澳大利亚湿热地区 A 组链球菌的携带率及其对咽喉拭子临床应用的影响。

Carrier rates of group A streptococci in Australian wet tropics and their impact on the clinical usefulness of throat swabs.

机构信息

MD, PhD, Adjunct Professor, General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; General Practice/Family, Region Västra Götaland, Research and Development Primary Health Care, Research and Development Center Södra Älvsborg, Sweden; General Practice/Family, Centre for Antibiotic Resistance Research (CARe) at University of Gothenburg, Gothenburg, Sweden.

MD, PhD, Director of Emergency Medicine Department, Mount Isa Hospital/North West Hospital and Health Service, Qld; Associate Professor, College of Medicine and Dentistry, James Cook University, Qld.

出版信息

Aust J Gen Pract. 2024 Oct;53(10):727-730. doi: 10.31128/AJGP-07-23-6897.

DOI:10.31128/AJGP-07-23-6897

PMID:39370157

Abstract

BACKGROUND AND OBJECTIVES

Rapid point-of-care tests (POCT) are likely to assist with the detection of group A streptococci (GAS), but their usefulness is determined by the presence of carriers of GAS. This is insufficiently explored in the wet tropics.

METHOD

This study included 77 patients attending primary care in the wet tropics complaining of a sore throat, and 49 healthy controls. Carrier rates of GAS and the positive and negative etiological predictive values (P-EPV and N-EPV, respectively) of a POCT were calculated.

RESULTS

The carrier rates were 8.3% among healthy children and 2.7% for adults. The P-EPV for children was 71% (95% confidence interval [CI]: 0.0-100%) and for adults it was 85% (95% CI: 0.0-100%). The corresponding N-EPV was 99% (95% CI: 95-100%) for children and 99% (95% CI: 98-100%) for adults.

DISCUSSION

N-EPV, ruling out GAS, was sufficiently high with narrow CIs to allow for defining a stopping rule to avoid unnecessary antibiotic prescribing.

摘要

背景与目的

即时检测(point-of-care test, POCT)可能有助于检测 A 组链球菌(group A streptococci, GAS)，但其有用性取决于 GAS 携带者的存在。在湿润热带地区，这方面的研究还不够充分。

方法

本研究纳入了 77 名在湿润热带地区因咽痛就诊于初级保健机构的患者和 49 名健康对照者。计算了 GAS 携带者率和 POCT 的阳性和阴性病原学预测值(positive and negative etiological predictive values, P-EPV 和 N-EPV)。

结果

健康儿童的携带率为 8.3%，成年人为 2.7%。儿童的 P-EPV 为 71%（95%置信区间[confidence interval, CI]：0.0-100%），而成人为 85%（95%CI：0.0-100%）。相应的 N-EPV 为儿童 99%（95%CI：95-100%），成人 99%（95%CI：98-100%）。