Development and evaluation of the automated multipurpose molecular testing system PCRpack for high-throughput SARS-CoV-2 testing

Increasing the reliable testing capacity for SARS-CoV-2 is important for the diagnosis and control of COVID-19. We developed an automated, customizable, easy-to-implement molecular testing system, named PCRpack, for the high-throughput testing of SARS-CoV-2. PCRpack includes a liquid handling instrument enclosed in a negative-pressure clean booth (Biomek i5), a laboratory information management system (SimpPCR), other equipment, and documents that are needed for testing operation. An in vitro diagnostic assay was employed to detect SARS-CoV-2. System performance was evaluated based on liquid handling accuracy and precision, analytical sensitivity, clinical diagnostic performance, and testing capacity per day. Clinical diagnostic performance was determined against the reference extraction-based reverse transcription-PCR assay using 3,965 upper respiratory samples. Analytical sensitivity analysis showed a lower limit of detection of 1,000 genome copies/mL of sample. The accuracy and precision of sample or reagent dispensing in PCRpack ranged from -2.24% to 0.73% and 0.83% to 4.52%, respectively. In the evaluation of clinical samples, PCRpack showed a positive percent agreement of 96.6% and a negative percent agreement of 100% compared with the reference assay. The average turnaround times per 94 samples and the maximum numbers of tests within an 8-hour shift of one operator were 2 hours and 28 minutes vs 2 hours and 1 minute and 564 vs 376 samples for PCRpack and the manual method, respectively. The developed PCRpack system shows high liquid handling and clinical diagnostic performance and is a promising testing system for increasing the SARS-CoV-2 testing capacity and testing future emerging pathogens.IMPORTANCEAccurate and fast molecular testing is important for the diagnosis and control of COVID-19. During patient surges in the COVID-19 pandemic, laboratories were challenged by a higher demand for molecular testing under skilled staff shortages. We developed an automated multipurpose molecular testing system, named PCRpack, for the rapid, high-throughput testing of infectious pathogens, including SARS-CoV-2. The system is provided in an all-in-one package, including a liquid handling instrument, a laboratory information management system, and other materials needed for testing operation; is highly customizable; and is easily implemented. PCRpack showed robust liquid handling performance, high clinical diagnostic performance, a shorter turn-around time with minimal hands-on time, and a high testing capacity. These features contribute to the rapid implementation of the high-performance and high-throughput molecular testing environment at any phase of the pandemic caused by SARS-CoV-2 or future emerging pathogens. Accurate and fast molecular testing is important for the diagnosis and control of COVID-19. During patient surges in the COVID-19 pandemic, laboratories were challenged by a higher demand for molecular testing under skilled staff shortages. We developed an automated multipurpose molecular testing system, named PCRpack, for the rapid, high-throughput testing of infectious pathogens, including SARS-CoV-2. The system is provided in an all-in-one package, including a liquid handling instrument, a laboratory information management system, and other materials needed for testing operation; is highly customizable; and is easily implemented. PCRpack showed robust liquid handling performance, high clinical diagnostic performance, a shorter turn-around time with minimal hands-on time, and a high testing capacity. These features contribute to the rapid implementation of the high-performance and high-throughput molecular testing environment at any phase of the pandemic caused by SARS-CoV-2 or future emerging pathogens.