1
|
Schneider UV, Knudsen JD, Koch A, Kirkby NS, Lisby JG. An Agreement of Antigen Tests on Oral Pharyngeal Swabs or Less Invasive Testing With Reverse Transcription Polymerase Chain Reaction for Detecting SARS-CoV-2 in Adults: Protocol for a Prospective Nationwide Observational Study. JMIR Res Protoc 2022; 11:e35706. [PMID: 35394449 PMCID: PMC9070418 DOI: 10.2196/35706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/20/2022] [Accepted: 03/29/2022] [Indexed: 01/01/2023] Open
Abstract
Background The SARS-CoV-2 pandemic has resulted in an unprecedented level of worldwide testing for epidemiologic and diagnostic purposes, and due to the extreme need for tests, the gold-standard Reverse Transcription Polymerase Chain Reaction (RT-PCR) testing capacity has been unable to meet the overall worldwide testing demand. Consequently, although the current literature has shown the sensitivity of rapid antigen tests (RATs) to be inferior to RT-PCR, RATs have been implemented on a large scale without solid data on performance. Objective This study will compare analytical and clinical sensitivities and specificities of 50 lateral flow– or laboratory-based RATs and 3 strand invasion–based amplification (SIBA)-RT-PCR tests from 30 manufacturers to RT-PCR testing of samples obtained from the deep oropharynx. In addition, the study will compare sensitivities and specificities of the included RATs as well as RT-PCR on clinical samples obtained from the deep oropharynx, the anterior nasal cavity, saliva, the deep nasopharynx, and expired air to RT-PCR on deep oropharyngeal samples. Methods In the prospective part of the study, 200 individuals found SARS-CoV-2 positive and 200 individuals found SARS-CoV-2 negative by routine RT-PCR testing will be retested with each RAT, applying RT-PCR as the reference method. In the retrospective part of the study, 304 deep oropharyngeal cavity swabs divided into 4 groups based on RT-PCR quantification cycle (Cq) levels will be tested with each RAT. Results The results will be reported in several papers with different aims. The first paper will report retrospective (analytical sensitivity, overall and stratified into different Cq range groups) and prospective (clinical sensitivity) data for RATs, with RT-PCR as the reference method. The second paper will report results for RAT based on anatomical sampling location. The third paper will compare different anatomical sampling locations by RT-PCR testing. The fourth paper will focus on RATs that rely on central laboratory testing. Tests from 4 different manufacturers will be compared for analytical performance data on retrospective deep oropharyngeal swab samples. The fifth paper will report the results of 4 RATs applied both as professional use and as self-tests. The last paper will report the results from 2 breath tests in the study. A comparison of sensitivity and specificity between RATs will be conducted using the McNemar test for paired samples and the chi-squared test for unpaired samples. Comparison of the positive predictive value (PPV) and negative predictive value (NPV) between RATs will be performed by the bootstrap test, and 95% CIs for sensitivity, specificity, PPV, and NPV will be calculated as bootstrap CIs. Conclusions The study will compare the sensitivities of a large number of RATs for SARS-CoV-2 to with those of RT-PCR and will address whether lateral flow–based RATs differ significantly from laboratory-based RATs. The anatomical test locations for both RATs and RT-PCR will also be compared. Trial Registration ClinicalTrials.gov NCT04913116; https://clinicaltrials.gov/ct2/show/NCT04913116 International Registered Report Identifier (IRRID) DERR1-10.2196/35706
Collapse
Affiliation(s)
- Uffe Vest Schneider
- Department of Clinical Microbiology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Jenny Dahl Knudsen
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
| | - Anders Koch
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | | | - Jan Gorm Lisby
- Department of Clinical Microbiology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| |
Collapse
|
2
|
Stefaniuk E, Bosacka K, Wanke-Rytt M, Hryniewicz W. The use of rapid test QuikRead go® Strep A in bacterial pharyngotonsillitis diagnosing and therapeutic decisions. Eur J Clin Microbiol Infect Dis 2017; 36:1733-1738. [DOI: 10.1007/s10096-017-2986-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 04/10/2017] [Indexed: 10/19/2022]
|
3
|
Yoon YK, Park CS, Kim JW, Hwang K, Lee SY, Kim TH, Park DY, Kim HJ, Kim DY, Lee HJ, Shin HY, You YK, Park DA, Kim SW. Guidelines for the Antibiotic Use in Adults with Acute Upper Respiratory Tract Infections. Infect Chemother 2017; 49:326-352. [PMID: 29299900 PMCID: PMC5754344 DOI: 10.3947/ic.2017.49.4.326] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Indexed: 12/20/2022] Open
Abstract
These guidelines were developed as part of the 2016 Policy Research Servicing Project by the Korea Centers for Disease Control and Prevention. A multidisciplinary approach was taken to formulate this guideline to provide practical information about the diagnosis and treatment of adults with acute upper respiratory tract infection, with the ultimate aim to promote the appropriate use of antibiotics. The formulation of this guideline was based on a systematic literature review and analysis of the latest research findings to facilitate evidence-based practice, and focused on key questions to help clinicians obtain solutions to clinical questions that may arise during the care of a patient. These guidelines mainly cover the subjects on the assessment of antibiotic indications and appropriate selection of antibiotics for adult patients with acute pharyngotonsillitis or acute sinusitis.
Collapse
Affiliation(s)
- Young Kyung Yoon
- Korean Society of Infectious Diseases, Seoul, Korea.,Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Chan Soon Park
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otolaryngology-Head and Neck Surgery, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Jae Wook Kim
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University hospital Seoul, Seoul, Korea
| | - Kyurin Hwang
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University hospital Seoul, Seoul, Korea
| | - Sei Young Lee
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Tae Hoon Kim
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Do Yang Park
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otorhinolaryngology, Ajou University, School of Medicine, Suwon, Korea
| | - Hyun Jun Kim
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otorhinolaryngology, Ajou University, School of Medicine, Suwon, Korea
| | - Dong Young Kim
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University, College of Medicine, Seoul, Korea
| | - Hyun Jong Lee
- Korean Association of Otorhinolaryngologists, Seoul, Korea
| | - Hyun Young Shin
- Korean Association of Family Medicine, Seoul, Korea.,Department of Family Medicine, Myongji Hospital, Seonam University, College of Medicine, Goyang, Korea
| | - Yong Kyu You
- Korean Medical Practitioners Association, Seoul, Korea.,Department of Internal Medicine, Nammoon Medical Clinic, Seoul, Korea
| | - Dong Ah Park
- Division of Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Shin Woo Kim
- Korean Society of Infectious Diseases, Seoul, Korea.,Korean Society for Chemotherapy, Seoul, Korea.,Department of Internal Medicine, Kungpook National University, School of Medicine, Daegu, Korea.
| |
Collapse
|
4
|
Cohen JF, Bertille N, Cohen R, Chalumeau M. Rapid antigen detection test for group A streptococcus in children with pharyngitis. Cochrane Database Syst Rev 2016; 7:CD010502. [PMID: 27374000 PMCID: PMC6457926 DOI: 10.1002/14651858.cd010502.pub2] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Group A streptococcus (GAS) accounts for 20% to 40% of cases of pharyngitis in children; the remaining cases are caused by viruses. Compared with throat culture, rapid antigen detection tests (RADTs) offer diagnosis at the point of care (within five to 10 minutes). OBJECTIVES To determine the diagnostic accuracy of RADTs for diagnosing GAS in children with pharyngitis. To assess the relative diagnostic accuracy of the two major types of RADTs (enzyme immunoassays (EIA) and optical immunoassays (OIA)) by indirect and direct comparison. SEARCH METHODS We searched CENTRAL, MEDLINE, EMBASE, Web of Science, CDSR, DARE, MEDION and TRIP (January 1980 to July 2015). We also conducted related citations tracking via PubMed, handsearched reference lists of included studies and relevant review articles, and screened all articles citing included studies via Google Scholar. SELECTION CRITERIA We included studies that compared RADT for GAS pharyngitis with throat culture on a blood agar plate in a microbiology laboratory in children seen in ambulatory care. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts for relevance, assessed full texts for inclusion, and carried out data extraction and quality assessment using the QUADAS-2 tool. We used bivariate meta-analysis to estimate summary sensitivity and specificity, and to investigate heterogeneity across studies. We compared the accuracy of EIA and OIA tests using indirect and direct evidence. MAIN RESULTS We included 98 unique studies in the review (116 test evaluations; 101,121 participants). The overall methodological quality of included studies was poor, mainly because many studies were at high risk of bias regarding patient selection and the reference standard used (in 73% and 43% of test evaluations, respectively). In studies in which all participants underwent both RADT and throat culture (105 test evaluations; 58,244 participants; median prevalence of participants with GAS was 29.5%), RADT had a summary sensitivity of 85.6%; 95% confidence interval (CI) 83.3 to 87.6 and a summary specificity of 95.4%; 95% CI 94.5 to 96.2. There was substantial heterogeneity in sensitivity across studies; specificity was more stable. There was no evidence of a trade-off between sensitivity and specificity. Heterogeneity in accuracy was not explained by study-level characteristics such as whether an enrichment broth was used before plating, mean age and clinical severity of participants, and GAS prevalence. The sensitivity of EIA and OIA tests was comparable (summary sensitivity 85.4% versus 86.2%). Sensitivity analyses showed that summary estimates of sensitivity and specificity were stable in low risk of bias studies. AUTHORS' CONCLUSIONS In a population of 1000 children with a GAS prevalence of 30%, 43 patients with GAS will be missed. Whether or not RADT can be used as a stand-alone test to rule out GAS will depend mainly on the epidemiological context. The sensitivity of EIA and OIA tests seems comparable. RADT specificity is sufficiently high to ensure against unnecessary use of antibiotics. Based on these results, we would expect that amongst 100 children with strep throat, 86 would be correctly detected with the rapid test while 14 would be missed and not receive antibiotic treatment.
Collapse
Affiliation(s)
- Jérémie F Cohen
- Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS), Inserm UMR1153, Paris Descartes UniversityObstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé)ParisFrance
- Necker Hospital, AP‐HP and Paris Descartes UniversityDepartment of PediatricsParisFrance
| | - Nathalie Bertille
- Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS), Inserm UMR1153, Paris Descartes UniversityObstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé)ParisFrance
| | - Robert Cohen
- Association Clinique et Thérapeutique Infantile du Val‐de‐Marne (ACTIV)27 Rue InkermannSaint‐Maur‐des‐FossésFrance
- Centre Hospitalier Intercommunal de Créteil (CHIC)Department of Microbiology40 avenue de VerdunCréteilFrance94010
| | - Martin Chalumeau
- Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS), Inserm UMR1153, Paris Descartes UniversityObstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé)ParisFrance
- Necker Hospital, AP‐HP and Paris Descartes UniversityDepartment of PediatricsParisFrance
| | | |
Collapse
|
5
|
Lean WL, Arnup S, Danchin M, Steer AC. Rapid diagnostic tests for group A streptococcal pharyngitis: a meta-analysis. Pediatrics 2014; 134:771-81. [PMID: 25201792 DOI: 10.1542/peds.2014-1094] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Effective management of group A streptococcal (GAS) pharyngitis is hindered by impracticality of the gold standard diagnostic test: throat culture. Rapid antigen diagnostic tests (RADTs) are a promising alternative, although concerns about their sensitivity and specificity, and variation between test methodologies, have limited their clinical use. The objective of this study was to perform a systematic review with meta-analysis of the diagnostic accuracy of RADTs for GAS pharyngitis. METHODS Medline and Embase from 1996 to 2013 were used as data sources. Of 159 identified studies, 48 studies of diagnostic accuracy of GAS RADTs using throat culture on blood agar as a reference standard were selected. Bivariate random-effects regression was used to estimate sensitivity and specificity with 95% confidence intervals (CIs). Additional meta-analyses were performed for pediatric data. RESULTS A total of 60 pairs of sensitivity and specificity from 48 studies were included. Overall summary estimates for sensitivity and specificity of RADTs were 0.86 (95% CI 0.83 to 0.88) and 0.96 (95% CI 0.94 to 0.97), respectively, and estimates for pediatric data were similar. Molecular-based RADTs had the best diagnostic accuracy. Considerable variability exists in methodology between studies. There were insufficient studies to allow meta-regression/subgroup analysis within each test type. CONCLUSIONS RADTs can be used for accurate diagnosis of GAS pharyngitis to streamline management of sore throat in primary care. RADTs may not require culture backup for negative tests in most low-incidence rheumatic fever settings. Newer molecular tests have the highest sensitivity, but are not true point-of-care tests.
Collapse
Affiliation(s)
- Wei Ling Lean
- Department of General Medicine, Royal Children's Hospital, Melbourne, Australia
| | - Sarah Arnup
- Clinical Epidemiology and Biostatistics Unit
| | - Margie Danchin
- Department of General Medicine, Royal Children's Hospital, Melbourne, Australia; Group A Streptococcal Research Group, and Vaccine and Immunisation Research Group, Murdoch Children's Research Institute, Melbourne, Australia; and
| | - Andrew C Steer
- Department of General Medicine, Royal Children's Hospital, Melbourne, Australia; Group A Streptococcal Research Group, and Centre for International Child Health, Department of Paediatrics, University of Melbourne, Melbourne, Australia
| |
Collapse
|
6
|
Rimoin AW, Hoff NA, Fischer Walker CL, Hamza HS, Vince A, Rahman NA, Andrasevic S, Emam S, Vukelic D, Elminawi N, Ghafar HA, da Cunha ALA, Qazi S, Gardovska D, Steinhoff MC. Treatment of streptococcal pharyngitis with once-daily amoxicillin versus intramuscular benzathine penicillin G in low-resource settings: a randomized controlled trial. Clin Pediatr (Phila) 2011; 50:535-42. [PMID: 21317198 PMCID: PMC6089546 DOI: 10.1177/0009922810394838] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Primary prevention of acute rheumatic fever is achieved by proper antibiotic treatment of group A β -hemolytic streptococcal (GAS) pharyngitis. METHODS To assess noninferiority of oral amoxicillin to intramuscular benzathine penicillin G (IM BPG). Children (2 to 12 years) meeting enrollment criteria were randomized 1:1 to receive antibiotic treatment in 2 urban outpatient clinics in Egypt and Croatia. RESULTS A total of 558 children (Croatia = 166, Egypt = 392) were randomized, with 368 evaluable in an intention-to-treat (ITT) analysis, and 272 evaluable in the per protocol (PP) analysis. In Croatia, ITT and PP treatment success rates were comparable for IM BPG and amoxicillin (2.5% difference vs 1.1% difference, respectively). In Egypt, amoxicillin was not comparable with IM BPG in ITT analysis (15.1% difference), but was comparable in PP analysis (-9.3% difference). CONCLUSION If compliance is a major issue, a single dose of IM BPG may be preferable for treatment of GAS pharyngitis.
Collapse
Affiliation(s)
| | | | | | | | - Adriana Vince
- University Hospital for Infectious Diseases, Zagreb, Croatia
| | | | - Sasa Andrasevic
- University Hospital for Infectious Diseases, Zagreb, Croatia
| | | | | | | | | | | | - Shamim Qazi
- World Health Organization, Geneva, Switzerland
| | - Dace Gardovska
- Riga Stradins University and Children’s University Hospital, Riga, Latvia
| | - Mark C. Steinhoff
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Cincinnati Children’s Hospital, Cincinnati, OH
| |
Collapse
|
7
|
Rimoin AW, Walker CLF, Hamza HS, Elminawi N, Ghafar HA, Vince A, da Cunha AL, Qazi S, Gardovska D, Steinhoff MC. The utility of rapid antigen detection testing for the diagnosis of streptococcal pharyngitis in low-resource settings. Int J Infect Dis 2010; 14:e1048-53. [DOI: 10.1016/j.ijid.2010.02.2269] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Accepted: 02/26/2010] [Indexed: 11/16/2022] Open
|
8
|
|
9
|
Gerber MA, Shulman ST. Rapid diagnosis of pharyngitis caused by group A streptococci. Clin Microbiol Rev 2004; 17:571-80, table of contents. [PMID: 15258094 PMCID: PMC452552 DOI: 10.1128/cmr.17.3.571-580.2004] [Citation(s) in RCA: 134] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Although commercial rapid antigen detection tests (RADTs) are more expensive than blood agar plate (BAP) cultures, the advantage they offer is the speed with which they provide results. Rapid identification and consequent prompt treatment of patients with pharyngitis due to group A beta-hemolytic streptococci (GABHS) can reduce the risk of spread of GABHS, can allow patients to return to school or work sooner, and may reduce the acute morbidity of this illness. In most studies, RADTs have been compared with BAP cultures as the criterion standard. However, these comparisons are complicated by the fact that there is no universally accepted procedure for performing a BAP culture. The great majority of the RADTs that are currently available have a high specificity (i.e., 95% or greater) and a sensitivity of between 70 and 90% compared with BAP cultures. Few published studies have compared the performance of various RADTs to each other or examined the performance of various RADTs in the office setting. There is also relatively little published information about how physicians in practice actually use RADTs, but the available information suggests that many physicians do not follow recommended guidelines. While the development of easy-to-perform RADTs for the diagnosis of GABHS pharyngitis has altered clinical practice substantially, only limited data about cost-effectiveness are currently available.
Collapse
Affiliation(s)
- Michael A Gerber
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MC5019, Cincinnati, OH 45229-3039, USA.
| | | |
Collapse
|
10
|
Armengol CE, Schlager TA, Hendley JO. Sensitivity of a rapid antigen detection test for group A streptococci in a private pediatric office setting: answering the Red Book's request for validation. Pediatrics 2004; 113:924-6. [PMID: 15060248 DOI: 10.1542/peds.113.4.924] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
In the office laboratory of our private practice, the sensitivity of a single rapid antigen detection (RAD) test for group A streptococci (compared with backup throat culture) was examined over 3 winter periods. When cultures were held only 24 hours, the sensitivity was 92%; in the second period, when cultures were held to 48 hours, the sensitivity declined significantly to 86%; when the cultures were read without knowledge of the RAD test result, the sensitivity was 85%. As the Red Book Committee has suggested, physician office laboratories should validate the sensitivity of their RAD test against culture onto blood agar before abandoning the backup throat culture.
Collapse
Affiliation(s)
- Carlos E Armengol
- Pediatric Associates of Charlottesville, Charlottesville, Virginia 22902, USA.
| | | | | |
Collapse
|
11
|
Ochoa Sangrador C. Réplica. An Pediatr (Barc) 2004. [DOI: 10.1016/s1695-4033(04)78294-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
12
|
Schmuziger N, Schneider S, Frei R. [Reliability and general practice value of 2 rapid Streptococcus A tests]. HNO 2003; 51:806-12. [PMID: 14523534 DOI: 10.1007/s00106-003-0816-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Rapid streptococcal-A-antigen detection assays have good specificity (over 90 percent) but moderate sensitivity (between 80 and 90 percent), when the tests are compared with a standard throat culture. Contradictory results have been found for one of the more recent tests, the optical immune assay Strep A OIA MAX, while for 6 years, we have been using the immune assay Strep A Plus. Results of the optical immunoassay and the conventional immune assay Strep A Plus were compared in 65 patients with acute pharyngitis. A standard culture was used as reference and confirmed by enhanced broth culturing and nucleic acid hybridization assay (Gen-Probe) when the two detection assays produced contradictory results. While both assays were equally sensitive (78.3%), Strep A OIA MAX and Strep A Plus had a similar specificity of 95.2% and 100%, respectively. Four and nine steps were required for Strep A Plus and for Strep A OIA MAX test procedures, respectively with results being available in 4-5 min and in 9-10 min, respectively. We conclude that both rapid immunoassays have a similar reliability while the handling of the Strep A Plus is much simpler than the handling of the Strep A OIA MAX. Neither rapid immunoassays are sensitive enough to eliminate the need for backup cultures.
Collapse
Affiliation(s)
- N Schmuziger
- HNO-Universitätsklinik, Kantonspital Basel, Germany.
| | | | | |
Collapse
|
13
|
Gieseker KE, Mackenzie T, Roe MH, Todd JK. Comparison of two rapid Streptococcus pyogenes diagnostic tests with a rigorous culture standard. Pediatr Infect Dis J 2002; 21:922-7. [PMID: 12394813 DOI: 10.1097/00006454-200210000-00007] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Comparisons of rapid antigen tests for the diagnosis of pharyngitis are often made between published studies but may not be reliable given differences in study design, sampling and reference standard definitions. Tests are rarely compared against each other in a single study. METHODS The sensitivity and specificity of two rapid diagnostic tests were compared against a multiplate culture standard defined as the identification of on any of four culture plates. Paired swabs were tested for antigen using Genzyme's OSOM Ultra Strep A Test and compared with Biostar's Strep A OIA Max Test. RESULTS Ninety-four (31.1%) of 302 matched samples were identified with The sensitivity of Genzyme's OSOM Ultra Strep A Test against the multiplate culture standard was 92.6%, significantly higher ( P= 0.001) than that (75.5%) of Biostar's Strep A OIA Max Test. Specificities were 92.8 and 97.1%, respectively. Data analysis of culture results and statistical modeling showed that cultures of two or more samples are necessary for a sensitivity of 95% or greater for a comparison standard compared with true disease status. CONCLUSIONS When comparing the performance of rapid antigen tests for pharyngitis, a rigorous culture standard should be used consisting of at least two separate samples (swabs and/or pledgets), ultimately plated on selective agar. Genzyme's OSOM Ultra Strep A Test was significantly more sensitive than Biostar's Strep A OIA Max Test in comparison with a multiplate culture standard and a same swab, single plate culture standard.
Collapse
Affiliation(s)
- Karen E Gieseker
- Department of Epidemiology, The Children's Hospital, and the Department of Preventive Medicine, University of Colorado Health Sciences Center, Denver, CO, USA
| | | | | | | |
Collapse
|
14
|
Cooper RJ, Hoffman JR, Bartlett JG, Besser RE, Gonzales R, Hickner JM, Sande MA. Principles of appropriate antibiotic use for acute pharyngitis in adults: background. Ann Emerg Med 2001; 37:711-9. [PMID: 11385345 DOI: 10.1067/s0196-0644(01)70090-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The following principles of appropriate antibiotic use for adults with acute pharyngitis apply to immunocompetent adults without complicated comorbid conditions, such as chronic lung or heart disease, and history of rheumatic fever. They do not apply during known outbreaks of group A streptococcus. 1. Group A beta-hemolytic streptococcus (GABHS) is the causal agent in approximately 10% of adult cases of pharyngitis. The large majority of adults with acute pharyngitis have a self-limited illness, for which supportive care only is needed. 2. Antibiotic treatment of adult pharyngitis benefits only those patients with GABHS infection. All patients with pharyngitis should be offered appropriate doses of analgesics and antipyretics, as well as other supportive care. 3. Limit antibiotic prescriptions to patients who are most likely to have GABHS infection. Clinically screen all adult patients with pharyngitis for the presence of the four Centor criteria: history of fever, tonsillar exudates, no cough, and tender anterior cervical lymphadenopathy (lymphadenitis). Do not test or treat patients with none or only one of these criteria, since these patients are unlikely to have GABHS infection. For patients with two or more criteria the following strategies are appropriate: (a) Test patients with two, three, or four criteria by using a rapid antigen test, and limit antibiotic therapy to patients with positive test results; (b) test patients with two or three criteria by using a rapid antigen test, and limit antibiotic therapy to patients with positive test results or patients with four criteria; or (c) do not use any diagnostic tests, and limit antibiotic therapy to patients with three or four criteria. 4. Throat cultures are not recommended for the routine primary evaluation of adults with pharyngitis or for confirmation of negative results on rapid antigen tests when the test sensitivity exceeds 80%. Throat cultures may be indicated as part of investigations of outbreaks of GABHS disease, for monitoring the development and spread of antibiotic resistance, or when such pathogens as gonococcus are being considered. 5. The preferred antibiotic for treatment of acute GABHS pharyngitis is penicillin, or erythromycin in a penicillin-allergic patient.
Collapse
Affiliation(s)
- R J Cooper
- UCLA Emergency Medicine Center, Los Angeles, California 90024, USA
| | | | | | | | | | | | | |
Collapse
|
15
|
Stewart MH, Siff JE, Cydulka RK. Evaluation of the patient with sore throat, earache, and sinusitis: an evidence based approach. Emerg Med Clin North Am 1999; 17:153-87, ix. [PMID: 10101345 DOI: 10.1016/s0733-8627(05)70051-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Sore throat, earache, and sinusitis are common presenting complaints in the emergency department, and all fall within the top ten in the United States. These complaints usually have a benign course but rarely can be a symptom of a serious disease process. This article provides an evidence-based review of the literature regarding the diagnosis of pharyngitis, otitis media, and sinusitis.
Collapse
Affiliation(s)
- M H Stewart
- Case Western Reserve University School of Medicine, Department of Emergency Medicine, Metro Health Medical Center, Cleveland, Ohio, USA
| | | | | |
Collapse
|