Diagnostic accuracy of rapid nucleic acid tests for group A streptococcal pharyngitis: systematic review and meta-analysis.

Humans Nucleic Acid Amplification Techniques Nucleic Acids Pharyngitis / diagnosis Point-of-Care Testing Sensitivity and Specificity Streptococcus pyogenes
Diagnosis Diagnostic techniques and procedures Group A streptococcus Meta-analysis Molecular probe techniques Pharyngitis Sensitivity and specificity Streptococcus pyogenes Systematic review

Journal

Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
ISSN: 1469-0691
Titre abrégé: Clin Microbiol Infect
Pays: England
ID NLM: 9516420

Informations de publication

Date de publication:
Dec 2021
Historique:
received: 21 01 2021
revised: 15 04 2021
accepted: 19 04 2021
pubmed: 9 5 2021
medline: 13 1 2022
entrez: 8 5 2021
Statut: ppublish

Résumé

Acute pharyngitis is one of the most common conditions in outpatient settings and an important source of inappropriate antibiotic prescribing. Rapid antigen detection tests (RADTs) offer diagnosis of group A streptococcus at the point of care but have limited sensitivity. Rapid nucleic acid tests (RNATs) are now available; a systematic review of their accuracy is lacking. To evaluate the accuracy of RNATs in patients with pharyngitis; to explore test-level and study-level factors that could explain variability in accuracy; and to compare the accuracy of RNATs with that of RADTs. MEDLINE, Embase, Web of Science (1990-2020). Cross-sectional studies and randomized trials. Patients with pharyngitis. RNAT commercial kits compared with throat culture. We assessed risk of bias and applicability using QUADAS-2. We performed meta-analysis of sensitivity and specificity using the bivariate random-effects model. Variability was explored by subgroup analyses and meta-regression. We included 38 studies (46 test evaluations; 17 411 test results). RNATs were most often performed in a laboratory. The overall methodological quality of primary studies was uncertain because of incomplete reporting. RNATs had a summary sensitivity of 97.5% (95% CI 96.2%-98.3%) and a summary specificity of 95.1% (95% CI 93.6%-96.3%). There was low variability in estimates across studies. Variability in sensitivity and specificity was partially explained by test type (p < 0.05 for both). Sensitivity analyses limited to studies with low risk of bias showed robust accuracy estimates. RNATs were more sensitive than RADTs (13 studies; 96.8% versus 82.3%, p 0.004); there was no difference in specificity (p 0.92). The high diagnostic accuracy of RNATs may allow their use as stand-alone tests to diagnose group A streptococcus pharyngitis. Based on direct comparisons, RNATs have greater sensitivity than RADTs and equal specificity. Further studies should evaluate RNATs in point-of-care settings.

Sections du résumé

BACKGROUND BACKGROUND
Acute pharyngitis is one of the most common conditions in outpatient settings and an important source of inappropriate antibiotic prescribing. Rapid antigen detection tests (RADTs) offer diagnosis of group A streptococcus at the point of care but have limited sensitivity. Rapid nucleic acid tests (RNATs) are now available; a systematic review of their accuracy is lacking.
OBJECTIVES OBJECTIVE
To evaluate the accuracy of RNATs in patients with pharyngitis; to explore test-level and study-level factors that could explain variability in accuracy; and to compare the accuracy of RNATs with that of RADTs.
DATA SOURCES METHODS
MEDLINE, Embase, Web of Science (1990-2020).
STUDY ELIGIBILITY CRITERIA METHODS
Cross-sectional studies and randomized trials.
PARTICIPANTS METHODS
Patients with pharyngitis.
INDEX TEST/S AND REFERENCE STANDARDS UNASSIGNED
RNAT commercial kits compared with throat culture.
METHODS METHODS
We assessed risk of bias and applicability using QUADAS-2. We performed meta-analysis of sensitivity and specificity using the bivariate random-effects model. Variability was explored by subgroup analyses and meta-regression.
RESULTS RESULTS
We included 38 studies (46 test evaluations; 17 411 test results). RNATs were most often performed in a laboratory. The overall methodological quality of primary studies was uncertain because of incomplete reporting. RNATs had a summary sensitivity of 97.5% (95% CI 96.2%-98.3%) and a summary specificity of 95.1% (95% CI 93.6%-96.3%). There was low variability in estimates across studies. Variability in sensitivity and specificity was partially explained by test type (p < 0.05 for both). Sensitivity analyses limited to studies with low risk of bias showed robust accuracy estimates. RNATs were more sensitive than RADTs (13 studies; 96.8% versus 82.3%, p 0.004); there was no difference in specificity (p 0.92).
CONCLUSIONS CONCLUSIONS
The high diagnostic accuracy of RNATs may allow their use as stand-alone tests to diagnose group A streptococcus pharyngitis. Based on direct comparisons, RNATs have greater sensitivity than RADTs and equal specificity. Further studies should evaluate RNATs in point-of-care settings.

Identifiants

DOI: 10.1016/j.cmi.2021.04.021 PMID: 33964409
pubmed: 33964409
pii: S1198-743X(21)00208-1
doi: 10.1016/j.cmi.2021.04.021
pii:
doi:

Substances chimiques

Nucleic Acids 0

Types de publication

Journal Article Meta-Analysis Review Systematic Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

1736-1745

Commentaires et corrections

Type : CommentIn

Informations de copyright

Copyright © 2021 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Auteurs

Constance Dubois (C)

Université de Paris, Centre of Research in Epidemiology and Statistics (CRESS), INSERM, Paris, France.

Pierre R Smeesters (PR)

Academic Children Hospital Queen Fabiola, Université libre de Bruxelles, Department of Paediatrics, Brussels, Belgium; Molecular Bacteriology Laboratory, Université libre de Bruxelles, Brussels, Belgium.

Yacine Refes (Y)

APHP, FHU CHILD, Paris, France.

Corinne Levy (C)

Association Clinique et Thérapeutique Infantile du Val-de-Marne, ACTIV, Créteil, France.

Philippe Bidet (P)

Robert Debré Hospital, APHP, Université de Paris, Department of Microbiology, Paris, France.

Robert Cohen (R)

Association Clinique et Thérapeutique Infantile du Val-de-Marne, ACTIV, Créteil, France.

Martin Chalumeau (M)

Université de Paris, Centre of Research in Epidemiology and Statistics (CRESS), INSERM, Paris, France; Necker-Enfants malades Hospital, APHP, Université de Paris, Department of General Paediatrics and Paediatric Infectious Diseases, Paris, France.

Julie Toubiana (J)

Necker-Enfants malades Hospital, APHP, Université de Paris, Department of General Paediatrics and Paediatric Infectious Diseases, Paris, France; Institut Pasteur, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France.

Jérémie F Cohen (JF)

Université de Paris, Centre of Research in Epidemiology and Statistics (CRESS), INSERM, Paris, France; Necker-Enfants malades Hospital, APHP, Université de Paris, Department of General Paediatrics and Paediatric Infectious Diseases, Paris, France. Electronic address: jeremie.cohen@inserm.fr.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Diagnostic accuracy of rapid nucleic acid...
questionsmedicales.fr › Techniques d'investigation › Techniques génétiques › Techniques d'amplification d'acides nucléiques › Diagnostic accuracy of rapid nucleic acid...
questionsmedicales.fr › Acides nucléiques, nucléotides et nucléosides › Acides nucléiques › Diagnostic accuracy of rapid nucleic acid...
questionsmedicales.fr › Maladies oto-rhino-laryngologiques › Maladies du pharynx › Pharyngite › Diagnostic accuracy of rapid nucleic acid...
questionsmedicales.fr › Administration des services de santé › Gestion des soins aux patients › Systèmes automatisés lit malade › Analyse sur le lieu d'intervention › Diagnostic accuracy of rapid nucleic acid...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Sensibilité et spécificité › Diagnostic accuracy of rapid nucleic acid...
questionsmedicales.fr › Bactéries › Bactéries à Gram positif › Lactobacillales › Streptococcaceae › Streptococcus › Streptococcus pyogenes › Diagnostic accuracy of rapid nucleic acid...