Antibiotic Prescribing in Adults Presenting with Pharyngitis Pre- and Post-Implementation of a Rapid Group A Streptococcus Test

Background: Group A Streptococcus (GAS) pharyngitis is the most common bacterial cause of acute pharyngitis and is often over treated with unnecessary antibiotics. The purpose was to evaluate if implementation of a rapid antigen detection test (RADT) for GAS would reduce the number of inappropriately prescribed antibiotics for adult patients presenting with symptoms of pharyngitis. Methods: This was a retrospective cohort study of adult urgent care clinic patients pre- and post-implementation of a GAS RADT. We included patients who had a diagnosis of GAS identified via ICD-10 codes and either a throat culture, GAS RADT, or antibiotic prescribed for GAS. Antibiotic prescribing was assessed as appropriate or inappropriate based on testing and IDSA guideline recommendations. Thirty-day follow-up visits related to pharyngitis or the prescribed antibiotics was also evaluated. Results: A total of 1734 patients were included; 912 and 822 in the pre- and post-implementation groups, respectively. Following implementation of the GAS RADT, there was an increase in the number of antibiotics prescribed for GAS (43.4% vs 59.1%, P < .001) as well as an increase in appropriate prescribing (67.6% vs 77.5%, P < .001). More 30-day pharyngitis-related follow-up visits were seen in the pre-intervention group (12.5% vs 9.3%, P = .03). Conclusion: Implementation of a RADT for GAS pharyngitis was associated with an increase in both the overall number of antibiotic prescriptions for GAS and the proportion of appropriately prescribed antibiotics. There was also a reduction in follow up visits related to GAS pharyngitis, however educational efforts to further increase appropriate prescribing is needed.

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Evaluation of Rapid Antigen Detection Test for Group A Streptococci Pharyngitis among Children in an Out-Patient Clinic in Malaysia

Sains Malaysiana ◽

10.17576/jsm-2021-5011-18 ◽

2021 ◽

Vol 50 (11) ◽

pp. 3345-3354

Author(s):

Zaili Zaki ◽

Asrul Abdul Wahab ◽

Ramliza Ramli ◽

Afaaf Esa ◽

Ezura Madiana Md. Monoto

Keyword(s):

Sore Throat ◽

Sensitivity And Specificity ◽

Throat Swab ◽

Group A Streptococcus ◽

Antigen Detection ◽

Preschool Age ◽

Throat Culture ◽

Care Clinic ◽

Rapid Antigen Detection Test ◽

Group A

One of the most common conditions encountered in the out-patient setting is acute pharyngitis. Group A Streptococcus (GAS) accounts for 15%-30% of cases of sore throat particularly in children under 15 years old. Rapid antigen testing (RADT) is an alternative diagnostic method to detect GAS pharyngitis. This study was done to evaluate the agreement between RADT whereby BIONEXIA® Strep A Plus (BioMérieux, France) kit was used and throat culture in the diagnosis of GAS pharyngitis in children presented with a sore throat. One hundred and ten children from a primary health care clinic with sore throat were included in this study. All children were evaluated based on McIsaac scoring and throat swab samples were taken for both throat culture and RADT testing. The prevalence of GAS pharyngitis by RADT in this study was 7.3% over one year. A higher incidence of GAS pharyngitis was noted in the school-aged children than the preschool-age children. There was no correlation between cough, lymph node enlargement, and tonsillar enlargement in predicting GAS pharyngitis. The sensitivity and specificity of RADT were 100% and 98%, respectively, when taking throat culture as a gold standard. A good agreement between RADT and throat culture was achieved (k=0.848). McIsaac scoring was noted to have good predictability for GAS pharyngitis with AUC=0.82. In conclusion, the rapid streptococcal antigen detection test showed excellent sensitivity and specificity and detecting GAS from the throat swab samples. Thus, it can be used to aid in the diagnosis of group A Streptococcal pharyngitis and could reduce the overuse of antibiotics. McIsaac score has also proven to be useful as a screening tool for bacterial pharyngitis.

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2568. Variability in Pediatric Antibiotic Prescribing for Upper Respiratory Illnesses by Provider Specialty

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy209.176 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S73-S74

Author(s):

Holly M Frost ◽

Huong McLean ◽

Brian Chow

Keyword(s):

Respiratory Infections ◽

Group A Streptococcus ◽

Acute Otitis Media ◽

Urgent Care ◽

Antibiotic Prescribing ◽

Respiratory Illnesses ◽

Upper Respiratory Infection ◽

Medical Diagnoses ◽

Group A ◽

Upper Respiratory

Abstract Background Antibiotic prescribing varies among providers, contributing to antibiotic resistance and adverse drug reactions. Objective. To evaluate variation in antibiotic prescribing between pediatric and nonpediatric providers for common upper respiratory illnesses. Methods Patient encounters for children aged <18 years from a regional healthcare system were identified. Electronic medical records from 2011 to 2016 were extracted for diagnoses of upper respiratory infection (URI), pharyngitis, acute otitis media (AOM), and sinusitis. Encounters with competing medical diagnoses, recent hospitalization, and antibiotic prescriptions within 30 days were excluded. Adherence to antibiotic guidelines was assessed by provider training (pediatric, nonpediatric physicians, and advance practice providers [APP]). Additional factors assessed included clinic or urgent care setting, calendar year, and patient’s age, gender, insurance status, and number of sick visits in the prior year. Results Across 6 years, 141,361 visits were examined: 43,914 for URI, 43,701 for pharyngitis, 43,925 for AOM, and 9,821 for sinusitis. Pediatricians were more likely than APPs and nonpediatric providers to have guideline-concordant prescribing for pharyngitis (pediatricians 66.7 (54.5, 77.0)%, nonpediatricians 49.1 (36.3, 62.0)%, APPs 52.2(39.4, 64.7)%, P < 0.0001) and sinusitis (pediatricians 70.8(53.8, 83.4)%, nonpediatricians 63.3(46.8, 77.2)%, APPs 62.1(45.1, 76.5)%, P = 0.48) and to withhold antibiotics for URI than APPs and nonpediatric providers (pediatricians 86.6(81.2, 90.6)%, nonpediatricians 80.8(73.0, 86.8)%, APPs 76.8(68.4, 83.5)%, P < 0.0001). Pediatricians were less likely to prescribe antibiotics for pharyngitis without a positive Group A Streptococcus test than APPs and nonpediatric providers (pediatricians 15.1(10.4, 21.6)%, nonpediatricians 29.4(20.8, 39.6)%, APPs 27.2(19.3, 36.9)%, P < 0.0001). First-line antibiotic prescribing for pharyngitis and AOM did not differ between provider specialties. A trend toward more guideline-concordant prescribing was seen for pharyngitis and sinusitis over the study period. Conclusion Pediatricians were more likely to adhere to guidelines for pediatric acute respiratory infections. Pediatric antibiotic stewardship efforts should also target non-pediatricians. Disclosures All authors: No reported disclosures.

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Positive Rate of Tests for Group a Streptococcus and Viral Features in Children with Acute Pharyngitis

Children ◽

10.3390/children8070599 ◽

2021 ◽

Vol 8 (7) ◽

pp. 599

Author(s):

Dasom Wi ◽

Soo-Han Choi

Keyword(s):

Laboratory Testing ◽

Older Patients ◽

Group A Streptococcus ◽

Throat Culture ◽

Acute Pharyngitis ◽

Rapid Antigen Detection Test ◽

Positive Rate ◽

Group A ◽

Centor Score ◽

Low Prevalence

Group A streptococcus (GAS) is an important cause of acute pharyngitis. We investigated the positive rate of GAS tests and clinical viral features in children with acute pharyngitis. A retrospective review was conducted for patients <15 years old with both rapid antigen detection test (RADT) and throat culture results. Patients were excluded if they were diagnosed with influenza or had received antibiotics within two weeks before these tests. A total of 377 patients were eligible. The median age of patients was 3.5 years, and 45.4% of total patients were <3 years old. Among all patients, 68.7% had at least one viral feature, and 39% had more than two. The overall positiv rate for GAS was 11.4%. The GAS positive rate was significantly lower in patients <3 years old than in older patients (1.8% vs. 19.4%, p < 0.0001). The overall sensitivity and specificity of RADT were 75.0% (95% CI: 57.8–87.9) and 97.9% (95% CI: 95.8–99.2), respectively. The GAS positive rate was not significantly different between patients with and without viral features (12.4% vs. 9.3%, p = 0.4854). In patients aged 3–14 years, the GAS positive rate was not associated with the modified Centor score or the frequency of clinical viral features. Despite a low prevalence of GAS pharyngitis, testing for GAS was frequently performed in children <3 years old in this study. Appropriate use of laboratory testing for GAS pharyngitis and judicious prescription of antibiotics were imperative.

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Notes from the Field: Group A Streptococcal Pharyngitis Misdiagnoses at a Rural Urgent-Care Clinic — Wyoming, March 2015

MMWR Morbidity and Mortality Weekly Report ◽

10.15585/mmwr.mm6450a4 ◽

2016 ◽

Vol 64 (50-51) ◽

pp. 1383-1385 ◽

Cited By ~ 3

Author(s):

Alexia Harrist ◽

Clayton Van Houten ◽

Stanford T. Shulman ◽

Chris Van Beneden ◽

Tracy Murphy

Keyword(s):

Streptococcal Pharyngitis ◽

Urgent Care ◽

Care Clinic ◽

Group A ◽

Urgent Care Clinic

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Rapid antigen detection test for group A streptococcus in children with pharyngitis

10.1002/14651858.cd010502 ◽

2013 ◽

Cited By ~ 3

Author(s):

Jérémie F Cohen ◽

Robert Cohen ◽

Martin Chalumeau

Keyword(s):

Group A Streptococcus ◽

Antigen Detection ◽

Rapid Antigen Detection Test ◽

Group A

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Molecular Testing for Detection of Groups A, C, and G β-Hemolytic Streptococci in Pharyngeal Samples from Children

The Journal of Applied Laboratory Medicine ◽

10.1373/jalm.2018.026104 ◽

2018 ◽

Vol 3 (3) ◽

pp. 429-437 ◽

Cited By ~ 1

Author(s):

Tam T Van ◽

Javier Mestas ◽

Jennifer Dien Bard

Keyword(s):

Group A Streptococcus ◽

Improve Patient Care ◽

Routine Care ◽

Streptococcal Pharyngitis ◽

Molecular Testing ◽

Culture Methods ◽

Rapid Antigen Detection Test ◽

Large Colony ◽

Group A ◽

Improve Patient

Abstract Background Group A Streptococcus (GAS) and large colony-forming group C (GCS) and G (GGS) β-hemolytic streptococci are important causes of acute pharyngitis in children and adults. Rapid and accurate diagnosis of streptococcal pharyngitis can improve patient care and potentially reduce transmission. In this study, we evaluated the performance of the Lyra Direct Strep (LDS) assay for detection of GAS and GCS/GGS compared with traditional culture methods. Methods Pharyngeal samples obtained from 278 children presenting to the emergency department with initial negative GAS rapid antigen detection test (RADT) were used. All samples were cultured as part of routine care and tested in batches using the LDS assay. Results Of 278 pharyngeal samples with negative GAS RADT, 37 (13.3%) and 63 (22.7%) patients were positive for GAS by culture and LDS assay, respectively. Four (1.4%) patients were positive for GCS or GGS by culture or LDS assay. The LDS assay demonstrated sensitivity and specificity of 97.6% and 89.0%, respectively, compared with culture as the gold standard. Repeat culture and an alternate PCR showed that 85.7% (24 of 28) of discrepant samples agreed with findings of the LDS assay. Since implementation, the LDS assay shows a positivity rate of 21.0% (281 of 1340) compared with 11.7% (246 of 2110) by culture in the previous year. Conclusions We successfully implemented the LDS assay at our institution and have observed a significant increase in the positivity rate of GAS compared with culture. The LDS assay alone allowed for the elimination of β-streptococci screening by culture at our institution.

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966. A Closer Look at Antibiotic Prescribing for Upper Respiratory Illnesses (URI) in People with HIV Compared with People Without HIV

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz359.068 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S31-S31

Author(s):

Anum Abbas ◽

Mackenzie R Keintz ◽

Elizabeth Lyden ◽

Jihyun Ma ◽

Sara H Bares ◽

...

Keyword(s):

Private Insurance ◽

Primary Care Clinic ◽

Antibiotic Use ◽

Prescribing Patterns ◽

Categorical Variables ◽

Antibiotic Prescribing ◽

Care Clinic ◽

Antibiotic Overuse ◽

Exact Test ◽

Icd 10

Abstract Background Antibiotic overuse is widespread, increasing healthcare cost and promoting antimicrobial resistance. People with HIV (PWH) who develop URIs may be assumed “higher risk,” compared with non-PWH, but comparative antibiotic use evaluations have not been performed. We evaluated antibiotic prescribing patterns for URI diagnoses (cough, sinusitis, bronchitis, and cold) in PWH and non-PWH. Methods This was an observational, single-center study comparing PWH and non-PWH diagnosed with URI (using ICD 10 codes for URI syndromes: cough, sinusitis, bronchitis, and cold) between January 1, 2014 and April 30, 2018. Patients were empaneled in an outpatient primary care clinic or specialty care clinic in one healthcare system. Appropriateness of antibiotic prescribing was defined based on published guidelines. Fisher’s exact test compared categorical variables with antibiotic prescribing patterns. Each encounter was considered an independent event. Results The two groups (PWH and non-PWH) were similar, with 34% of subjects in both groups being female. PWH had median CD4+ count of 610 cells/mm3 with 91% on antiretrovirals and 77% with HIV RNA < 20 copies/mL. Overall, 37% of visits resulted in antibiotic prescriptions, 92% of which were inappropriate (discordant with guidelines). Antibiotics were prescribed slightly more frequently in non-PWH (40% vs. 33%, P = 0.056; Figure 1) and inappropriate more often in non-PWH (37% vs. 30%, P = 0.029). Over 20% of PWH antibiotic prescriptions were too long, and 22% of non-PWH received the wrong drug (Figure 2; P = 0.011). 47% of the non-PWH receiving antibiotics for URI had private insurance (compared with other payers; P < 0.0001) vs. 33% in PWH (P = 0.32) (Figure 3). Conclusion Outpatient antibiotic overuse remains prevalent among patients evaluated for URIs. This is the first study, to our knowledge, comparing antibiotic use for URIs in PWH compared with non-PWH. Counterintuitively, we found less-frequent inappropriate antibiotic use in PWH. We speculate that PWH are more likely to be evaluated by infectious disease/HIV specialists, possibly explaining the lower rate of antibiotic prescriptions for URIs in this population. Future analyses will evaluate the association between provider specialty and inappropriate antibiotic use. Disclosures All Authors: No reported Disclosures.

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Spectrum and Inoculum Size Effect of a Rapid Antigen Detection Test for Group A Streptococcus in Children with Pharyngitis

PLoS ONE ◽

10.1371/journal.pone.0039085 ◽

2012 ◽

Vol 7 (6) ◽

pp. e39085 ◽

Cited By ~ 27

Author(s):

Jérémie F. Cohen ◽

Martin Chalumeau ◽

Corinne Levy ◽

Philippe Bidet ◽

Franck Thollot ◽

...

Keyword(s):

Size Effect ◽

Group A Streptococcus ◽

Inoculum Size ◽

Antigen Detection ◽

Rapid Antigen Detection Test ◽

Group A

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COMPARISON OF SURGICAL INTERVENTIONS FOR DEGENERATIVE DEFORMITIES AND INSTABILITY OF THE SPINE AMONG ELDERLY PATIENTS

Coluna/Columna ◽

10.1590/s1808-185120181703193268 ◽

2018 ◽

Vol 17 (3) ◽

pp. 216-220

Author(s):

Dmitrii Mikhaylov ◽

Anton Denisov ◽

Dmitrii Ptashnikov ◽

Sergei Masevnin ◽

Nikita Zaborovskii

Keyword(s):

Elderly Patients ◽

Spinal Stenosis ◽

Intervention Group ◽

Deformity Correction ◽

Thoracic Region ◽

Transpedicular Fixation ◽

Group A ◽

The Mean ◽

Group D

ABSTRACT Objective: To evaluate the surgical results among elderly patients with degenerative deformities and instability of the spine. Methods: A retrospective study of 437 patients (337 women, 100 men) with a mean age 60. The mean follow-up time was five years. The inclusion criteria were diseases and complications following spinal trauma associated with deformities, degenerative processes, acute pain syndrome, and spinal stenosis with neurological deficit. Four study groups (A, B, C and D) were created and defined by type of surgical intervention. Group A patients (the reference group) - decompression of neural structures on both sides without fixation. Group B - decompression and transpedicular fixation performed without correction of the deformity. Group C - patients operated up to the lower-thoracic region with transpedicular screws, correction of the deformity and decompression of spinal stenosis. Group D - transpedicular fixation up to higher-thoracic region; correction of the deformity and decompression of neurological structures. The mean follow-up time was five years. Results: Group D patients achieved the best outcome. The results observed were good in 57.2% of cases (60 patients); satisfactory in 40% of cases (42 patients); and unsatisfactory in 2.8% of cases (three patients). The worst findings were observed in Group A: satisfactory in 13.4% of cases (15 patients); and, unsatisfactory in 86.6% of cases (97 patients). No good results were observed in this group. Conclusion: The results suggest that performing full deformity correction with transpedicular fixation up to the higher-thoracic region gives the best outcomes for elderly patients, and helps to prevent long-term complications. Evidence level III; Retrospective Comparative Study.

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