SOCIEDAD ANDALUZA DE MICROBIOLOGÍA Y PARASITOLOGÍA



SOCIEDAD ANDALUZA DE MICROBIOLOG?A Y PARASITOLOG?ARECOMENDACIONES PARA LA UTILIZACI?N DE PRUEBAS R?PIDAS DE DETECCI?N DE ANT?GENO DE ESTREPTOCOCOS DEL GRUPO A EN LAS CONSULTAS DE PEDIATR?A DE ATENCI?N PRIMARIALa faringoamigdalitis por estreptococos del grupo A (SGA) puede ser una enfermedad leve, pero su trascendencia clínica se deriva de la aparición de posibles complicaciones como la glomerulonefritis postestreptocócica y la fiebre reumática aguda. La administración precoz de tratamiento específico tiene como objetivo principal prevenir complicaciones, en particular la fiebre reumática, disminuir la morbilidad asociada y la erradicación de S. pyogenes de la orofaringe para interrumpir la transmisión. Entre un 20-40% de los episodios de faringitis en la edad pediátrica son causados por SGA, con una mayor incidencia entre los 5-15 a?os ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1542/peds.2009-2648", "ISSN" : "1098-4275", "PMID" : "20696723", "abstract" : "OBJECTIVES: Prevalence estimates can help clinicians make informed decisions regarding diagnostic testing of children who present with symptoms of pharyngitis. We conducted a meta-analysis to determine the (1) prevalence of streptococcal infection among children who presented with sore throat and (2) prevalence of streptococcal carriage among asymptomatic children.\n\nMETHODS: We searched Medline for articles on pediatric streptococcal pharyngitis. We included articles in our review when they contained data on the prevalence of group A Streptococcus (GAS) from pharyngeal specimens in children who were younger than 18 years. Two evaluators independently reviewed, rated, and abstracted data from each article. Prevalence estimates were pooled in a meta-analysis and stratified according to age group.\n\nRESULTS: Of the 266 articles retrieved, 29 met all inclusion criteria. Among children of all ages who present with sore throat, the pooled prevalence of GAS was 37% (95% confidence interval [CI]: 32%-43%). Children who were younger than 5 years had a lower prevalence of GAS (24% [95% CI: 21%-26%]). The prevalence of GAS carriage among well children with no signs or symptoms of pharyngitis was 12% (95% CI: 9%-14%).\n\nCONCLUSIONS: Prevalence rates of GAS disease and carriage varied by age; children who were younger than 5 years had lower rates of throat cultures that were positive for GAS.", "author" : [ { "dropping-particle" : "", "family" : "Shaikh", "given" : "Nader", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Leonard", "given" : "Erica", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Martin", "given" : "Judith M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Pediatrics", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2010", "9", "1" ] ] }, "page" : "e557-64", "title" : "Prevalence of streptococcal pharyngitis and streptococcal carriage in children: a meta-analysis.", "type" : "article-journal", "volume" : "126" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(1)", "plainTextFormattedCitation" : "(1)", "previouslyFormattedCitation" : "(1)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(1) . En los menores de 3 a?os y en los adultos la mayoría de estos cuadros son de origen viral, siendo muy bajo el riesgo de faringoamigdalitis por SGA y las complicaciones post-estreptocócicas ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1093/cid/cis629", "ISSN" : "10584838", "PMID" : "22965026", "abstract" : "The guideline is intended for use by healthcare providers who care for adult and pediatric patients with group A streptococcal pharyngitis. The guideline updates the 2002 Infectious Diseases Society of America guideline and discusses diagnosis and management, and recommendations are provided regarding antibiotic choices and dosing. Penicillin or amoxicillin remain the treatments of choice, and recommendations are made for the penicillin-allergic patient, which now include clindamycin.", "author" : [ { "dropping-particle" : "", "family" : "Shulman", "given" : "Stanford T.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bisno", "given" : "Alan L.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Clegg", "given" : "Herbert W.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gerber", "given" : "Michael a.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kaplan", "given" : "Edward L.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lee", "given" : "Grace", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Martin", "given" : "Judith M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Beneden", "given" : "Chris", "non-dropping-particle" : "Van", "parse-names" : false, "suffix" : "" } ], "container-title" : "Clinical Infectious Diseases", "id" : "ITEM-1", "issue" : "10", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "86-102", "title" : "Clinical practice guideline for the diagnosis and management of group a streptococcal pharyngitis: 2012 update by the infectious diseases society of America", "type" : "article-journal", "volume" : "55" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(2)", "manualFormatting" : "(2", "plainTextFormattedCitation" : "(2)", "previouslyFormattedCitation" : "(2)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(2,ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Cots", "given" : "Josep Maria", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Al\u00f3s", "given" : "Juan-Ignacio", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "B\u00e1rcena", "given" : "Mario", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Boleda", "given" : "Xavier", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ca\u00f1ada", "given" : "Jos\u00e9 Luis", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "G\u00f3mez", "given" : "Niceto", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mendoza", "given" : "Ana", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vilaseca", "given" : "Isabel", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Llor", "given" : "Carles", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Atenci\u00f3n Primaria", "id" : "ITEM-1", "issue" : "8", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "532-543", "title" : "Recomendaciones para el manejo de la faringoamigdalitis aguda del adulto", "type" : "article-journal", "volume" : "47" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(3)", "manualFormatting" : "3)", "plainTextFormattedCitation" : "(3)", "previouslyFormattedCitation" : "(3)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }3).El diagnóstico basado exclusivamente en criterios clínicos no es lo suficientemente sensible y específico como para diferenciar eficazmente los cuadros de origen vírico de los bacterianos ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.1469-0691.2012.03766.x", "ISSN" : "1198743X", "abstract" : "The European Society for Clinical Microbiology and Infectious Diseases established the Sore Throat Guideline Group to write an updated guideline to diagnose and treat patients with acute sore throat. In diagnosis, Centor clinical scoring system or rapid antigen test can be helpful in targeting antibiotic use. The Centor scoring system can help to identify those patients who have higher likelihood of group A streptococcal infection. In patients with high likelihood of streptococcal infections (e.g. 3-4 Centor criteria) physicians can consider the use of rapid antigen test (RAT). If RAT is performed, throat culture is not necessary after a negative RAT for the diagnosis of group A streptococci. To treat sore throat, either ibuprofen or paracetamol are recommended for relief of acute sore throat symptoms. Zinc gluconate is not recommended to be used in sore throat. There is inconsistent evidence of herbal treatments and acupuncture as treatments for sore throat. Antibiotics should not be used in patients with less severe presentation of sore throat, e.g. 0-2 Centor criteria to relieve symptoms. Modest benefits of antibiotics, which have been observed in patients with 3-4 Centor criteria, have to be weighed against side effects, the effect of antibiotics on microbiota, increased antibacterial resistance, medicalisation and costs. The prevention of suppurative complications is not a specific indication for antibiotic therapy in sore throat. If antibiotics are indicated, penicillin V, twice or three times daily for 10days is recommended. At the present, there is no evidence enough that indicates shorter treatment length. (copyright) 2012 The Authors. Clinical Microbiology and Infection (copyright) 2012 European Society of Clinical Microbiology and Infectious Diseases", "author" : [ { "dropping-particle" : "", "family" : "Pelucchi", "given" : "C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Grigoryan", "given" : "L.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Galeone", "given" : "C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Esposito", "given" : "S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Huovinen", "given" : "P.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Little", "given" : "P.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Verheij", "given" : "T.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Clinical Microbiology and Infection", "id" : "ITEM-1", "issue" : "SUPPL.1", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "1-28", "publisher" : "European Society of Clinical Microbiology and Infectious Diseases", "title" : "Guideline for the management of acute sore throat: ESCMID Sore Throat Guideline Group C. Pelucchi et al. Guideline for management of acute sore throat", "type" : "article-journal", "volume" : "18" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(4)", "plainTextFormattedCitation" : "(4)", "previouslyFormattedCitation" : "(4)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(4), por lo que un porcentaje importante de los cuadros de faringoamigdalitis aguda en atención primaria reciben tratamiento antibiótico sin que sea necesario. El cultivo del exudado faringoamigdalar es el procedimiento de referencia y el resultado definitivo se obtiene en 48 horas. Las técnicas rápidas de detección de antígeno (TRDA) estreptocócico permiten realizar un diagnóstico etiológico en pocos minutos con una elevada especificidad y en general buena sensibilidad.Actualmente, la evidencia científica disponible se?ala que las TRDA para detección de SGA realizadas en las consultas de Atención Primaria pueden ser una herramienta útil en el manejo de la faringoamigdalitis aguda y mejorar la prescripción de antibióticos en este ámbito ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.aprim.2014.02.006", "ISSN" : "15781275", "PMID" : "24768657", "abstract" : "Objective: To evaluate the effectiveness of two types of intervention in reducing antibiotic prescribing in respiratory tract infections (RTI).\nDesign: Before-after audit-based study.\nSetting: Primary Care centres in Spain.\nParticipants: General practitioners (GPs) registered all patients with RTIs for 15 days in winter 2008 (pre-intervention), and again in winter 2009 (post-intervention).\nInterventions: Intervention activities included meetings, with the presentation and discussion of the results, and several training meetings on RTI guidelines, information brochures for patients, workshops on point-of-care tests - rapid antigen detection tests and C-reactive protein rapid test - and provision of these tests in the clinic. All GPs, with the exception of those in Catalonia, made up the full intervention group (FIG); conversely, Catalan doctors underwent the same intervention, except for the workshop on rapid tests (partial intervention group, PIG). Multilevel logistic regression was performed taking the prescription of antibiotics as the dependent variable.\nResults: Out of a total of 309 GPs involved in the first register, 281 completed the intervention and the second register (90.9%), of which 210 were assigned to the FIG, and 71 to the PIG. The odds ratio of antibiotic prescribing after the intervention was 0.99 (95% CI: 0.89-1.10) among GPs assigned to PIG, and 0.50 (95% CI: 0.44-0.57, p < 0.001) among those who were allocated to FIG. The reduction in antibiotic prescribing in FIG was more marked in flu infection, common cold, acute pharyngitis, acute tonsillitis, and acute bronchitis.\nConclusions: Active participation of GPs with the performance of point-of-care tests in the clinic is accompanied by a drastic reduction of antibiotic use in RTIs, primarily in infections considered as mainly viral.", "author" : [ { "dropping-particle" : "", "family" : "Llor", "given" : "Carles", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cots", "given" : "Josep Maria", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hern\u00e1ndez", "given" : "Silvia", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ortega", "given" : "Jes\u00fas", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Arranz", "given" : "Javier", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Monedero", "given" : "Mar\u00eda Jos\u00e9", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Alc\u00e1ntara", "given" : "Juan De Dios", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "P\u00e9rez", "given" : "Carolina", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Garc\u00eda", "given" : "Guillermo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "G\u00f3mez", "given" : "Manuel", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Guerra", "given" : "Gloria", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cid", "given" : "Marina", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cig\u00fcenza", "given" : "Mar\u00eda Luisa", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pineda", "given" : "Vicenta", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Paredes", "given" : "Jos\u00e9", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Burgazzoli", "given" : "Juan Luis", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Munck", "given" : "Anders", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cordoba-Currea", "given" : "Gloria", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bjerrum", "given" : "Lars", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Atencion Primaria", "id" : "ITEM-1", "issue" : "9", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "492-500", "title" : "Effectiveness of two types of intervention on antibiotic prescribing in respiratory tract infections in Primary Care in Spain. Happy Audit Study", "type" : "article-journal", "volume" : "46" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(5)", "manualFormatting" : "(5", "plainTextFormattedCitation" : "(5)", "previouslyFormattedCitation" : "(5)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(5,ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1093/cid/cis629", "ISSN" : "10584838", "PMID" : "22965026", "abstract" : "The guideline is intended for use by healthcare providers who care for adult and pediatric patients with group A streptococcal pharyngitis. The guideline updates the 2002 Infectious Diseases Society of America guideline and discusses diagnosis and management, and recommendations are provided regarding antibiotic choices and dosing. Penicillin or amoxicillin remain the treatments of choice, and recommendations are made for the penicillin-allergic patient, which now include clindamycin.", "author" : [ { "dropping-particle" : "", "family" : "Shulman", "given" : "Stanford T.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bisno", "given" : "Alan L.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Clegg", "given" : "Herbert W.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gerber", "given" : "Michael a.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kaplan", "given" : "Edward L.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lee", "given" : "Grace", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Martin", "given" : "Judith M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Beneden", "given" : "Chris", "non-dropping-particle" : "Van", "parse-names" : false, "suffix" : "" } ], "container-title" : "Clinical Infectious Diseases", "id" : "ITEM-1", "issue" : "10", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "86-102", "title" : "Clinical practice guideline for the diagnosis and management of group a streptococcal pharyngitis: 2012 update by the infectious diseases society of America", "type" : "article-journal", "volume" : "55" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(2)", "manualFormatting" : "2)", "plainTextFormattedCitation" : "(2)", "previouslyFormattedCitation" : "(2)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }2).Ante la solicitud por parte de Asociación Espa?ola de Pediatría de Atención Primaria (AEPap) de la incorporación de estas técnicas a la dotación de las consultas de Atención primaria, la Sociedad Andaluza de Microbiología y Parasitología (SAMPAC) considera que la aplicación de estos métodos diagnósticos en las consultas sería muy útil para los clínicos y beneficioso para los pacientes.Sin embargo, queremos destacar que la implantación de esta metodología debe realizarse mediante el trabajo en equipo de Pediatría y Microbiología. Los microbiólogos, en colaboración con los pediatras, deben participar en las tareas de asesoramiento, formación y seguimiento del proceso para que esta intervención tenga un impacto positivo en el manejo de los pacientes.Selección de la población a la que aplicar las TRDA. Este aspecto requiere el asesoramiento y seguimiento por parte de Pediatría.Las TRDA ofrecen resultados más fiables y precisos cuando se aplican en poblaciones con mayor probabilidad de padecer faringoamigdalitis por SGA ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1128/CMR.17.3.571", "author" : [ { "dropping-particle" : "", "family" : "Gerber", "given" : "Michael A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Shulman", "given" : "Stanford T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Clinical Microbiology Reviews", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2004" ] ] }, "page" : "571-580", "title" : "Rapid Diagnosis of Pharyngitis Caused by Group A Streptococci Rapid Diagnosis of Pharyngitis Caused by Group A Streptococci", "type" : "article-journal", "volume" : "17" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1371/journal.pone.0039085", "ISBN" : "10.1371/journal.pone.0039085", "ISSN" : "1932-6203", "PMID" : "22768060", "abstract" : "BACKGROUND: The stability of the accuracy of a diagnostic test is critical to whether clinicians can rely on its result. We aimed to assess whether the performance of a rapid antigen detection test (RADT) for group A streptococcus (GAS) is affected by the clinical spectrum and/or bacterial inoculum size.\n\nMETHODS: Throat swabs were collected from 785 children with pharyngitis in an office-based, prospective, multicenter study (2009-2010). We analysed the effect of clinical spectrum (i.e., the McIsaac score and its components) and inoculum size (light or heavy GAS growth) on the accuracy (sensitivity, specificity, likelihood ratios and predictive values) of a RADT, with laboratory throat culture as the reference test. We also evaluated the accuracy of a McIsaac-score-based decision rule.\n\nRESULTS: GAS prevalence was 36% (95CI: 33%-40%). The inoculum was heavy for 85% of cases (81%-89%). We found a significant spectrum effect on sensitivity, specificity, likelihood ratios and positive predictive value (p<0.05) but not negative predictive value, which was stable at about 92%. RADT sensitivity was greater for children with heavy than light inoculum (95% vs. 40%, p<0.001). After stratification by inoculum size, the spectrum effect on RADT sensitivity was significant only in patients with light inoculum, on univariate and multivariate analysis. The McIsaac-score-based decision rule had 99% (97%-100%) sensitivity and 52% (48%-57%) specificity.\n\nCONCLUSIONS: Variations in RADT sensitivity only occur in patients with light inocula. Because the spectrum effect does not affect the negative predictive value of the test, clinicians who want to rule out GAS can rely on negative RADT results regardless of clinical features if they accept that about 10% of children with negative RADT results will have a positive throat culture. However, such a policy is more acceptable in populations with very low incidence of complications of GAS infection.", "author" : [ { "dropping-particle" : "", "family" : "Cohen", "given" : "J\u00e9r\u00e9mie F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chalumeau", "given" : "Martin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Levy", "given" : "Corinne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bidet", "given" : "Philippe", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thollot", "given" : "Franck", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wollner", "given" : "Alain", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bingen", "given" : "Edouard", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cohen", "given" : "Robert", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "PloS one", "id" : "ITEM-2", "issue" : "6", "issued" : { "date-parts" : [ [ "2012", "1", "29" ] ] }, "page" : "e39085", "publisher" : "Public Library of Science", "title" : "Spectrum and inoculum size effect of a rapid antigen detection test for group A streptococcus in children with pharyngitis.", "type" : "article-journal", "volume" : "7" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(6, 7)", "plainTextFormattedCitation" : "(6, 7)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(6, 7). Las guías de práctica clínica actuales recomiendan seleccionar a los pacientes a los que se les van a realizan estas pruebas mediante escalas basadas en criterios clínicos ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.1469-0691.2012.03766.x", "ISSN" : "1198743X", "abstract" : "The European Society for Clinical Microbiology and Infectious Diseases established the Sore Throat Guideline Group to write an updated guideline to diagnose and treat patients with acute sore throat. In diagnosis, Centor clinical scoring system or rapid antigen test can be helpful in targeting antibiotic use. The Centor scoring system can help to identify those patients who have higher likelihood of group A streptococcal infection. In patients with high likelihood of streptococcal infections (e.g. 3-4 Centor criteria) physicians can consider the use of rapid antigen test (RAT). If RAT is performed, throat culture is not necessary after a negative RAT for the diagnosis of group A streptococci. To treat sore throat, either ibuprofen or paracetamol are recommended for relief of acute sore throat symptoms. Zinc gluconate is not recommended to be used in sore throat. There is inconsistent evidence of herbal treatments and acupuncture as treatments for sore throat. Antibiotics should not be used in patients with less severe presentation of sore throat, e.g. 0-2 Centor criteria to relieve symptoms. Modest benefits of antibiotics, which have been observed in patients with 3-4 Centor criteria, have to be weighed against side effects, the effect of antibiotics on microbiota, increased antibacterial resistance, medicalisation and costs. The prevention of suppurative complications is not a specific indication for antibiotic therapy in sore throat. If antibiotics are indicated, penicillin V, twice or three times daily for 10days is recommended. At the present, there is no evidence enough that indicates shorter treatment length. (copyright) 2012 The Authors. Clinical Microbiology and Infection (copyright) 2012 European Society of Clinical Microbiology and Infectious Diseases", "author" : [ { "dropping-particle" : "", "family" : "Pelucchi", "given" : "C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Grigoryan", "given" : "L.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Galeone", "given" : "C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Esposito", "given" : "S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Huovinen", "given" : "P.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Little", "given" : "P.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Verheij", "given" : "T.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Clinical Microbiology and Infection", "id" : "ITEM-1", "issue" : "SUPPL.1", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "1-28", "publisher" : "European Society of Clinical Microbiology and Infectious Diseases", "title" : "Guideline for the management of acute sore throat: ESCMID Sore Throat Guideline Group C. Pelucchi et al. Guideline for management of acute sore throat", "type" : "article-journal", "volume" : "18" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(4)", "manualFormatting" : "(3", "plainTextFormattedCitation" : "(4)", "previouslyFormattedCitation" : "(4)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(3ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1093/cid/cis629", "ISSN" : "10584838", "PMID" : "22965026", "abstract" : "The guideline is intended for use by healthcare providers who care for adult and pediatric patients with group A streptococcal pharyngitis. The guideline updates the 2002 Infectious Diseases Society of America guideline and discusses diagnosis and management, and recommendations are provided regarding antibiotic choices and dosing. Penicillin or amoxicillin remain the treatments of choice, and recommendations are made for the penicillin-allergic patient, which now include clindamycin.", "author" : [ { "dropping-particle" : "", "family" : "Shulman", "given" : "Stanford T.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bisno", "given" : "Alan L.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Clegg", "given" : "Herbert W.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gerber", "given" : "Michael a.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kaplan", "given" : "Edward L.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lee", "given" : "Grace", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Martin", "given" : "Judith M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Beneden", "given" : "Chris", "non-dropping-particle" : "Van", "parse-names" : false, "suffix" : "" } ], "container-title" : "Clinical Infectious Diseases", "id" : "ITEM-1", "issue" : "10", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "86-102", "title" : "Clinical practice guideline for the diagnosis and management of group a streptococcal pharyngitis: 2012 update by the infectious diseases society of America", "type" : "article-journal", "volume" : "55" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(2)", "manualFormatting" : ", 5)", "plainTextFormattedCitation" : "(2)", "previouslyFormattedCitation" : "(2)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }, 5) como Centor ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "0272-989X", "PMID" : "6763125", "abstract" : "Adult patients who presented to an urban emergency room complaining of a sore throat had cultures and clinical information recorded. Models were constructed, using logistic regression analysis, of both a positive culture for Group A beta streptococcus and a positive guess by a resident. The model of a positive culture consisted of four variables--tonsillar exudates, swollen tender anterior cervical nodes, lack of a cough, and history of fever. Patients with all 4 variables had a 56% probability of a positive culture; 3 variables, 32%; 2 variables, 15%; 1 variable, 6.5%; and 0 variables, 2.5%. The model of a positive guess by a resident demonstrated an over-reliance on physical exam and an underuse of history. The model of a positive culture allows stratification of patients to assist clinicians in the management strategies.", "author" : [ { "dropping-particle" : "", "family" : "Centor", "given" : "R M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Witherspoon", "given" : "J M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dalton", "given" : "H P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brody", "given" : "C E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Link", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medical decision making : an international journal of the Society for Medical Decision Making", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "1981", "1" ] ] }, "page" : "239-46", "title" : "The diagnosis of strep throat in adults in the emergency room.", "type" : "article-journal", "volume" : "1" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(8)", "plainTextFormattedCitation" : "(8)", "previouslyFormattedCitation" : "(8)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(8) o McIsaac ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "0820-3946", "PMID" : "9475915", "abstract" : "OBJECTIVE: To validate a score based on clinical symptoms and signs for the identification of group A Streptococcus (GAS) infection in general practice patients with score throat. DESIGN: A single throat swab was used as the gold standard for diagnosing GAS infection. Clinical information was recorded by experienced family physicians on standardized encounter forms. Score criteria were identified by means of logistic regression modelling of data from patients enrolled in the first half of the study. The score was then validated among the remaining patients. SETTING: University-affiliated family medicine centre in Toronto. PATIENTS: A total of 521 patients aged 3 to 76 years presenting with a new upper respiratory tract infection from December 1995 to February 1997. OUTCOME MEASURES: Sensitivity, specificity and likelihood ratios for identification of GAS infection with the score approach compared with throat culture. Proportion of patients prescribed antibiotics, throat culture use, and sensitivity and specificity with usual physician care and with score-based recommendations were compared. RESULTS: A score was developed ranging in value from 0 to 4. The sensitivity of the score for identifying GAS infection was 83.1%, compared with 69.4% for usual physician care (p = 0.06); the specificity values of the 2 approaches were similar. Among patients aged 3 to 14 years, the sensitivity of the score approach was higher than that of usual physician care (96.9% v. 70.6%) (p < 0.05). The proportion of patients receiving initial antibiotic prescriptions would have been reduced 48% by following score-based recommendations compared with observed physician prescribing (p < 0.001), without any increase in throat culture use. CONCLUSIONS: An age-appropriate sore throat score identified GAS infection in children and adults with sore throat better than usual care by family physicians, with significant reductions in unnecessary prescribing of antibiotics. A randomized trial comparing the 2 approaches is recommended to determine the ability of the score approach to reduce unnecessary prescribing of antibiotics during routine clinical encounters.", "author" : [ { "dropping-particle" : "", "family" : "McIsaac", "given" : "W J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "White", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tannenbaum", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Low", "given" : "D E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Canadian Medical Association journal", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "1998", "1", "13" ] ] }, "page" : "75-83", "title" : "A clinical score to reduce unnecessary antibiotic use in patients with sore throat.", "type" : "article-journal", "volume" : "158" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(9)", "plainTextFormattedCitation" : "(9)", "previouslyFormattedCitation" : "(9)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(9). Por lo general estas escalas tienen mayor valor predictivo negativo que positivo, por lo que permiten descartar a los individuos con baja probabilidad de padecer faringitis estreptocócica, de manera que aumentan la validez de las TRDA y el coste-efectividad de la medida ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s00431-011-1410-0", "ISSN" : "1432-1076", "PMID" : "21308380", "abstract" : "Acute pharyngitis is one of the most frequent causes of primary care physician visits; however, there is no agreement about which is the best strategy to diagnose and manage acute pharyngitis in children. The aim of the current study was to evaluate the cost-effectiveness of the recommended strategies to diagnose and manage acute pharyngitis in a paediatric population. A decision tree analysis was performed to compare the following six strategies: \"treat all\", \"clinical scoring\", \"rapid test\", \"culture\", \"rapid test + culture\" and \"clinical scoring + rapid test\". The cost data came from the Spanish National Health Service sources. Cost-effectiveness was calculated from the payer's perspective. Effectiveness was measured as the proportion of patients cured without complications from the disease and did not have any reaction to penicillin therapy; a sensitivity analysis was performed. The findings revealed that the \"clinical scoring + rapid test\" strategy is the most cost-effective, with a cost-effectiveness ratio of 50.72 <euro>. This strategy dominated all others except \"culture\", which was the most effective but also the most costly. The sensitivity analysis showed that \"rapid test\" became the most cost-effective strategy when the clinical scoring sensitivity was <91% and its specificity was \u22649%. In conclusion, the use of a clinical scoring system to triage the diagnoses and performing a rapid antigen test for those with a high score is the most cost-effective strategy for the diagnosis and management of acute pharyngitis in children. When the clinical scoring system has a low diagnostic accuracy, testing all patients with rapid test becomes the most cost-effective strategy.", "author" : [ { "dropping-particle" : "", "family" : "Giraldez-Garcia", "given" : "Carolina", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rubio", "given" : "Beltran", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gallegos-Braun", "given" : "Jose F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Imaz", "given" : "I\u00f1aki", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gonzalez-Enriquez", "given" : "Jesus", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sarria-Santamera", "given" : "Antonio", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "European journal of pediatrics", "id" : "ITEM-1", "issue" : "8", "issued" : { "date-parts" : [ [ "2011", "8" ] ] }, "page" : "1059-67", "title" : "Diagnosis and management of acute pharyngitis in a paediatric population: a cost-effectiveness analysis.", "type" : "article-journal", "volume" : "170" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(10)", "plainTextFormattedCitation" : "(10)", "previouslyFormattedCitation" : "(10)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(10).El documento de la AEPap “Utilidad del test rápido de detección de antígeno estreptocócico en el abordaje de la faringoamigdalitis aguda en pediatría”ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Garc\u00eda Vera", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Asociaci\u00f3n espa\u00f1ola de pediatr\u00eda de atenci\u00f3n primaria.", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "1-11", "title" : "Utilidad del test r\u00e1pido de detecci\u00f3n de ant\u00edgeno estreptoc\u00f3cico (TRDA) en el abordaje de la faringoamigdalitis aguda en pediatr\u00eda", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(11)", "plainTextFormattedCitation" : "(11)", "previouslyFormattedCitation" : "(11)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(11), detalla claramente qué criterios deben cumplirse y a qué pacientes se les realizaría el TRDA:Se realizará TRDA de SGA en ni?os de edad ≥ 3* a?os, en los que tras aplicar la escala clínica de Centor (fiebre mayor de 38?C, adenopatías subangulomandibulares, exudado amigdalar, ausencia de tos) o McIsaac (igual, pero da un punto más cuando la edad de los pacientes es 3-14 a?os), obtienen una puntuación de 3-4 en el caso de aplicar el test de Centor y 4-5 para el test de McIsaac.*En el documento AEPap recomiendan como edad de corte 4 a?os. En la guía clínica IDSA recomiendan menores de 3 a?os ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1093/cid/cis629", "ISSN" : "10584838", "PMID" : "22965026", "abstract" : "The guideline is intended for use by healthcare providers who care for adult and pediatric patients with group A streptococcal pharyngitis. The guideline updates the 2002 Infectious Diseases Society of America guideline and discusses diagnosis and management, and recommendations are provided regarding antibiotic choices and dosing. Penicillin or amoxicillin remain the treatments of choice, and recommendations are made for the penicillin-allergic patient, which now include clindamycin.", "author" : [ { "dropping-particle" : "", "family" : "Shulman", "given" : "Stanford T.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bisno", "given" : "Alan L.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Clegg", "given" : "Herbert W.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gerber", "given" : "Michael a.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kaplan", "given" : "Edward L.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lee", "given" : "Grace", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Martin", "given" : "Judith M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Beneden", "given" : "Chris", "non-dropping-particle" : "Van", "parse-names" : false, "suffix" : "" } ], "container-title" : "Clinical Infectious Diseases", "id" : "ITEM-1", "issue" : "10", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "86-102", "title" : "Clinical practice guideline for the diagnosis and management of group a streptococcal pharyngitis: 2012 update by the infectious diseases society of America", "type" : "article-journal", "volume" : "55" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(2)", "plainTextFormattedCitation" : "(2)", "previouslyFormattedCitation" : "(2)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(2).Se recomienda no realizar TRDA de SGA en los siguientes casos:1. Alta sospecha de infección viral: a pesar de cumplir alguno de los criterios de los test de Centor/McIsaac se detectan síntomas o signos claros de infección viral (tos, mucosidad, ronquera, vesículas en el paladar y en pilares anteriores,…) (no es necesario tratar ni realizar cultivo bacteriano.2. Paciente que haya recibido antibioterapia en los días previos. 3. Paciente inmunodeprimido (tratamiento en todos los casos, no es necesario realizar cultivo bacteriano).4. Paciente con historia de fiebre reumática (tratar siempre, no realizar cultivo bacteriano).5. Contexto de brote comunitario por SGA (tratar, no realizar cultivo bacteriano).6. Faringitis crónica (validez menor del test, realizar cultivo).7. Menores de 3* a?os, salvo que exista algún criterio suplementario que sugiera infección estreptocócica (ambiente epidémico, exantema escarlatiniforme, petequias en paladar, lengua aframbuesada,…) debido a la baja incidencia en este grupo de edad.*En el documento AEPap recomiendan como edad de corte 4 a?os. En la guía clínica IDSA recomiendan menores de 3 a?os ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1093/cid/cis629", "ISSN" : "10584838", "PMID" : "22965026", "abstract" : "The guideline is intended for use by healthcare providers who care for adult and pediatric patients with group A streptococcal pharyngitis. The guideline updates the 2002 Infectious Diseases Society of America guideline and discusses diagnosis and management, and recommendations are provided regarding antibiotic choices and dosing. Penicillin or amoxicillin remain the treatments of choice, and recommendations are made for the penicillin-allergic patient, which now include clindamycin.", "author" : [ { "dropping-particle" : "", "family" : "Shulman", "given" : "Stanford T.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bisno", "given" : "Alan L.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Clegg", "given" : "Herbert W.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gerber", "given" : "Michael a.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kaplan", "given" : "Edward L.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lee", "given" : "Grace", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Martin", "given" : "Judith M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Beneden", "given" : "Chris", "non-dropping-particle" : "Van", "parse-names" : false, "suffix" : "" } ], "container-title" : "Clinical Infectious Diseases", "id" : "ITEM-1", "issue" : "10", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "86-102", "title" : "Clinical practice guideline for the diagnosis and management of group a streptococcal pharyngitis: 2012 update by the infectious diseases society of America", "type" : "article-journal", "volume" : "55" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(2)", "plainTextFormattedCitation" : "(2)", "previouslyFormattedCitation" : "(2)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(2).Se realizará cultivo del exudado faringoamigdalar: Pacientes con TRDA negativo (según algoritmo propuesto por la AEPap).Sospecha de infección por otra bacteria distinta a SGA.Paciente alérgico a penicilina en el que el tratamiento recomendado sería macrólidos o clindamicina y se tendría que realizar aislamiento y antibiograma.Selección de los test de detección de antígeno de SGA más adecuados. Será responsabilidad de los especialistas en Microbiología la elección del test más adecuado atendiendo a criterios de calidad y eficiencia.Tipos de pruebas rápidas:Existen diversos formatos de técnicas de detección de antígeno. Entre ellas, las técnicas inmunocromatográficas presentan varias ventajas para su utilización como prueba point-of-care por su facilidad de uso, rapidez, almacenamiento de reactivos a temperatura ambiente, caducidad prolongada y precio. Características analíticas de los TRDA:Aunque la sensibilidad es menor que el cultivo del exudado faringoamigdalar (método de referencia), en general presentan buena precisión diagnóstica ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.diagmicrobio.2015.06.012", "ISSN" : "18790070", "PMID" : "26159722", "abstract" : "Streptococcus pyogenes (group A Streptococcus [GAS]) is the leading cause of bacterial pharyngitis. To perform a rapid diagnosis of GAS pharyngitis, rapid antigen detection tests (RADTs) have been developed. In this study, we evaluated and compared the sensitivity and specificity of 5 RADTs (bioNexia Strep A plus???, bioNexia Strep A dipstick???, Clearview Strep A???, QuickVue Strep A plus???, and Streptatest???), using analytical approaches combining dilutions in NaCl 0.9% or in pharyngeal flora. The practicability of each RADT was also determined. Among the 630 RADTs performed in this work, all were specific, as no false positive was found resulting in a specificity of 100%. The 5 RADTs detected GAS at 10⁶CFU/mL in NaCl 0.9% or pooled pharyngeal flora. Regarding the practicability analysis, bioNexia Strep A plus, bioNexia Strep A dipstick and Streptatest RADTs obtained the highest scores for secondary items including kit content and instructions for use information. We concluded that these 5 easy-to-use RADTs are suitable for diagnosis of GAS pharyngitis, as they all detect GAS at a concentration commonly found during pharyngitis.", "author" : [ { "dropping-particle" : "", "family" : "Plainvert", "given" : "C??line", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Duquesne", "given" : "Igor", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Touak", "given" : "G??rald", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dmytruk", "given" : "Nicolas", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Poyart", "given" : "Claire", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Diagnostic Microbiology and Infectious Disease", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "105-111", "publisher" : "Elsevier Inc.", "title" : "In vitro evaluation and comparison of 5 rapid antigen detection tests for the diagnosis of beta-hemolytic group A streptococcal pharyngitis", "type" : "article-journal", "volume" : "83" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1177/0009922810376235", "ISSN" : "1938-2707", "PMID" : "20724334", "abstract" : "Previous studies of the accuracy of rapid in-office tests for group A Streptococcus had disparate results, ranging from sensitivity of 70% to more than 90%. The sensitivity and specificity of 3 commercially available Strep A tests were determined in 2 private pediatric office settings. Acceava Strep A, Genzyme OSOM Strep A, and the Quidel QuickVue Strep A tests were the representative rapid tests for detection of Streptococcus pyogenes. Overnight culture on standard 5% sheep blood agar was the reference standard for this study. All 3 CLIA (Clinical Laboratory Improvement Amendments)-waived tests had sensitivities and specificities that exceeded 95%.", "author" : [ { "dropping-particle" : "", "family" : "Rogo", "given" : "Tanya", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schwartz", "given" : "Richard H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ascher", "given" : "David P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Clinical pediatrics", "id" : "ITEM-2", "issue" : "11", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "1050-2", "title" : "Comparison of the Inverness Medical Acceava Strep A test with the Genzyme OSOM and Quidel QuickVue Strep A tests.", "type" : "article-journal", "volume" : "49" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1128/JCM.02516-15", "ISSN" : "0095-1137", "abstract" : "<p> Rapid antigen detection tests (RADTs) detecting group A <italic>Streptococci</italic> (GAS) are widely used for diagnosing acute pharyngitis, which has led to a considerable reduction of antibiotic prescription over the last decade. Across this intended use, their reassessment on invasive samples may be relevant for managing life-threatening GAS infections. To this end, we evaluated the performance of three RADTs, culture, GAS-PCR and 16S rDNA PCR assays in comparison with a composite gold standard (GAS-PCR assay and/or culture) for the diagnosis of severe GAS infections. A total of 192 specimens from deep tissue (mostly normally sterile) sites enriched for 75 positive samples were enrolled in the study. </p>", "author" : [ { "dropping-particle" : "", "family" : "Gazzano", "given" : "Vincent", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Berger", "given" : "Anne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Benito", "given" : "Yvonne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Freydiere", "given" : "Anne-Marie", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tristan", "given" : "Anne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Boisset", "given" : "Sandrine", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Carricajo", "given" : "Anne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Poyart", "given" : "Claire", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vandenesch", "given" : "Fran\u00e7ois", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Descours", "given" : "Ghislaine", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Clinical Microbiology", "id" : "ITEM-3", "issue" : "January", "issued" : { "date-parts" : [ [ "2016" ] ] }, "page" : "JCM.02516-15", "title" : "Reassessment of the role of rapid antigen detection tests (RADTs) for the diagnosis of invasive Group A Streptococcal infections", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(12\u201314)", "plainTextFormattedCitation" : "(12\u201314)", "previouslyFormattedCitation" : "(12\u201314)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(12–14). Sin embargo, según recientes meta-análisis, sus características analíticas (valores predictivos, sensibilidad y especificidad) varían mucho según la población estudiada, tipo de test, marca comercial o personal que realiza la técnica, siendo difícil estimar valores globales debido a la elevada heterogeneidad de los estudios publicados ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1371/journal.pone.0111727", "ISBN" : "1932-6203 (Electronic)\\r1932-6203 (Linking)", "ISSN" : "1932-6203", "PMID" : "25369170", "abstract" : "BACKGROUND: Pharyngitis management guidelines include estimates of the test characteristics of rapid antigen streptococcus tests (RAST) using a non-systematic approach.\\n\\nOBJECTIVE: To examine the sensitivity and specificity, and sources of variability, of RAST for diagnosing group A streptococcal (GAS) pharyngitis.\\n\\nDATA SOURCES: MEDLINE, Cochrane Reviews, Centre for Reviews and Dissemination, Scopus, SciELO, CINAHL, guidelines, 2000-2012.\\n\\nSTUDY SELECTION: Culture as reference standard, all languages.\\n\\nDATA EXTRACTION AND SYNTHESIS: Study characteristics, quality.\\n\\nMAIN OUTCOME(S) AND MEASURE(S): Sensitivity, specificity.\\n\\nRESULTS: We included 59 studies encompassing 55,766 patients. Forty three studies (18,464 patients) fulfilled the higher quality definition (at least 50 patients, prospective data collection, and no significant biases) and 16 (35,634 patients) did not. For the higher quality immunochromatographic methods in children (10,325 patients), heterogeneity was high for sensitivity (inconsistency [I(2)] 88%) and specificity (I(2) 86%). For enzyme immunoassay in children (342 patients), the pooled sensitivity was 86% (95% CI, 79-92%) and the pooled specificity was 92% (95% CI, 88-95%). For the higher quality immunochromatographic methods in the adult population (1,216 patients), the pooled sensitivity was 91% (95% CI, 87 to 94%) and the pooled specificity was 93% (95% CI, 92 to 95%); however, heterogeneity was modest for sensitivity (I(2) 61%) and specificity (I(2) 72%). For enzyme immunoassay in the adult population (333 patients), the pooled sensitivity was 86% (95% CI, 81-91%) and the pooled specificity was 97% (95% CI, 96 to 99%); however, heterogeneity was high for sensitivity and specificity (both, I(2) 88%).\\n\\nCONCLUSIONS: RAST immunochromatographic methods appear to be very sensitive and highly specific to diagnose group A streptococcal pharyngitis among adults but not in children. We could not identify sources of variability among higher quality studies. The present systematic review provides the best evidence for the wide range of sensitivity included in current guidelines.", "author" : [ { "dropping-particle" : "", "family" : "Stewart", "given" : "Emily H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Davis", "given" : "Brian", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Clemans-Taylor", "given" : "B Lee", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Littenberg", "given" : "Benjamin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Estrada", "given" : "Carlos a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Centor", "given" : "Robert M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "PloS one", "id" : "ITEM-1", "issue" : "11", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "e111727", "title" : "Rapid antigen group A streptococcus test to diagnose pharyngitis: a systematic review and meta-analysis.", "type" : "article-journal", "volume" : "9" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(15)", "manualFormatting" : "(3, ", "plainTextFormattedCitation" : "(15)", "previouslyFormattedCitation" : "(15)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(3, ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.anpedi.2009.12.012", "ISSN" : "16954033", "abstract" : "Resumen Introduccio \u00b4n: La faringitis estreptoco \u00b4cica constituye uno de los motivos ma \u00b4s frecuentes de consulta en Atencio \u00b4n Primaria y Pedia \u00b4trica. El tratamiento inadecuado puede conllevar efectos adversos y resistencia bacteriana. Las te \u00b4cnicas de deteccio \u00b4n antige \u00b4nica preemitir\u0131 \u00b4an el diagno \u00b4stico de infeccio \u00b4n por Streptococcus pyogenes en pocos minutos. Esta revisio \u00b4n pretende evaluar las te \u00b4cnicas ra \u00b4pidas de deteccio \u00b4n antige \u00b4nica para el diagno \u00b4stico de S. pyogenes a partir de exudado faringoamigdalar. Material y me \u00b4todos: Revisio \u00b4n sistema \u00b4tica y metaana \u00b4lisis (2000 \u2013 2009). Se realizo \u00b4 una bu \u00b4squeda en las bases de datos MedLine, Embase, Cochrane Library, Cinahl, CRD, ECRI, Hayes y bases de datos de Agencias de Evaluacio \u00b4n. La calidad de los estudios se analizo \u00b4 segu \u00b4n los criterios QUADAS. Se calcularon los \u0131\u00b4ndices de validez diagno \u00b4stica y se elaboro \u00b4un metaana \u00b4lisis para sintetizar los resultados. Resultados: Se incluyeron 24 estudios de pruebas diagno \u00b4sticas, de calidad moderada. La sensibilidad estuvo comprendida entre 65,6 \u2013 96,4%; la especificidad oscilo \u00b4 entre 68,7 y 99,3%; el valor predictivo positivo tuvo un rango de 59,4 \u2013 97,4%, y el valor predictivo negativo entre 87,8 \u2013 98%. El metaana \u00b4lisis determino \u00b4 una sensibilidad global de 0,85 [IC: 0,84 \u2013 0,87], la especificidad fue de 0,96 (IC: 0,96 \u2013 0,97), el cociente de probabilidad positivo de 22,21 (IC: 15,12 \u2013 32,63), y el negativo de 0,15 (IC: 0,13 \u2013 0,18). La prueba presento \u00b4 un buen rendimiento diagno \u00b4stico. Conclusiones: Las te \u00b4cnicas ofrecen buena respuesta para usarlas como me \u00b4todo diagno \u00b4stico; sin embargo, estos dispositivos tienen que ser complementados con la realizacio \u00b4n del cultivo microbiolo \u00b4gico debido a la existencia falsos positivos y falsos negativos.", "author" : [ { "dropping-particle" : "", "family" : "Ruiz-Arag\u00f3n", "given" : "J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rodr\u00edguez L\u00f3pez", "given" : "R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Molina Linde", "given" : "J.M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Anales de Pediatr\u00eda", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "391-402", "title" : "Evaluaci\u00f3n de los m\u00e9todos r\u00e1pidos para la detecci\u00f3n de Streptococcus pyogenes. Revisi\u00f3n sistem\u00e1tica y metaan\u00e1lisis", "type" : "article-journal", "volume" : "72" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(16)", "manualFormatting" : "4)", "plainTextFormattedCitation" : "(16)", "previouslyFormattedCitation" : "(16)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }4). Criterios de calidad:Los test seleccionados deben tener una sensibilidad y especificidad mayores del 80%, y valor predictivo negativo mayor del 90%, si es posible, avalados por estudios independientes en atención primaria.Otras consideraciones:Para el uso en una consulta de atención primaria se recomiendan presentaciones que contengan unos 20-25 test por caja, para que puedan utilizarse en un tiempo medio de 2-3 meses. No se deben utilizar los test más allá de la fecha de caducidad que conste en el kit.También se tendrán en cuenta la rapidez y facilidad de uso del kit.Formación del personal que utilizará y/o realizará las TDRA. Esta formación debe ser dirigida y coordinada por microbiólogos y pediatras, según su área de conocimiento.Aunque las TRDA son técnicamente sencillas de realizar es muy importante que el personal sanitario que utilice estas determinaciones reciba la formación adecuada. No sólo en cuanto a la realización de la técnica, sino que debe incluir varios aspectos para que su implantación en las consultas de atención primaria tenga el impacto esperado en el manejo de estas infecciones y la medida sea coste-efectivaADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.aprim.2014.02.006", "ISSN" : "15781275", "PMID" : "24768657", "abstract" : "Objective: To evaluate the effectiveness of two types of intervention in reducing antibiotic prescribing in respiratory tract infections (RTI).\nDesign: Before-after audit-based study.\nSetting: Primary Care centres in Spain.\nParticipants: General practitioners (GPs) registered all patients with RTIs for 15 days in winter 2008 (pre-intervention), and again in winter 2009 (post-intervention).\nInterventions: Intervention activities included meetings, with the presentation and discussion of the results, and several training meetings on RTI guidelines, information brochures for patients, workshops on point-of-care tests - rapid antigen detection tests and C-reactive protein rapid test - and provision of these tests in the clinic. All GPs, with the exception of those in Catalonia, made up the full intervention group (FIG); conversely, Catalan doctors underwent the same intervention, except for the workshop on rapid tests (partial intervention group, PIG). Multilevel logistic regression was performed taking the prescription of antibiotics as the dependent variable.\nResults: Out of a total of 309 GPs involved in the first register, 281 completed the intervention and the second register (90.9%), of which 210 were assigned to the FIG, and 71 to the PIG. The odds ratio of antibiotic prescribing after the intervention was 0.99 (95% CI: 0.89-1.10) among GPs assigned to PIG, and 0.50 (95% CI: 0.44-0.57, p < 0.001) among those who were allocated to FIG. The reduction in antibiotic prescribing in FIG was more marked in flu infection, common cold, acute pharyngitis, acute tonsillitis, and acute bronchitis.\nConclusions: Active participation of GPs with the performance of point-of-care tests in the clinic is accompanied by a drastic reduction of antibiotic use in RTIs, primarily in infections considered as mainly viral.", "author" : [ { "dropping-particle" : "", "family" : "Llor", "given" : "Carles", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cots", "given" : "Josep Maria", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hern\u00e1ndez", "given" : "Silvia", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ortega", "given" : "Jes\u00fas", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Arranz", "given" : "Javier", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Monedero", "given" : "Mar\u00eda Jos\u00e9", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Alc\u00e1ntara", "given" : "Juan De Dios", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "P\u00e9rez", "given" : "Carolina", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Garc\u00eda", "given" : "Guillermo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "G\u00f3mez", "given" : "Manuel", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Guerra", "given" : "Gloria", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cid", "given" : "Marina", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cig\u00fcenza", "given" : "Mar\u00eda Luisa", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pineda", "given" : "Vicenta", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Paredes", "given" : "Jos\u00e9", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Burgazzoli", "given" : "Juan Luis", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Munck", "given" : "Anders", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cordoba-Currea", "given" : "Gloria", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bjerrum", "given" : "Lars", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Atencion Primaria", "id" : "ITEM-1", "issue" : "9", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "492-500", "title" : "Effectiveness of two types of intervention on antibiotic prescribing in respiratory tract infections in Primary Care in Spain. Happy Audit Study", "type" : "article-journal", "volume" : "46" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(5)", "plainTextFormattedCitation" : "(5)", "previouslyFormattedCitation" : "(5)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(5).El uso inapropiado de estas pruebas puede dar lugar a la sobreutilización de los recursos, además de aumentar los resultados falsamente positivos y negativos ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s10096-012-1783-7", "ISSN" : "1435-4373", "PMID" : "23207649", "abstract" : "Rapid antigen detection tests (RADT) are widely used for the rapid diagnosis of group A streptococcal (GAS) tonsillopharyngitis. In a prospective 3-year study, the reliability of two different RADT methods was compared, as performed by lab technicians versus physicians. Sensitivity and specificity, as well as positive and negative predictive values, were calculated. When performed by physicians, the results (44.4 %, 8.3 %, 26.7 % and 16.7 %) of a latex agglutination test (LAT) were unacceptably low. However, after switching to a lateral-flow immunoassay (LFIT) and implementing additional hands-on training, the performance improved dramatically (100 %, 92.6 %, 84.6 % and 100 %). In conclusion, technical errors, along with a lack of experience and expertise, negatively impact RADT accuracy.", "author" : [ { "dropping-particle" : "", "family" : "Toepfner", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Henneke", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Berner", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hufnagel", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2013", "5" ] ] }, "page" : "609-11", "title" : "Impact of technical training on rapid antigen detection tests (RADT) in group A streptococcal tonsillopharyngitis.", "type" : "article-journal", "volume" : "32" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(17)", "plainTextFormattedCitation" : "(17)", "previouslyFormattedCitation" : "(17)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(17). Sería responsabilidad de Microbiología la formación en las siguientes áreas:Entrenamiento en el uso de los kits de detección de antígeno, lectura e interpretación de resultados, conservación de reactivos, control de calidad.Utilidad de los TRDA y sus limitaciones.Manual de toma de muestra, manejo de muestras biológicas y normas de bioseguridad.Sería responsabilidad de Pediatría la formación en las siguientes áreas:Talleres de actualización de guías de práctica clínica, criterios de selección/rechazo de pacientes a los que realizar la prueba.Entrenamiento en la correcta toma de rmación y comunicación con el paciente (cuándo realizar TRDA, resultados, prescripción antibióticos).Evaluación “in situ” del impacto de la introducción de TRDA de SGA en las consultas de atención primaria. Esta evaluación estaría coordinada entre Pediatría y Microbiología.La precisión diagnóstica de un test está influenciada por diversos factores relacionados con el propio test y otros factores ajenos al mismo (el personal que lo realiza, toma de muestra, pacientes, cepas circulantes, etc) ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1128/CMR.17.3.571", "author" : [ { "dropping-particle" : "", "family" : "Gerber", "given" : "Michael A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Shulman", "given" : "Stanford T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Clinical Microbiology Reviews", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2004" ] ] }, "page" : "571-580", "title" : "Rapid Diagnosis of Pharyngitis Caused by Group A Streptococci Rapid Diagnosis of Pharyngitis Caused by Group A Streptococci", "type" : "article-journal", "volume" : "17" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(6)", "plainTextFormattedCitation" : "(6)", "previouslyFormattedCitation" : "(6)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(6). Por ello, sería conveniente comprobar la validez de las TRDA cuando se realizan en las consultas de atención primaria. Para ello se realizaría durante 6 meses un estudio piloto en cada Centro de Salud, realizando en paralelo TRDA de SGA en la consulta y cultivo del exudado faringoamigdalar en el laboratorio de Microbiología. Esto permitiría conocer la prevalencia de SGA en infección, portadores asintomáticos, características analíticas (sensibilidad, especificidad, valores predictivos) de las TRDA en cada centro, además de permitir evaluar si ha mejorado o no la prescripción antibiótica.Registro de los resultados de TRDA. Esta actividad la realizarían los pediatras y deberá contar con el apoyo técnico de los Servicios de Informática del SAS.La información del resultado del test debe incorporarse a la historia clínica del paciente. Además, sería conveniente que los resultados quedaran registrados en una base de datos que permitiera la explotación informática y estadística de los mismos (?facilitar a los pediatras el registro de resultados de pruebas point-of-care en Diraya Clínica a través del peticionario de pruebas al laboratorio, base de datos común tipo excell gestionada por cada Centro de Salud,..?). Este registro facilitará la labor de seguimiento y evaluación de la utilidad de los TRDA de SGA.Programa de control de calidad. Microbiología participará en el dise?o y elaboración de este programa.Para asegurar la calidad de los resultados ofrecidos es recomendable realizar un control de calidad externo con una periodicidad, al menos, semestral. Desde una entidad acreditada se enviarán muestras para control de calidad. Las muestras de control de calidad se procesarán de la misma manera y por el mismo personal sanitario que realice habitualmente las TRDA en cada Centro de Salud. Los resultados de las determinaciones se remitirán a la entidad de control de calidad que emitirá un informe con los resultados del control.Establecimiento de un sistema o programa centinela para vigilar la evolución de la resistencia a antimicrobianos de las cepas de SGA circulantes. Este punto deberá contar con la participación de especialistas en Epidemiología, Pediatría y Microbiología.La existencia de un sistema centinela permitiría conocer la epidemiología y evolución de las resistencias a antimicrobianos de las cepas circulantes de SGA. Además facilitaría la evaluación del impacto que supone la utilización de los TRDA de SGA en el ámbito de Atención Primaria.El dise?o de este sistema debe tener en cuenta que la población sujeta a vigilancia sea representativa del conjunto de la población atendida para que los datos obtenidos tengan la máxima validez posible. La participación de los Pediatras en este programa sería voluntaria y se seleccionarían en función del número de médicos necesarios para conseguir esta representatividad. Los Laboratorios de Microbiología que voluntariamente participen en este programa deberán utilizar una metodología común (medios de cultivo, tiempo de incubación, sistema de identificación y antibiograma) para que los resultados sean comparables.Las actividades de vigilancia realizadas en el programa centinela dependerá de los recursos disponibles. Debería incluir al menos la recogida de datos clínicos y epidemiológicos y la confirmación del diagnóstico etiológico mediante métodos de referencia (cultivo del exudado faringoamigdalar).Comunicación por parte de los pediatras centinela de los nuevos casos sospechosos de faringoamigdalitis estreptocócica que atienden en las consultas, aportando datos clínicos, demográficos y resultados de TRDA de SGA si se realizara.Recogida de muestras de exudado faringoamigdalar de los pacientes atendidos que se enviarán al Laboratorio de Microbiología para su cultivo. En función de la incidencia de la enfermedad se establecerán el número de muestras que se deberán tomar semanalmente. Se realizará cultivo de todas las muestras, independientemente del resultado del TRDA. El laboratorio de Microbiología identificará y realizará antibiograma a las cepas de SGA obtenidas.BIBLIOGRAF?AADDIN Mendeley Bibliography CSL_BIBLIOGRAPHY 1. Shaikh N, Leonard E, Martin JM. 2010. Prevalence of streptococcal pharyngitis and streptococcal carriage in children: a meta-analysis. Pediatrics 126:e557–64.2. Shulman ST, Bisno AL, Clegg HW, Gerber M a., Kaplan EL, Lee G, Martin JM, Van Beneden C. 2012. 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. 55:86–102.3. Cots JM, Alós J-I, Bárcena M, Boleda X, Ca?ada JL, Gómez N, Mendoza A, Vilaseca I, Llor C. 2015. Recomendaciones para el manejo de la faringoamigdalitis aguda del adulto. Atención Primaria 47:532–543.4. Pelucchi C, Grigoryan L, Galeone C, Esposito S, Huovinen P, Little P, Verheij T. 2012. Guideline for the management of acute sore throat: ESCMID Sore Throat Guideline Group C. Pelucchi et al. Guideline for management of acute sore throat. Clin. Microbiol. Infect. 18:1–28.5. Llor C, Cots JM, Hernández S, Ortega J, Arranz J, Monedero MJ, Alcántara JDD, Pérez C, García G, Gómez M, Guerra G, Cid M, Cigüenza ML, Pineda V, Paredes J, Burgazzoli JL, Munck A, Cordoba-Currea G, Bjerrum L. 2014. Effectiveness of two types of intervention on antibiotic prescribing in respiratory tract infections in Primary Care in Spain. Happy Audit Study. Aten. Primaria 46:492–500.6. Gerber MA, Shulman ST. 2004. Rapid Diagnosis of Pharyngitis Caused by Group A Streptococci Rapid Diagnosis of Pharyngitis Caused by Group A Streptococci. Clin. Microbiol. Rev. 17:571–580.7. Cohen JF, Chalumeau M, Levy C, Bidet P, Thollot F, Wollner A, Bingen E, Cohen R. 2012. Spectrum and inoculum size effect of a rapid antigen detection test for group A streptococcus in children with pharyngitis. PLoS One 7:e39085.8. Centor RM, Witherspoon JM, Dalton HP, Brody CE, Link K. 1981. The diagnosis of strep throat in adults in the emergency room. Med. Decis. Making 1:239–46.9. McIsaac WJ, White D, Tannenbaum D, Low DE. 1998. A clinical score to reduce unnecessary antibiotic use in patients with sore throat. Can. Med. Assoc. J. 158:75–83.10. Giraldez-Garcia C, Rubio B, Gallegos-Braun JF, Imaz I, Gonzalez-Enriquez J, Sarria-Santamera A. 2011. Diagnosis and management of acute pharyngitis in a paediatric population: a cost-effectiveness analysis. Eur. J. Pediatr. 170:1059–67.11. García Vera C. 2014. Utilidad del test rápido de detección de antígeno estreptocócico (TRDA) en el abordaje de la faringoamigdalitis aguda en pediatría. Asoc. espa?ola pediatría atención primaria. 1–11.12. Plainvert C, Duquesne I, Touak G, Dmytruk N, Poyart C. 2015. In vitro evaluation and comparison of 5 rapid antigen detection tests for the diagnosis of beta-hemolytic group A streptococcal pharyngitis. Diagn. Microbiol. Infect. Dis. 83:105–111.13. Rogo T, Schwartz RH, Ascher DP. 2010. Comparison of the Inverness Medical Acceava Strep A test with the Genzyme OSOM and Quidel QuickVue Strep A tests. Clin. Pediatr. (Phila). 49:1050–2.14. Gazzano V, Berger A, Benito Y, Freydiere A-M, Tristan A, Boisset S, Carricajo A, Poyart C, Vandenesch F, Descours G. 2016. Reassessment of the role of rapid antigen detection tests (RADTs) for the diagnosis of invasive Group A Streptococcal infections. J. Clin. Microbiol. JCM.02516–15.15. Stewart EH, Davis B, Clemans-Taylor BL, Littenberg B, Estrada C a, Centor RM. 2014. Rapid antigen group A streptococcus test to diagnose pharyngitis: a systematic review and meta-analysis. PLoS One 9:e111727.16. Ruiz-Aragón J, Rodríguez López R, Molina Linde JM. 2010. Evaluación de los métodos rápidos para la detección de Streptococcus pyogenes. Revisión sistemática y metaanálisis. An. Pediatría 72:391–402.17. Toepfner N, Henneke P, Berner R, Hufnagel M. 2013. Impact of technical training on rapid antigen detection tests (RADT) in group A streptococcal tonsillopharyngitis. Eur. J. Clin. Microbiol. Infect. Dis. 32:609–11. ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download