title: Reassessment of the Role of Rapid Antigen Detection Tests in Diagnosis of Invasive Group A Streptococcal Infections.
abstract: Rapid antigen detection tests (RADTs) for group A streptococci (GAS) are widely used for diagnosing acute pharyngitis, which has led to a considerable reduction in antibiotic prescriptions over the past decade. Beyond this intended use, their reassessment on invasive samples may be relevant in the management of life-threatening GAS infections. To this end, we evaluated the performances of three RADTs, culture, GAS PCR, and 16S rRNA gene PCR assays, and compared them with a composite gold standard (GAS-PCR assay and/or culture) for the diagnosis of severe GAS infection. A total of 192 specimens from deep-tissue (mostly normally sterile) sites enriched for 75 GAS-positive samples were enrolled in the study. The three evaluated RADTs showed sensitivities ranging from 88.0% to 94.7% versus 98.7% for GAS PCR, 84% for 16S rRNA gene PCR, and 77.3% for culture. The sensitivities of the ImmunoCardSTAT! Strep A test (Meridian Bioscience) and the NADAL Strep A strip (Nal Von Minden) were similar to that of GAS PCR (P= 0.25 and 0.03, respectively) and higher than that of culture (P= 0.001 and 0.006, respectively), whereas the SD Bioline Strep A test strip (Standard Diagnostics) showed a performance similar to that of culture (P= 0.02). The three RADTs detected 10 distinctemmtypes, including a predominance ofemm1 (33.3%),emm89 (10.6%), andemm12 (7.6%). No false-positive results were observed, leading to a specificity of 100% for all the evaluated RADTs. The GAS RADTs turned out to be sensitive, specific, and easy-to-use tools that may aid in the management of invasive GAS infections in 24/7 point-of-care laboratories by enabling early diagnosis and focused therapy.
authors.affiliation: Hospices Civils de Lyon, Laboratoire de Bactériologie, Centre de Biologie et de Pathologie Est, Bron, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Gazzano
authors.affiliation: Laboratoire de Bactériologie, CHU de Saint-Etienne, Saint-Etienne, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Berger
authors.affiliation: Hospices Civils de Lyon, Laboratoire de Bactériologie, Centre de Biologie et de Pathologie Est, Bron, France CIRI, Centre International de Recherche en Infectiologie, Université de Lyon, Lyon, France INSERM, U1111, Lyon, France Ecole Normale Supérieure de Lyon, Lyon, France Université Lyon 1, Lyon, France CNRS, UMR 5308, Lyon, France.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Benito
authors.affiliation: Hospices Civils de Lyon, Laboratoire de Bactériologie, Centre de Biologie et de Pathologie Est, Bron, France.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Freydiere
authors.affiliation: Hospices Civils de Lyon, Laboratoire de Bactériologie, Centre de Biologie et de Pathologie Est, Bron, France CIRI, Centre International de Recherche en Infectiologie, Université de Lyon, Lyon, France INSERM, U1111, Lyon, France Ecole Normale Supérieure de Lyon, Lyon, France Université Lyon 1, Lyon, France CNRS, UMR 5308, Lyon, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Tristan
authors.affiliation: Laboratoire de Bactériologie, CHU de Grenoble, Université Joseph Fourier, Grenoble, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Boisset
authors.affiliation: Laboratoire de Bactériologie, CHU de Saint-Etienne, Saint-Etienne, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Carricajo
authors.affiliation: Centre National de Référence des Streptocoques, Paris, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Poyart
authors.affiliation: Hospices Civils de Lyon, Laboratoire de Bactériologie, Centre de Biologie et de Pathologie Est, Bron, France CIRI, Centre International de Recherche en Infectiologie, Université de Lyon, Lyon, France INSERM, U1111, Lyon, France Ecole Normale Supérieure de Lyon, Lyon, France Université Lyon 1, Lyon, France CNRS, UMR 5308, Lyon, France.
authors.forename: François
authors.initials: F
authors.lastname: Vandenesch
authors.affiliation: Hospices Civils de Lyon, Laboratoire de Bactériologie, Centre de Biologie et de Pathologie Est, Bron, France CIRI, Centre International de Recherche en Infectiologie, Université de Lyon, Lyon, France INSERM, U1111, Lyon, France Ecole Normale Supérieure de Lyon, Lyon, France Université Lyon 1, Lyon, France CNRS, UMR 5308, Lyon, France ghislaine.descours@univ-lyon1.fr.
authors.forename: Ghislaine
authors.initials: G
authors.lastname: Descours
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000942:Antigens, Bacterial / Q000032:analysis*; D001431:Bacteriological Techniques / Q000379:methods; D002648:Child; D002675:Child, Preschool; D002846:Chromatography, Affinity / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction / Q000379:methods; D012680:Sensitivity and Specificity; D013290:Streptococcal Infections / Q000175:diagnosis*; D013297:Streptococcus pyogenes / Q000302:isolation & purification*; D013997:Time Factors; D055815:Young Adult
chemical_list: D000942:Antigens, Bacterial
references.citation: Br J Gen Pract. 2011 May;61(586):e244-51
references.pmid: 21619748
references.citation: J Clin Microbiol. 2015 Jul;53(7):2079-83
references.pmid: 25903570
references.citation: J Clin Microbiol. 2012 Aug;50(8):2770-3
references.pmid: 22593599
references.citation: J Clin Microbiol. 2012 Aug;50(8):2786-7
references.pmid: 22622442
references.citation: Eur J Clin Microbiol Infect Dis. 2012 Oct;31(10):2817-26
references.pmid: 22610663
references.citation: Eur J Clin Microbiol Infect Dis. 2013 May;32(5):609-11
references.pmid: 23207649
references.citation: J Clin Microbiol. 2013 May;51(5):1474-7
references.pmid: 23447639
references.citation: J Microbiol Methods. 2013 May;93(2):116-20
references.pmid: 23499921
references.citation: Eur J Clin Microbiol Infect Dis. 2013 Jun;32(6):787-93
references.pmid: 23340863
references.citation: J Pediatr. 2013 Jun;162(6):1282-4, 1284.e1
references.pmid: 23465407
references.citation: J Infect Dis. 2001 Apr 1;183(7):1135-7
references.pmid: 11237843
references.citation: J Clin Microbiol. 2003 Feb;41(2):763-6
references.pmid: 12574279
references.citation: Pediatr Infect Dis J. 2003 Aug;22(8):726-31
references.pmid: 12913775
references.citation: JAMA. 2004 Apr 7;291(13):1587-95
references.pmid: 15069046
references.citation: Pediatrics. 1987 Nov;80(5):659-63
references.pmid: 3313256
references.citation: Pediatr Infect Dis J. 1996 Aug;15(8):715-7
references.pmid: 8858682
references.citation: Euro Surveill. 2005 Sep;10(9):179-84
references.pmid: 16280610
references.citation: Med J Aust. 2007 Jun 4;186(11):565-9
references.pmid: 17547544
references.citation: Clin Infect Dis. 2007 Oct 1;45(7):853-62
references.pmid: 17806049
references.citation: J Microbiol Methods. 2007 Dec;71(3):336-9
references.pmid: 17936386
references.citation: J Clin Microbiol. 2008 Jul;46(7):2359-67
references.pmid: 18463210
references.citation: J Antimicrob Chemother. 2008 Dec;62(6):1407-12
references.pmid: 18786938
references.citation: Pediatr Emerg Care. 2009 Nov;25(11):748-50
references.pmid: 19864964
references.citation: Arch Pediatr. 2013 Oct;20(10):1083-8
references.pmid: 23932873
references.citation: Clin Infect Dis. 2014 Aug 1;59(3):358-65
references.pmid: 24785239
references.citation: Clin Infect Dis. 2014 Sep 15;59(6):851-7
references.pmid: 24928291
references.citation: Arch Pediatr. 2014 Nov;21 Suppl 2:S62-8
references.pmid: 25456682
references.citation: Arch Pediatr. 2014 Nov;21 Suppl 2:S84-6
references.pmid: 25456686
references.citation: Clin Infect Dis. 2015 Jan 15;60(2):267-70
references.pmid: 25313248
references.citation: J Clin Microbiol. 2015 Jul;53(7):2015-21
references.pmid: 25878351
references.citation: Clin Microbiol Infect. 2012 Jul;18(7):702-10
references.pmid: 21883669