Publication: Prevalence of group a streptococcus in primary care patients and the utility of c-reactive protein and clinical scores for its identification in Thailand
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Issued Date
2020-01-01
Resource Type
ISSN
00029637
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2-s2.0-85079076159
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Mahidol University
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SCOPUS
Bibliographic Citation
American Journal of Tropical Medicine and Hygiene. Vol.102, No.2 (2020), 377-383
Suggested Citation
Rachel Greer, Thomas Althaus, Clare Ling, Daranee Intralawan, Supalert Nedsuwan, Janjira Thaipadungpanit, Tri Wangrangsimakul, Christopher Butler, Nicolas Day, Yoel Lubell Prevalence of group a streptococcus in primary care patients and the utility of c-reactive protein and clinical scores for its identification in Thailand. American Journal of Tropical Medicine and Hygiene. Vol.102, No.2 (2020), 377-383. doi:10.4269/ajtmh.19-0502 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/53709
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Title
Prevalence of group a streptococcus in primary care patients and the utility of c-reactive protein and clinical scores for its identification in Thailand
Abstract
© 2020 by The American Society of Tropical Medicine and Hygiene. Pharyngitis is usually caused by a viral infection for which antibiotics are often unnecessarily prescribed, adding to the burden of antimicrobial resistance. Identifying who needs antibiotics is challenging; microbiological confirmation and clinical scores are used but have limitations. In a cross-sectional study nested within a randomized controlled trial, we estimated the prevalence and antibiotic susceptibility profiles of group A Streptococcus (GAS) in patients presenting to primary care with a sore throat and fever in northern Thailand. We then evaluated the use of C-reactive protein (CRP) and clinical scores (Centor and FeverPAIN) to identify the presence of GAS. One hundred sixty-nine patients were enrolled, of whom 35 (20.7%) had β-hemolytic Streptococci (BHS) isolated from throat swab culture, and 11 (6.5%) had GAS. All GAS isolates were sensitive to penicillin G. The median CRP of those without BHS isolation was 10 mg/L (interquartile range [IQR] ≤ 8-18), compared with 18 mg/L (IQR 9-71, P = 0.0302) for those with GAS and 14 mg/L (IQR ≤ 8-38, P = 0.0516) for those with any BHS isolated. However, there were no significant relationships betweenCRP> 8mg/L (P = 0.112),Centor ≥ 3 (P = 0.212), and FeverPAIN ≥ 4 (P = 1.000), and the diagnosis of GAS compared with no BHS isolation. Identifying who requires antibiotics for pharyngitis remains challenging and necessitates further larger studies. C-reactive protein testing alone, although imperfect, can reduce prescribing compared with routine care. Targeted CRP testing through clinical scoringmay be themost cost-effective approach to ruling out GAS infection.