Group A streptococcus molecular point of care testing in a paediatric emergency department
File(s)
Accepted version
Supporting information
Author(s)
Mills, Ewurabena A
Bingham, Rebekah
Nijman, Ruud G
Sriskandan, Shiranee
Type
Journal Article
Abstract
Background
An upsurge in Streptococcus pyogenes infections 2022-2023 highlighted potential benefits of point-of-care tests (POCT) to support clinical pathways, prevent outbreaks,
and optimise antibiotic use.
Objectives
We conducted a pilot research study in a west London paediatric emergency department (ED) to determine whether a molecular POCT had potential to alter
management in children who were also having a conventional throat swab taken for culture.
Methods
Children <16 years presenting to ED who had a throat swab requested by a clinician were invited to have a second swab taken for research purposes only. Clinical
management was unaffected by the research swab result, which was processed using a molecular POCT that was not approved for use in the host NHS Trust.
Results
Prevalence of streptococcal infection was low during the study (May 2023-June 2025); swab positivity in symptomatic children was 12.8% (6/47). Overall, 38/49 (77.6%) participants who had throat swabs received antibiotics. Of those children recommended to receive antibiotics, 29/38 (76.3%) had a negative POCT. Mean time to reporting of positive throat swab culture results was 3.67 days (range 3-5 days) leading to occasional delay in treatment, although POCT identified positive results within minutes.
Conclusion
Antibiotic use was frequent and could be avoided by use of a ‘rule out’ POCT in many children in the ED, provided suspicion of S. pyogenes is the main driver for prescribing. POCT were easy to process and produced immediate results compared with culture. More research is needed to establish if POCT confers overall net benefit.
An upsurge in Streptococcus pyogenes infections 2022-2023 highlighted potential benefits of point-of-care tests (POCT) to support clinical pathways, prevent outbreaks,
and optimise antibiotic use.
Objectives
We conducted a pilot research study in a west London paediatric emergency department (ED) to determine whether a molecular POCT had potential to alter
management in children who were also having a conventional throat swab taken for culture.
Methods
Children <16 years presenting to ED who had a throat swab requested by a clinician were invited to have a second swab taken for research purposes only. Clinical
management was unaffected by the research swab result, which was processed using a molecular POCT that was not approved for use in the host NHS Trust.
Results
Prevalence of streptococcal infection was low during the study (May 2023-June 2025); swab positivity in symptomatic children was 12.8% (6/47). Overall, 38/49 (77.6%) participants who had throat swabs received antibiotics. Of those children recommended to receive antibiotics, 29/38 (76.3%) had a negative POCT. Mean time to reporting of positive throat swab culture results was 3.67 days (range 3-5 days) leading to occasional delay in treatment, although POCT identified positive results within minutes.
Conclusion
Antibiotic use was frequent and could be avoided by use of a ‘rule out’ POCT in many children in the ED, provided suspicion of S. pyogenes is the main driver for prescribing. POCT were easy to process and produced immediate results compared with culture. More research is needed to establish if POCT confers overall net benefit.
Date Acceptance
2026-07-30
Citation
Journal of Antimicrobial Chemotherapy
ISSN
0305-7453
Publisher
Oxford University Press
Journal / Book Title
Journal of Antimicrobial Chemotherapy
Copyright Statement
Copyright This paper is embargoed until publication. Once published the Version of Record (VoR) will be available on immediate open access.
License URL
Publication Status
Accepted