二種快速鏈球菌檢查對於特殊的咽頭炎患者是有用的


  2003年6月6日—根據發表於6月小兒科期刊電子版本中的報告顯示,在陰性迅速鏈球菌試驗之後,反覆實施快速抗原試驗幾乎能與組織培養後的快速測試的敏感度不相上下,研究也顯示,這種方法在特定的病人中可能是有用的。
  
  丹佛市科羅拉多大學健康科學中心的Karen E.Gieseker博士說道,美國小兒科學院建議所有陰性迅速Streptococcus pyogenes咽頭炎的診斷測試必須經由組織培養所支援,使得臨床醫生診療時需在沒有完整診斷資訊下做出治療決定,並造成其困擾,透過使用後續的一系列迅速抗原試驗可以取代後續的組織培養而提供更適時的結果。
  
  研究由被懷疑患有 S. pyogenes 咽頭炎的887個孩子身上,各搜集約二個綿球的試樣,其中一個用於組織培養,而另一個使用 OSOM 特殊 Strep A 試驗之迅速抗原試驗,887 份咽喉培養中,有210(23.7%)份達到 Strep 咽頭炎的金色檢驗標準,可以被定義為在二個組織培養盤之中的任何一個經過鑒定定為S. pyogenes。
  
  研究中,在進行單一一次迅速抗原試驗時,其敏感度為 87.6%(95%信賴區間 [ CI ], 83.2%-92.1%),一次迅速抗原試驗後實施迅速抗原試驗時為91.4%(95% CI, 87.6%-95.2%);以及一次迅速抗原試驗後實施後續組織培養則為95.7%(95% CI, 93.0%-98.5%),與其他二者比較下明顯的來得高。
  
  然而,當這些試驗策略施用於具有S. pyogenes 咽頭炎相關的臨床徵兆子群組中進行評估時,所有的敏感度皆增加,其中沒有任何的策略顯著的與其他二者不同,並沒有超過 95% 敏感度極限值。
  
  作者表示,美國小兒科學會用於患咽炎孩童身上的 S. pyogenes偵測策略,多需要實施組織培養以支援陰性抗原的測試,沒有任何其他的試驗策略能突破,可是,快速、迅速的診斷策略可以明智的替病患的挑選臨床操作而達到近似之效果,很明顯地,在問診診療時能提供準確度的策略,最好能以單一試驗、具有重要性、且能在 S.pyogenes 咽頭炎的診斷上,提供附加研究調查的挑戰。
  

Two Rapid Strep Tests May Be U

By Laurie Barclay, MD
Medscape Medical News

June 6, 2003 — Following a negative rapid Strep test with a repeat rapid antigen test was almost as sensitive as the rapid test followed by culture, according to a report in the electronic edition of the June issue of Pediatrics. This approach may be useful in select patients.

"The American Academy of Pediatrics recommends that all negative rapid diagnostic tests for Streptococcus pyogenes pharyngitis be backed up by culture, which creates a dilemma for clinicians who must make treatment decisions without complete diagnostic information at the time of visit," write Karen E. Gieseker, PhD, from the University of Colorado Health Sciences Center in Denver. "The use of a follow-up serial rapid antigen test instead of a follow-up culture would provide a more timely result."

Two swabs were collected from each of 887 children suspected of having S. pyogenes pharyngitis, one for culture and one for an OSOM Ultra Strep A Test rapid antigen test. Of 887 throat cultures, 210 (23.7%) met the gold standard for diagnosis of Strep pharyngitis, defined as the identification of S. pyogenes on either of two culture plates.

Sensitivity was 87.6% (95% confidence interval [CI], 83.2% - 92.1%) for a single rapid antigen test; 91.4% (95% CI, 87.6% - 95.2%) for a rapid antigen test with follow-up rapid antigen test; and 95.7% (95% CI, 93.0% - 98.5%) for a rapid antigen test with follow-up culture, which was significantly higher than the others.

However, when these test strategies were evaluated in a subgroup with clinical symptoms typically associated with S. pyogenes pharyngitis, all the sensitivities increased. None of the strategies were significantly different from each other, and none reliably exceeded a 95% sensitivity threshold.

"The American Academy of Pediatrics strategy for S. pyogenes detection in children with pharyngitis, requiring a backup culture for those with negative antigen tests, was not exceeded by any other test strategy; however, a rapid-rapid diagnostic strategy may approximate it with the use of judicious clinical selection of patients." the authors write. "Clearly, a strategy that provides accuracy in diagnosis at the time of visit, preferably with a single test, is of importance and is a challenge that invites additional research on the diagnosis of S. pyogenes pharyngitis."

Genzyme funded this study.

Pediatrics. 2003;111:e666-e670

Reviewed by Gary D. Vogin, MD

    
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