Diagnosis and antibiotic treatment of group a streptococcal pharyngitis in children in a primary care setting: impact of point-of-care polymerase chain reaction
Abstract Background To compare the sensitivity and specificity of the recommended 2-step rapid antigen detection test (RADT) with confirmatory culture vs the point-of-care (POC) polymerase chain reaction (PCR) Roche cobas® Liat® Strep A test for detection of group A Streptococcus (GAS) in pediatric...
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| Format: | Article |
| Language: | English |
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BMC
2019-01-01
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| Series: | BMC Pediatrics |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12887-019-1393-y |
| _version_ | 1819018730546397184 |
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| author | Arundhati Rao Bradley Berg Theresa Quezada Robert Fader Kimberly Walker Shaowu Tang Ula Cowen Dana Duncan Joanna Sickler |
| author_facet | Arundhati Rao Bradley Berg Theresa Quezada Robert Fader Kimberly Walker Shaowu Tang Ula Cowen Dana Duncan Joanna Sickler |
| author_sort | Arundhati Rao |
| collection | DOAJ |
| description | Abstract Background To compare the sensitivity and specificity of the recommended 2-step rapid antigen detection test (RADT) with confirmatory culture vs the point-of-care (POC) polymerase chain reaction (PCR) Roche cobas® Liat® Strep A test for detection of group A Streptococcus (GAS) in pediatric patients with pharyngitis, and to investigate the impact of these tests on antibiotic use in a large pediatric clinic. Methods This prospective, open-label study was conducted at a single site during fall/winter 2016–2017. A total of 275 patients aged 3 to 18 years with symptoms of pharyngitis had a throat-swab specimen analyzed using RADT, POC PCR, and culture. The sensitivity, specificity, and percentage agreement (95% CI) between assays and a laboratory-based nucleic acid amplification test were calculated. DNA sequencing was used to adjudicate discrepancies. The RADT or POC PCR result was provided to clinicians on alternating weeks to compare the impact on antibiotic use. Results A total of 255 samples were evaluated; 110 (43.1%) were GAS positive. Sensitivities (95% CI) for POC PCR, RADT, and culture were 95.5% (89.7–98.5%), 85.5% (77.5–1.5%), and 71.8% (62.4–80.0%), respectively. Specificities (95% CI) for POC PCR, RADT, and culture were 99.3% (96.2–99.98%), 93.7% (88.5–97.1%), and 100% (97.5–100%), respectively. Compared with RADT, POC PCR resulted in significantly greater appropriate antibiotic use (97.1% vs 87.5%; P = .0065). Conclusion Under real-world conditions, RADT results were less specific and culture results were less sensitive than found in established literature and led to increased rates of inappropriate antibiotic use. POC PCR had high sensitivity and specificity and rapid turnaround times, and led to more appropriate antibiotic use. Trial registration ID number ISRCTN84562679. Registered October 162,018, retrospectively registered. |
| first_indexed | 2024-12-21T03:24:04Z |
| format | Article |
| id | doaj.art-6f7f558820c2422682c8f557d425eb19 |
| institution | Directory Open Access Journal |
| issn | 1471-2431 |
| language | English |
| last_indexed | 2024-12-21T03:24:04Z |
| publishDate | 2019-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pediatrics |
| spelling | doaj.art-6f7f558820c2422682c8f557d425eb192022-12-21T19:17:38ZengBMCBMC Pediatrics1471-24312019-01-011911810.1186/s12887-019-1393-yDiagnosis and antibiotic treatment of group a streptococcal pharyngitis in children in a primary care setting: impact of point-of-care polymerase chain reactionArundhati Rao0Bradley Berg1Theresa Quezada2Robert Fader3Kimberly Walker4Shaowu Tang5Ula Cowen6Dana Duncan7Joanna Sickler8Molecular Genetics and Technical Pathology, Scott and White Medical Center–TempleBaylor Scott & White HealthMolecular Genetics and Technical Pathology, Scott and White Medical Center–TempleMolecular Genetics and Technical Pathology, Scott and White Medical Center–TempleMolecular Genetics and Technical Pathology, Scott and White Medical Center–TempleRoche Molecular SystemsRoche Molecular SystemsRoche Molecular SystemsRoche Molecular SystemsAbstract Background To compare the sensitivity and specificity of the recommended 2-step rapid antigen detection test (RADT) with confirmatory culture vs the point-of-care (POC) polymerase chain reaction (PCR) Roche cobas® Liat® Strep A test for detection of group A Streptococcus (GAS) in pediatric patients with pharyngitis, and to investigate the impact of these tests on antibiotic use in a large pediatric clinic. Methods This prospective, open-label study was conducted at a single site during fall/winter 2016–2017. A total of 275 patients aged 3 to 18 years with symptoms of pharyngitis had a throat-swab specimen analyzed using RADT, POC PCR, and culture. The sensitivity, specificity, and percentage agreement (95% CI) between assays and a laboratory-based nucleic acid amplification test were calculated. DNA sequencing was used to adjudicate discrepancies. The RADT or POC PCR result was provided to clinicians on alternating weeks to compare the impact on antibiotic use. Results A total of 255 samples were evaluated; 110 (43.1%) were GAS positive. Sensitivities (95% CI) for POC PCR, RADT, and culture were 95.5% (89.7–98.5%), 85.5% (77.5–1.5%), and 71.8% (62.4–80.0%), respectively. Specificities (95% CI) for POC PCR, RADT, and culture were 99.3% (96.2–99.98%), 93.7% (88.5–97.1%), and 100% (97.5–100%), respectively. Compared with RADT, POC PCR resulted in significantly greater appropriate antibiotic use (97.1% vs 87.5%; P = .0065). Conclusion Under real-world conditions, RADT results were less specific and culture results were less sensitive than found in established literature and led to increased rates of inappropriate antibiotic use. POC PCR had high sensitivity and specificity and rapid turnaround times, and led to more appropriate antibiotic use. Trial registration ID number ISRCTN84562679. Registered October 162,018, retrospectively registered.http://link.springer.com/article/10.1186/s12887-019-1393-yCobas Liat strep a assayGroup a StreptococcusRapid antigen detection testMolecular point-of-care testing |
| spellingShingle | Arundhati Rao Bradley Berg Theresa Quezada Robert Fader Kimberly Walker Shaowu Tang Ula Cowen Dana Duncan Joanna Sickler Diagnosis and antibiotic treatment of group a streptococcal pharyngitis in children in a primary care setting: impact of point-of-care polymerase chain reaction BMC Pediatrics Cobas Liat strep a assay Group a Streptococcus Rapid antigen detection test Molecular point-of-care testing |
| title | Diagnosis and antibiotic treatment of group a streptococcal pharyngitis in children in a primary care setting: impact of point-of-care polymerase chain reaction |
| title_full | Diagnosis and antibiotic treatment of group a streptococcal pharyngitis in children in a primary care setting: impact of point-of-care polymerase chain reaction |
| title_fullStr | Diagnosis and antibiotic treatment of group a streptococcal pharyngitis in children in a primary care setting: impact of point-of-care polymerase chain reaction |
| title_full_unstemmed | Diagnosis and antibiotic treatment of group a streptococcal pharyngitis in children in a primary care setting: impact of point-of-care polymerase chain reaction |
| title_short | Diagnosis and antibiotic treatment of group a streptococcal pharyngitis in children in a primary care setting: impact of point-of-care polymerase chain reaction |
| title_sort | diagnosis and antibiotic treatment of group a streptococcal pharyngitis in children in a primary care setting impact of point of care polymerase chain reaction |
| topic | Cobas Liat strep a assay Group a Streptococcus Rapid antigen detection test Molecular point-of-care testing |
| url | http://link.springer.com/article/10.1186/s12887-019-1393-y |
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