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Point-of-care testing of group A streptococcal antigen: performance evaluated by external quality assessment

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Abstract

The purpose of this study was to evaluate the overall performance of rapid antigen detection (RAD) in group A streptococcus (GAS) in Finland by using the results of external quality assurance (EQA) samples. We also compared the performance of laboratory professionals to that of nursing professionals. Around 22,800 EQA results among a total of 383 laboratories and physician’s offices were analysed. Vocational data on the personnel who carried out the tests were available for 10,088 EQA samples, 7,428 of which were tested by laboratory technicians and 2,531 by nursing staff. The best overall performance was found with GAS-negative samples: 99% of the reports were correct. In contrast, the overall performance was only 76% when the samples were weakly positive for GAS antigen. The laboratory technicians performed statistically significantly better than the nursing staff, with both strongly positive (correct results 98.9% vs. 95.1%, respectively; p<0.001) and weakly positive (79.3% vs. 65.3%, respectively; p<0.001) samples. With negative samples, no difference in performance between the laboratory and nursing staff was found (99.5% vs. 99.0%, respectively). The professional skills of the person performing the RAD test for GAS have a major impact on the sensitivity of the test. Based on the results of this study, we suggest that EQA-like artificial specimens could be used as a tool to improve and validate the quality of RAD testing in individual testing sites.

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References

  1. Gerber MA, Shulman ST (2004) Rapid diagnosis of pharyngitis caused by group A streptococci. Clin Microbiol Rev 17:571–580

    Article  PubMed  Google Scholar 

  2. Edmonson MB, Farwell KR (2005) Relationship between the clinical likelihood of group A streptococcal pharyngitis and the sensitivity of a rapid antigen-detection test in a pediatric practice. Pediatrics 115:280–285

    Article  PubMed  Google Scholar 

  3. Bisno AL, Gerber MA, Gwaltney JM Jr, Kaplan EL, Schwartz RH (2002) Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis. Clin Infect Dis 35:113–125

    Article  PubMed  Google Scholar 

  4. Donatelli J, Macone A, Goldman DA, Poon R, Hinberg I, Nanji A, Thorne GM (1992) Rapid detection of group A streptococci: comparative performance by nurses and laboratory technologists in pediatric satellite laboratories using three test kits. J Clin Microbiol 30:138–142

    PubMed  CAS  Google Scholar 

  5. Morandi PA, Deom A, Mauris A, Rohner P (2003) External quality control of direct antigen tests to detect group A streptococcal antigen. Eur J Clin Microbiol Infect Dis 22:670–674

    Article  PubMed  CAS  Google Scholar 

  6. Roe M, Kishiyama C, Davidson K, Schaefer L, Todd J (1995) Comparison of BioStar Strep A OIA optical immune assay, Abbott TestPack Plus Strep A, and culture with selective media for diagnosis of group A streptococcal pharyngitis. J Clin Microbiol 33:1551–1553

    PubMed  CAS  Google Scholar 

  7. Facklam RR (1997) Screening for streptococcal pharyngitis: current technology. Infect Med 14:891–898

    Google Scholar 

  8. Kurtz B, Kurtz M, Roe M, Todd J (2000) Importance of inoculum size and sampling effect in rapid antigen detection for diagnosis of Streptococcus pyogenes pharyngitis. J Clin Microbiol 38:279–281

    PubMed  CAS  Google Scholar 

  9. Labquality Ltd. Home page at: http://www.labquality.fi

  10. Kellogg JA (1990) Suitability of throat culture procedures for detection of group A streptococci and as reference standards for evaluation of streptococcal antigen detection kits. J Clin Microbiol 28:165–169

    PubMed  CAS  Google Scholar 

  11. Nerbrand C, Jasir A, Schalén C (2002) Are current rapid detection tests for group A streptococci sensitive enough? Evaluation of 2 commercial kits. Scand J Infect Dis 34:797–799

    Article  PubMed  CAS  Google Scholar 

  12. Chapin KC, Blake P, Wilson CD (2002) Performance characteristics and utilization of rapid antigen test, DNA probe, and culture for detection of group A streptococci in an acute care clinic. J Clin Microbiol 40:4207–4210

    Article  PubMed  CAS  Google Scholar 

  13. Bisno AL (2001) Acute pharyngitis. N Engl J Med 344:205–211

    Article  PubMed  CAS  Google Scholar 

  14. Erlich JE, Demopoulos BP, Daniel KR Jr, Ricarte MC, Glied S (2002) Cost-effectiveness of treatment options for prevention of rheumatic heart disease from group A streptococcal pharyngitis in a pediatric population. Prev Med 35:250–257

    Article  Google Scholar 

  15. Webb KH, Needham CA, Kurtz SR (2000) Use of a high-sensitivity rapid strep test without culture confirmation of negative results: 2 years’ experience. J Fam Pract 49:34–38

    PubMed  CAS  Google Scholar 

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Acknowledgements

We thank all of the Finnish laboratories and the other health care units for their permission to use their external quality results for this study.

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Author notes

  1. P. Strandén

    Present address: Seinäjoki Central Hospital, Seinäjoki, Finland

  2. J. Takkinen

    Present address: European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden

Authors and Affiliations

  1. Microbiology Laboratory, Central Hospital of Central Finland, Keskussairaalantie 19, 40620, Jyväskylä, Finland

    A. Nissinen

  2. Enteric Bacteria Laboratory, Department of Bacterial and Inflammatory Diseases, National Public Health Institute (KTL), Helsinki, Finland

    P. Strandén & A. Siitonen

  3. Labquality Oy, Helsinki, Finland

    R. Myllys & Y. Björkman

  4. Department of Infectious Diseases Epidemiology, National Public Health Institute (KTL), Helsinki, Finland

    J. Takkinen & P. Leinikki

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  1. A. Nissinen
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  2. P. Strandén
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  3. R. Myllys
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Correspondence to A. Nissinen.

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Nissinen, A., Strandén, P., Myllys, R. et al. Point-of-care testing of group A streptococcal antigen: performance evaluated by external quality assessment. Eur J Clin Microbiol Infect Dis 28, 17–20 (2009). https://doi.org/10.1007/s10096-008-0580-9

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  • DOI: https://doi.org/10.1007/s10096-008-0580-9

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