Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Mar 24;9(5):ofac147.
doi: 10.1093/ofid/ofac147. eCollection 2022 May.

The Impact of Point-of-Care Polymerase Chain Reaction Testing on Prescribing Practices in Primary Care for Management of Strep A: A Retrospective Before-After Study

Larissa May  1 , Joanna Sickler  2 , Elissa M Robbins  2 , Shaowu Tang  2 , Kamal Chugh  2 , Nam Tran  3
Affiliations

The Impact of Point-of-Care Polymerase Chain Reaction Testing on Prescribing Practices in Primary Care for Management of Strep A: A Retrospective Before-After Study

Larissa May et al. Open Forum Infect Dis. .

Abstract

Background: Rapid antigen detection tests (RADTs) are the standard of care (SOC) for testing in patients with suspected group A β-hemolytic Streptococcus (Strep A) infection. Due to lower sensitivity, guidelines recommend confirmatory microbiological culture following negative RADT results. This process is time-consuming, and adherence is often poor, resulting in high rates of inappropriate antibiotic prescribing. We sought to evaluate the impact of switching from RADTs to point-of-care (POC) polymerase chain reaction (PCR) testing on use of antibiotics in primary care, when used as part of an antibiotic stewardship initiative.

Methods: In this retrospective before-after study, electronic medical records of any patients presenting with suspected acute pharyngitis (June 2018-May 2019) across 15 outpatient primary care clinics were evaluated. Strep A was detected using the cobas Strep A assay (cobas Liat system).

Results: Analysis of 10 081 eligible patient records showed that POC PCR testing resulted in a 44.1% reduction in antibiotic prescribing for patients with a negative POC PCR test result (10.1% PCR vs 18.0% RADT; P < .0001). Rates of antibiotic prescription varied across clinical sites, ranging between 10.7% and 33.8% and 12.4% and 34.4% during the use of PCR tests and RADTs, respectively. POC PCR had no impact on prescription rates in patients with positive POC test results compared to RADTs (76.2% vs 76.5%, respectively). More than 99% of antibiotics were prescribed during the initial primary care encounter.

Conclusions: As part of a broader antibiotic stewardship initiative, implementation of POC PCR as SOC in outpatients with acute pharyngitis symptoms reduced the volume of inappropriate antibiotic prescriptions.

Keywords: Streptococcus pyogenes; antibiotic stewardship; nucleic acid amplification test; point-of-care testing; rapid antigen detection test.

PubMed Disclaimer

References

    1. et al. National ambulatory medical care survey: 2018 national summary tables. 2021. https://www.cdc.gov/nchs/data/nhamcs/web_tables/2018-ed-web-tables-508.pdf. Accessed 30 March 2022.
    1. Bisno A. Acute pharyngitis: etiology and diagnosis. Pediatrics 1996; 97:949–54. - PubMed
    1. Shaikh N, Leonard E, Martin JM.. Prevalence of streptococcal pharyngitis and streptococcal carriage in children: a meta-analysis. Pediatrics 2010; 126:e557–64. - PubMed
    1. Ebell MH, Smith MA, Barry HC, Ives K, Carey M.. The rational clinical examination. Does this patient have strep throat? JAMA 2000; 284:2912–8. - PubMed
    1. Shulman S, Bisno A, Clegg H, et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis 2012; 55:e86–102. - PMC - PubMed