Maltezou Helen C, Tsagris Vasilios, Antoniadou Anastasia, Galani Labrini, Douros Constantinos, Katsarolis Ioannis, Maragos Antonios, Raftopoulos Vasilios, Biskini Panagiota, Kanellakopoulou Kyriaki, Fretzayas Andreas, Papadimitriou Theodoros, Nicolaidou Polyxeni, Giamarellou Helen
Office for Nosocomial Infections, Antimicrobial Resistance, and Rational Use of Antibiotics, Hellenic Center for Disease Control and Prevention, Athens, Greece.
J Antimicrob Chemother. 2008 Dec;62(6):1407-12. doi: 10.1093/jac/dkn376. Epub 2008 Sep 11.
To study the performance of the Becton-Dickinson Link 2 Strep A Rapid Test, a rapid antigen detection test (RADT) for diagnosing streptococcal pharyngitis in children presenting to private offices and to the Pediatric Outpatient Clinic of a university hospital, in relation to clinical criteria (fever, tender anterior cervical lymph nodes, tonsillar exudate and absence of cough), and its impact on antibiotic prescription.
Children were enrolled in Group A (enrolment by private-practice paediatricians; diagnosis by clinical picture only), Group B (enrolment by private-practice paediatricians; diagnosis by RADT and culture) or Group C (enrolment by hospital-affiliated paediatricians in the Pediatric Outpatient Clinic; diagnosis by RADT and culture).
During a 2 year period, 820 children were enrolled [369 (45%) in Group A, 270 (33%) in Group B and 181 (22%) in Group C]. Streptococcal pharyngitis was diagnosed by RADT and culture in 146 (32.4%) of the 451 tested children. The sensitivity, specificity and positive and negative predictive values of the RADT were 83.1%, 93.3%, 82.4% and 93.6%, respectively. A stepwise increase in the sensitivity of the RADT was noted among children with one, two, three or four clinical criteria (60.9% to 95.8%). Paediatricians without access to laboratory tests were more likely to prescribe antibiotics compared with paediatricians with access to tests (72.2% versus 28.2%, P < 0.001). Private-practice paediatricians prescribed antibiotics more frequently compared with hospital-affiliated paediatricians (55.7% versus 19.9%, P < 0.001).
Our findings support screening of all children with pharyngitis for Centor criteria and subsequently performing an RADT to guide decision for antibiotic administration. Such a strategy has an important impact on limiting throat culture testing and is associated with reduced antibiotic prescription.
研究Becton-Dickinson Link 2 A群链球菌快速检测法（一种用于诊断前往私人诊所和大学医院儿科门诊就诊儿童的链球菌性咽炎的快速抗原检测法）与临床标准（发热、颈前淋巴结压痛、扁桃体渗出物及无咳嗽）的相关性，及其对抗生素处方的影响。
将儿童分为A组（由私人执业儿科医生招募；仅通过临床表现诊断）、B组（由私人执业儿科医生招募；通过快速抗原检测法和培养诊断）或C组（由大学医院附属儿科医生在儿科门诊招募；通过快速抗原检测法和培养诊断）。
在2年期间，共招募了820名儿童[A组369名（45%），B组270名（33%），C组181名（22%）]。在451名接受检测的儿童中，有146名（32.4%）通过快速抗原检测法和培养诊断为链球菌性咽炎。快速抗原检测法的敏感性、特异性、阳性预测值和阴性预测值分别为83.1%、93.3%、82.4%和93.6%。在具有一项、两项、三项或四项临床标准的儿童中，快速抗原检测法的敏感性呈逐步上升趋势（60.9%至95.8%）。与能够进行实验室检测的儿科医生相比，无法进行实验室检测的儿科医生更有可能开具抗生素（72.2%对28.2%，P<0.001）。与大学医院附属儿科医生相比，私人执业儿科医生更频繁地开具抗生素（55.7%对19.9%，P<0.001）。
我们的研究结果支持对所有咽炎儿童进行森托标准筛查，随后进行快速抗原检测法以指导抗生素使用决策。这样的策略对限制咽拭子培养检测具有重要影响，并与减少抗生素处方相关。
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