Diagnostic accuracy of QuickVue® Dipstick Strep A test and its effect on antibiotic prescribing in children in the United Arab Emirates

Abstract

Background: Unnecessary antibiotic prescription to patients with upper respiratory tract infections (URTIs) has led to the increase in antibiotics resistant bacteria rates. In this study, we evaluated the diagnostic accuracy of QuickVue® Dipstick Strep A test (QV-SAT) in children presenting with acute pharyngotonsillitis and its effect on antibiotic prescribing. Methods: A single-gated diagnostic accuracy study of children with fever, runny nose, and tonsillitis presenting to a paediatric clinic between March 2016 and September 2018. Paired throat swabs for QV-SAT and culture were collected. None of the children received antibiotics prior to sample collection. Furthermore, positive predictive value (PPV), negative predictive value (NPV) and likelihood ratios of the test were calculated. Results: 204 children were included in this study. 111 (54.4%) were boys and 146 (71.6%) were under the age of five years. QV-SAT was positive in 44 (21.6%) and throat culture was positive for Group A β- haemolytic Streptococcus (GAS) in 42 (20.6%) of the children. The results of QV-SAT were highly consistent with culture results: only 2 (0.9%) children with negative results had a positive throat culture. The sensitivity of the QV-SAT in the identification of GAS infection was 100% (95% CI 91.6%, 100%) and the NPV was 100% (95% CI 70%, 95%). Only 42 children (21%) were given antibiotics, while 162 (79%) were not. Conclusion: The QV-SAT is a quick and reliable test that can help dramatically reduce antibiotic prescriptions to children presenting with fever and acute pharyngotonsillitis.

Diagnosis of group A streptococcal pharyngitis in the paediatric emergency department using a fluorescence-based RADT: predicted impact on antibiotic prescription

“…This could be attributed to the higher sensitivity of the FIA-RADT compared to the standard culture method as discussed below. The sensitivity and specificity of the FIA-RADT in our study were very high; however, the percentages were lower than those reported in a recent study from the United Arab Emirates (UAE) [21]. This can be explained by the fact that 70 % of the population in the UAE study comprised children under 5 years of age, who are known to have low incidence of group A streptococcal pharyngitis.…”

High diagnostic accuracy of automated rapid Strep A test reduces antibiotic prescriptions for children in the United Arab Emirates

“…Among our patients, the prevalence of GAS pharyngitis was 30.9%. This is higher than the previously reported prevalence of 14% between 2004 and 2006 [23] and 20.6% between 2016 and 2018 [22] among children in the United Arab Emirates. The increase in reported prevalence in our current study could represent a referral bias of sicker children presenting to the ER rather than to an outpatient clinic.…”

“…This is the first study evaluating the accuracy of A-SAT in the Middle East. We have previously reported a high diagnostic accuracy of rapid streptococcal antigen tests, comparable to throat culture, when performed by an attending pediatrician in the outpatient clinic setting in the United Arab Emirates [22,23]. Unfortunately, those findings were not generalizable to a "real world" scenario where children are often assessed by general physicians and throat samples are taken by non-pediatric healthcare providers.…”

“…This laboratory runs 24 h and is accredited by the College of American Pathologists (CAP), Joint Commission International (JCI) and holds the ISO-15189 certification. Throat swabs for culture were inoculated as described previously [22].…”

“…We have previously reported a high diagnostic accuracy of QuickVue® Dipstick Strep A rapid test in a paediatric outpatient clinic setting where high-quality swabs were taken by the attending paediatrician [22]. A similar study in the UAE demonstrated a similarly high diagnostic accuracy of Diaquick Strep A Test [23].…”