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Effect of clinical spectrum, inoculum size and physician characteristics on sensitivity of a rapid antigen detection test for group A streptococcal pharyngitis

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Abstract

We aimed to assess the independent effect of clinical spectrum, bacterial inoculum size and physician characteristics on the sensitivity of a rapid antigen detection test (RADT) for group A streptococcus (GAS) in children. Double throat swabs were collected from 1,482 children with pharyngitis and 294 asymptomatic children in a French prospective, office-based, multicenter (n = 17) study, from October 2009 to May 2011. Patient- and physician-level factors potentially affecting RADT sensitivity were studied by univariate and multivariate multilevel analysis, with laboratory throat culture as the reference test. In children with pharyngitis and asymptomatic children, the prevalence of GAS was 38 % (95 % confidence interval 36–41 %) and 11 % (7–14 %), respectively. Overall, RADT sensitivity was 87 % (84–90 %). On stratified and multivariate multilevel analysis, RADT sensitivity was higher for children with pharyngitis than asymptomatic children (89 % vs. 41 %), children <9 than ≥9 years old (88 % vs. 79 %) and those with heavy than light inoculum (94 % vs. 53 %). RADT sensitivity was influenced by the physician performing the test (range 56–96 %, p = 0.01) and was higher for physicians with hospital-based clinical activity in addition to office-based practice (adjusted odds ratio 3.4 [95 % confidence interval 1.9–6.3], p < 0.001); inter-physician variations in RADT sensitivity were largely explained by this variable (proportional change in variance >99 %). The sensitivity of the RADT is independently affected by patient- and physician-level factors. Physicians who base their diagnosis of GAS pharyngitis on the results of a RADT alone should consider diagnostic accuracy monitoring and adequate training when needed.

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Acknowledgments

The authors thank A. Liboz (Department of Microbiology, Robert Debré Hospital); M. Boucherat, MD (database design); F. de La Rocque, MD (study conception); I. Ramay, D. Menguy, S. Tortorelli and M. de Pereira (ACTIV); B. Khoshnood, MD, PhD (multilevel analysis methodological support); and all the physician investigators who participated in the RADT GAS study: F. Corrard, MD, P. Deberdt, MD, A. Elbez, MD, M. Goldrey, MD, J. Gosselin, MD, P. Martin, MD, A.S. Michot, MD, N. Panis, MD, D. Qutob, MD, C. Romain, MD, O. Romain, MD, C. Schlemmer, MD, F. Thollot, MD, A. Wollner, MD.

Funding sources

This study was internally funded by ACTIV and externally by Dectrapharm, manufacturer of the RADT (Rapid Antigen Detection Test). JFC was supported by educational grants from Agence Régionale de Santé d’Ile-de-France, Laboratoires Guigoz - Société Française de Pédiatrie - Groupe de Pédiatrie Générale - Groupe de Recherches Epidémiologiques en Pédiatrie, and a research grant from the French Ministry of Health (PHRC Régional 2012, AOR 12089). The external funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Conflicts of interest

The authors declare that they have no conflict of interest.

Previous presentations

This work was presented in part at the 30th Annual Meeting of the European Society for Pediatric Infectious Diseases, Thessaloniki, Greece, May 2012 (Abstract A-435-0007-01213).

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Authors and Affiliations

  1. INSERM, UMR S953, Epidemiological Research Unit on Perinatal Health and Women’s and Children’s Health, Maternité de Port Royal, 6e étage, 53 avenue de l’Observatoire, 75014, Paris, France

    J. F. Cohen & M. Chalumeau

  2. Department of Pediatrics, Necker-Enfants-Malades Hospital, Assistance Publique-Hôpitaux de Paris, Univ Paris Descartes, Sorbonne Paris Cité, Paris, France

    J. F. Cohen & M. Chalumeau

  3. Association Clinique et Thérapeutique du Val-de-Marne (ACTIV), Saint-Maur-des-Fossés, France

    C. Levy, M. Benani, M. Koskas & R. Cohen

  4. Centre de Recherche Clinique (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France

    C. Levy

  5. Department of Microbiology, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France

    P. Bidet & E. Bingen

  6. Department of Microbiology, Centre Hospitalier Intercommunal de Créteil, Créteil, France

    R. Cohen

Authors
  1. J. F. Cohen
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  2. M. Chalumeau
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  3. C. Levy
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  4. P. Bidet
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  5. M. Benani
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  6. M. Koskas
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  7. E. Bingen
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  8. R. Cohen
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Correspondence to J. F. Cohen.

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Prof. Edouard Bingen, *In memoriam

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Cohen, J.F., Chalumeau, M., Levy, C. et al. Effect of clinical spectrum, inoculum size and physician characteristics on sensitivity of a rapid antigen detection test for group A streptococcal pharyngitis. Eur J Clin Microbiol Infect Dis 32, 787–793 (2013). https://doi.org/10.1007/s10096-012-1809-1

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  • DOI: https://doi.org/10.1007/s10096-012-1809-1

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