Usefulness of Leukocyte Esterase Test Versus Rapid Strep Test for Diagnosis of Acute Strep Pharyngitis

Point of care testing for the diagnosis of periprosthetic joint infections: a review

BACKGROUND

Periprosthetic joint infection (PJI) remains a major complication following total joint arthroplasties (TJA), significantly affecting patient outcomes and healthcare costs. Despite advances in diagnostic techniques, challenges persist in accurately diagnosing PJI, underscoring the need for effective point-of-care testing (POCT).

METHODS

This review examines the current literature and latest developments in POCT for diagnosing PJI, focusing on biomarkers such as alpha-defensin, leukocyte esterase, calprotectin, and C-reactive protein (CRP). Criteria from various societies like the Musculoskeletal Infection Society, Infectious Diseases Society of America, and the International Consensus Meeting were compared to evaluate the effectiveness of these biomarkers in a point-of-care setting.

RESULTS

POCT provides rapid results essential for the timely management of PJI, with alpha-defensin and leukocyte esterase showing high specificity and sensitivity. Recent advancements have introduced novel biomarkers like calprotectin, which demonstrate high diagnostic accuracy. However, challenges such as the variability in test performance and the need for validation under different clinical scenarios remain.

DISCUSSION

While POCT for PJI shows promising results, their integration into clinical practice requires standardized protocols and further validation. The evolution of these diagnostic tools offers a potential shift toward more personalized and immediate care, potentially improving outcomes for patients undergoing TJA.

Appropriateness of Use of Streptococcal Pharyngitis Testing and Associated Antibiotic Prescribing in the Urgent Care Setting

The primary objective was to evaluate Group A streptococcal (GAS) tests performed with a Modified Centor Criteria (MCC) Score < 3 at Urgent Care Clinics (UCC). Secondary objectives included evaluating the MCC sensitivity and specificity, antibiotics prescribed with an MCC score < 3, and association between palatal petechiae and GAS pharyngitis infections. This was a retrospective review from July 1, 2018, to June 30, 2019, of Rapid Antigen Detection Tests (RADTs) on patients with ICD codes associated with pharyngitis. Fifteen hundred patient charts were reviewed. The majority of MCC scores were < 3 at 60.0% (878/1464). Sensitivity of GAS testing (RADT/culture) slightly increased for MCC scores ≥ 3 and was better than the specificity of those scores. In comparison, MCC scores < 3, showed better specificity compared to sensitivity. Over 50% of RADTs performed were inappropriate per clinical guidelines. MCC score < 3 had higher rates of negative test results.

Application of leukocyte esterase strip test in the screening of periprosthetic joint infections and prospects of high-precision strips

Periprosthetic joint infection (PJI) represents one of the most challenging complications after total joint arthroplasty (TJA). Despite the availability of a variety of diagnostic techniques, the diagnosis of PJI remains a challenge due to the lack of well-established diagnostic criteria. The leucocyte esterase (LE) strips test has been proved to be a valuable diagnostic tool for PJI, and its weight in PJI diagnostic criteria has gradually increased. Characterized by its convenience, speed and immediacy, leucocyte esterase strips test has a prospect of broad application in PJI diagnosis. Admittedly, the leucocyte esterase strips test has some limitations, such as imprecision and liability to interference. Thanks to the application of new technologies, such as machine reading, quantitative detection and artificial intelligence, the LE strips test is expected to overcome the limitations and improve its accuracy.