Diagnostic accuracy of rapid nucleic acid tests for group A streptococcal pharyngitis: systematic review and meta-analysis. (December 2021)

• Record Type: Journal Article
• Authors: Dubois, Constance; Smeesters, Pierre R.; Refes, Yacine; Levy, Corinne; Bidet, Philippe; Cohen, Robert; Chalumeau, Martin; Toubiana, Julie; Cohen, Jérémie F.
• Is Part Of: Clinical microbiology and infection. Volume 27:Number 12(2021)
• Page Start: 1736
• Page End: 1745
• Publication Date: 2021-12
• Subjects: Diagnosis -- Diagnostic techniques and procedures -- Group A streptococcus -- Meta-analysis -- Molecular probe techniques -- Pharyngitis -- Sensitivity and specificity -- Streptococcus pyogenes -- Systematic review; Medical microbiology -- Periodicals; Diagnostic microbiology -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 616.01
• DOI: 10.1016/j.cmi.2021.04.021
• Languages: English
• ISSNs: 1198-743X

Abstract

Abstract: 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: 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: MEDLINE, Embase, Web of Science (1990–2020). Study eligibility criteria: Cross-sectional studies and randomized trials. Participants: Patients with pharyngitis. Index test/s and reference standards: RNAT commercial kits compared with throat culture. 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: 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: 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.