosed acute sinusitis (AS). 


Syracuse University

NP swabs are less invasive than nasal wash or nasal curettage, and more sensitive to viral detection and RNA collection than other non-invasive sample collection methods for respiratory testing such as anterior nares swabs, nose blowing, and nasosorption. Performance of multiple tests typically requires use of multiple specimens, although clinical research has explored the viability of using single NP swabs for multiple testing.

Nasopharyngeal (NP) Swabs

Lopez, S.M.C., Martin, J.M., Johnson, M. et al. A method of processing nasopharyngeal swabs to enable multiple testing. Pediatr Res 86, 651–654 (2019). https://doi-org.libezproxy2.syr.edu/10.1038/s41390-019-0498-1
https://www.nature.com/articles/s41390-019-0498-1

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