Point-of-Care Testing for Group A Streptococcus Infection and Influenza

Rapid turnaround real-time polymerase chain reaction (PCR) has recently become available as a point-of-care test for group A Streptococcus (GAS) in children presenting with pharyngitis. Our aim in this pilot study was to determine if GAS can be detected in the saliva of children with sore throat using swabs inoculated by children sucking on them as they would a lollipop. Twenty children with positive rapid antigen detection tests for GAS from pharyngeal swabs were enrolled. Pharyngeal and lollipop samples underwent PCR testing using the cobas Liat system. All 20 pharyngeal swabs were positive; 19 of 20 lollipop samples were positive. The increased sensitivity of the new PCR kits for GAS may permit use of less invasive and more comfortable sampling techniques for diagnosis.

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Detection of Group A Streptococcus from Pharyngeal Swab Samples by Bacterial Culture Is Challenged by a Novel mariPOC Point-of-Care Test

Journal of Clinical Microbiology ◽

10.1128/jcm.00018-15 ◽

2015 ◽

Vol 53 (7) ◽

pp. 2079-2083 ◽

Cited By ~ 9

Author(s):

Jukka Vakkila ◽

Janne O. Koskinen ◽

Annika Brandt ◽

Anna Muotiala ◽

Viivi Liukko ◽

...

Keyword(s):

Bacterial Culture ◽

Group A Streptococcus ◽

Point Of Care ◽

Clinical Importance ◽

Test System ◽

Lower Sensitivity ◽

Patients Âgés ◽

Point Of Care Test ◽

Group A ◽

Tract Infections

mariPOC is a novel point-of-care test system for rapid detection of respiratory tract infections. We compared the performance of the mariPOC test to that of bacterial culture for detecting group A streptococcus (GAS) in 219 pharyngitis patients (ages 1–64 years) and 109 healthy asymptomatic controls (ages 19–69 years). In addition, 42 patient samples were analyzed by quantitative PCR (qPCR). Of the 219 pharyngeal patient samples, 32 were positive in a GAS bacterial culture (prevalence 15%) and 65 (30%) in the mariPOC test. The amount of GAS in samples reported positive by the mariPOC test and negative by culture was, on average, 10-fold less than that of those positive in both methods. This indicated that the negative results in bacterial cultures were due to lower sensitivity. The qPCR results were positive and in line with the mariPOC results in 43% of the discordant samples studied. Two GAS culture-positive samples were negative by the mariPOC test. The prevalences of GAS in the control subjects were 2% and 6% by culture and mariPOC results, respectively. We conclude that the mariPOC antigen detection test is more sensitive than the conventional bacterial culture for the detection of GAS among symptomatic pharyngitis patients. The higher prevalence of GAS by the mariPOC test among symptomatic patients was probably not due to carriership, since among the control patients, the difference in the prevalence of GAS by the mariPOC test and culture was not nearly as high, 15% versus 4%, respectively. Clinical trials are needed to show the clinical importance of our findings.

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Group A Streptococcus Testing in Pediatrics: the Move to Point-of-Care Molecular Testing

Journal of Clinical Microbiology ◽

10.1128/jcm.01494-19 ◽

2020 ◽

Vol 58 (6) ◽

Cited By ~ 1

Author(s):

Thomas Z. Thompson ◽

Allison R. McMullen

Keyword(s):

Point Of Care ◽

Streptococcal Pharyngitis ◽

Molecular Methods ◽

Multiple Point ◽

Molecular Testing ◽

Point Of Care Testing ◽

Culture Methods ◽

Content Type ◽

Molecular Group ◽

Group A

ABSTRACT Each year, there are an estimated 11 million visits to ambulatory care centers for pharyngitis in children between the ages of 3 and 18 years. While there are many causes of pediatric pharyngitis, group A streptococcal pharyngitis represents 15 to 30% of infections and is the only cause for which treatment is recommended. Unfortunately, clinical suspicion is insufficient for the accurate diagnosis of group A streptococcal pharyngitis, and laboratory testing for confirmation of Streptococcus pyogenes infection is required to prevent complications of infection. Traditionally, throat swabs are inoculated onto agar plates for isolation of the large-zone beta-hemolytic streptococcus. However, traditional culture methods present a potential delay in treatment due to turnaround times of 18 to 48 h. In order to improve turnaround times and enhance antimicrobial stewardship, multiple point-of-care assays have been developed. This review describes current point-of-care testing for group A streptococcal pharyngitis, including rapid antigen detection tests and more recent molecular methods. Additional attention is given to the diagnostic considerations when choosing a method for group A streptococcal point-of-care testing, implementation of molecular group A streptococcal testing, and the institutional cost of immunoassays compared to those of newer molecular methods.

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Point of care testing for group A streptococci in patients presenting with pharyngitis will improve appropriate antibiotic prescription

Emergency Medicine Australasia ◽

10.1111/1742-6723.12567 ◽

2016 ◽

Vol 28 (2) ◽

pp. 199-204 ◽

Cited By ~ 8

Author(s):

Ulrich Orda ◽

Biswadev Mitra ◽

Sabine Orda ◽

Mark Fitzgerald ◽

Ronny Gunnarsson ◽

...

Keyword(s):

Antibiotic Prescription ◽

Point Of Care ◽

Group A Streptococci ◽

Point Of Care Testing ◽

Group A

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Preventing Medical Errors in Point-of-Care Testing

Archives of Pathology & Laboratory Medicine ◽

10.5858/2001-125-1307-pmeipo ◽

2001 ◽

Vol 125 (10) ◽

pp. 1307-1315 ◽

Cited By ~ 4

Author(s):

Gerald J. Kost

Keyword(s):

Medical Errors ◽

Information Exchange ◽

Point Of Care ◽

Point Of Care Testing ◽

Consensus Process ◽

Process Step ◽

Error Prevention ◽

Group A ◽

Emergency Systems ◽

Group B

Abstract Objective.—To prevent medical errors, improve user performance, and enhance the quality, safety, and connectivity (bidirectional communication) of point-of-care testing. Participants.—Group A included 37 multidisciplinary experts in point-of-care testing programs in critical care and other hospital disciplines. Group B included 175 professional point-of-care managers, specialists, clinicians, and researchers. The total number of participants equaled 212. Evidence.—This study followed a systems approach. Expert specifications for prevention of medical errors were incorporated into the designs of security, validation, performance, and emergency systems. Additional safeguards need to be implemented through instrument software options and point-of-care coordinators. Connectivity will be facilitated by standards that eliminate deficiencies in instrument communication and device compatibility. Assessment of control features on handheld, portable, and transportable point-of-care instruments shows that current error reduction features lag behind needs. Consensus Process.—Step 1: United States national survey and collation of group A expert requirements for security, validation, and performance. Step 2: Design of parallel systems for these functions. Step 3: Written critique and improvement of the error-prevention systems during 4 successive presentations to group B participants over 9 months until system designs stabilized into final consensus form. Conclusions.—The consensus process produced 6 conclusions for preventing medical errors in point-of-care testing: (1) adopt operator certification and validation in point-of-care testing programs; (2) implement security, validation, performance, and emergency systems on existing and new devices; (3) require flexible, user-defined error-prevention system options on instruments as a prerequisite to federal licensing of new diagnostic tests and devices; (4) integrate connectivity standards for bidirectional information exchange; (5) preserve fast therapeutic turnaround time of point-of-care test results; and (6) monitor invalid use, operator competence, quality compliance, and other performance improvement indices to reduce errors, thereby focusing on patient outcomes. (Arch Pathol Lab Med. 2001;1307–1315)

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Point-of-Care Testing for Pharyngitis in the Pharmacy

Antibiotics ◽

10.3390/antibiotics9110743 ◽

2020 ◽

Vol 9 (11) ◽

pp. 743

Author(s):

Sabiha Essack ◽

John Bell ◽

Douglas Burgoyne ◽

Wirat Tongrod ◽

Martin Duerden ◽

...

Keyword(s):

Antibiotic Resistance ◽

Regional Differences ◽

Point Of Care ◽

Antibiotic Use ◽

Community Pharmacies ◽

Point Of Care Testing ◽

Healthcare Settings ◽

Group A ◽

Limiting Condition ◽

Opinion Article

Pharyngitis (also known as sore throat) is a common, predominately viral, self-limiting condition which can be symptomatically managed without antibiotic treatment. Inappropriate antibiotic use for pharyngitis contributes to the development and spread of antibiotic resistance. However, a small proportion of sore throats caused by group A streptococcal (GAS) infection may benefit from the provision of antibiotics. Establishing the cause of infection is therefore an important step in effective antibiotic stewardship. Point-of-care (POC) tests, where results are available within minutes, can distinguish between viral and GAS pharyngitis and can therefore guide treatment in primary healthcare settings such as community pharmacies, which are often the first point of contact with the healthcare system. In this opinion article, the evidence for the use of POC testing in the community pharmacy has been discussed. Evidence suggests that pharmacy POC testing can promote appropriate antibiotic use and reduce the need for general practitioner consultations. Challenges to implementation include cost, training and ‘who prescribes’, with country and regional differences presenting a particular issue. Despite these challenges, POC testing for pharyngitis has become widely available in pharmacies in some countries and may represent a strategy to contain antibiotic resistance and contribute to antimicrobial stewardship.

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