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

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 Streptococcus Infection and Influenza

Clinical Microbiology Newsletter ◽

10.1016/j.clinmicnews.2017.09.004 ◽

2017 ◽

Vol 39 (19) ◽

pp. 151-157 ◽

Cited By ~ 1

Author(s):

Jennifer Woo ◽

Valerie Arboleda ◽

Omai B. Garner

Keyword(s):

Group A Streptococcus ◽

Point Of Care ◽

Point Of Care Testing ◽

Group A

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Effect of swab type on the analytical sensitivity of five point-of-care tests for group A streptococci

British Journal of Biomedical Science ◽

10.1080/09674845.2011.11978232 ◽

2011 ◽

Vol 68 (2) ◽

pp. 91-94 ◽

Cited By ~ 1

Author(s):

G. M. Lasseter ◽

C. A. M. Mcnulty ◽

F. D. R. Hobbs ◽

D. Mant ◽

P. Little

Keyword(s):

Point Of Care ◽

Analytical Sensitivity ◽

Group A Streptococci ◽

Group A ◽

Point Of Care Tests

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Association between bacterial finding, antibiotic treatment and clinical course in patients with pharyngotonsillitis: a registry-based study in primary healthcare in Sweden

BMC Infectious Diseases ◽

10.1186/s12879-021-06511-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jon Pallon ◽

Martin Sundqvist ◽

Mattias Rööst ◽

Katarina Hedin

Keyword(s):

Antibiotic Treatment ◽

Primary Healthcare ◽

Antibiotic Prescription ◽

Electronic Medical Record System ◽

Group A Streptococci ◽

Record System ◽

Bacterial Aetiology ◽

Medical Record System ◽

Group A ◽

Return Visits

Abstract Background The role of non-group A streptococci and Fusobacterium necrophorum in pharyngotonsillitis has been disputed and few prospective studies have evaluated the effect of antibiotic treatment. This study uses registry data to investigate the relation between antibiotic prescription for pharyngotonsillitis in primary healthcare and return visits for pharyngotonsillitis, complications, and tonsillectomy. Methods Retrospective data were extracted from the regional electronic medical record system in Kronoberg County, Sweden, for all patients diagnosed with pharyngotonsillitis between 2012 and 2016. From these data, two cohorts were formed: one based on rapid antigen detection tests (RADT) for group A streptococci (GAS) and one based on routine throat cultures for β-haemolytic streptococci and F. necrophorum. The 90 days following the inclusion visit were assessed for new visits for pharyngotonsillitis, complications, and tonsillectomy, and related to bacterial aetiology and antibiotic prescriptions given at inclusion. Results In the RADT cohort (n = 13,781), antibiotic prescription for patients with a positive RADT for GAS was associated with fewer return visits for pharyngotonsillitis within 30 days compared with no prescription (8.7% vs. 12%; p = 0.02), but not with the complication rate within 30 days (1.5% vs. 1.8%; p = 0.7) or with the tonsillectomy rate within 90 days (0.27% vs. 0.26%; p = 1). In contrast, antibiotic prescription for patients with a negative RADT was associated with more return visits for pharyngotonsillitis within 30 days (9.7% vs. 7.0%; p = 0.01). In the culture cohort (n = 1 370), antibiotic prescription for patients with Streptococcus dysgalactiae ssp. equisimilis was associated with fewer return visits for pharyngotonsillitis within 30 days compared with no prescription (15% vs. 29%; p = 0.03). Conclusions Antibiotic prescription was associated with fewer return visits for pharyngotonsillitis in patients with a positive RADT for GAS but with more return visits in patients with a negative RADT for GAS. There were no differences in purulent complications related to antibiotic prescription.

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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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