소아의 급성 인두염에서 연쇄구균 신속항원검사의 유용성
Utility of Streptococcal Rapid Antigen Detection Test in Children with Acute Pharyngitis
2
조회
0
다운로드
1
인용
0
참고문헌
초록
목 적 : 최근 소아 급성 인두염에서 부적절한 항생제 투여가 문제시 되고 있으나 증상만으로 항생제 사용 여부를 결정하기는 어려우며 인두배양검사가 확진 방법이다. 그러나 검사에 시간이 요구되므로 미국소아과학회에서는 배양검사와 신속항원검사를 시행하여 신속항원검사가 음성이면 항생제 사용을 보류하도록 권하고 있다. 저자들은 이와 같은 지침을 국내에서도 적용할 수 있는지 알아보고자 연쇄구균 신속항원검사의 유용성을 조사하였다.방 법 : 2004년 9월부터 2005년 8월까지 한림대학교 강동성심병원 소아과를 방문하여 급성 인두염으로 진단받은 70명을 대상으로 하였다. 편도 삼출, 발열, 피부 발진 등의 임상적 특징과 내원 전 항생제 투여 여부를 조사하고, CBC, ASO, CRP 등의 혈액 검사와 인두에서 연쇄구균 신속항원검사와 배양검사를 시행하였다.
Abstract
Purpose : The purpose of this study was to evaluate the utility of rapid antigen detection test for group A streptococci in children with acute pharyngitis. Methods : Seventy children with acute pharyngitis enrolled the study, who visited the Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym Medical Center from September 2004 to August 2005. The presence of clinical features such as tonsillar exudates, fever, scarletiniform rash and previous antibiotic use were evaluated and throat swab culture, rapid antigen detection test for group A Streptococci, CBC, ASO, and CRP were performed. Results : Among 70 children with acute pharyngitis, the prevalence of group A beta- hemolytic Streptococcus by throat swab culture and rapid antigen detection test was 14(20.0 %) and 22(31.4%), respectively. The sensitivity of the rapid antigen detection test was 78.6 %, specificity was 80.4%, the positive predictive value was 50.0% and the negative predictive value was 93.8%. The positivity of the throat swab culture and rapid antigen detection test showed no signigicant differences according to the presence of the clinical symptoms except scarletiniform rash. Laboratory data such as CBC, ASO or CRP proved not valuable to predict the positivity of the throat swab culture and/or rapid antigen detection test for group A Streptococcus. There was a tendency of negative throat swab culture and positive rapid antigen detection test in cases of previous antibiotic use. Conclusion : The rapid antigen detection test can be a useful diagnostic tool for early detection of the group A Streptococcus in children with acute pharyngitis and can be helpful for the clinician to reduce the inappropriate use of antibiotics.
참고문헌 (26)
- "Diagnosis and treatment of pharyngitis in children", 52, pp.729~747 (2005)
- "Antibiotics for the primary prevention of acute rheumatic fever:a meta-analysis", 5 (2005)
- "A streptococcal score card revisited", 14, pp.109~111 (1998)
- "Red Book : report of the Committee on Infectious Diseases" (2003), Elk Grove Village(IL) American Academy of Pediatrics
- "Performance of a predictive model for streptococcal pharyngitis in children", 155, pp.687~691 (2001)
- "Clinical manifestations of group A β- hemolytic streptococcal pharyngitis and usefulness of rapid antigen test", 44, pp.732~740 (2001)
- "Comparison of two rapid antigen detection tests for diagnosis of group A streptococcal pharyngotonsillitis", 45, pp.973~979 (2002)
- "Are current rapid detection tests for group A streptococci sensitive enough? evaluation of 2 commercial kits", 34, pp.797~799 (2002)
- "Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis", 35, pp.113~125 (2002)
- "Principles of appropriate antibiotic use of acute pharyngitis in adults", 134, pp.506~508 (2001)
- "Comparison of throat cultures and rapid strep tests for diagnosis of streptococcal pharyngitis", 8, pp.820~4 (1989)
- "Effect of antibiotic therapy on the clinical course of streptococcal pharyngitis", 106, pp.870~5 (1985)
- "Clinical evaluation of a latex agglutination test for streptococcal pharyngitis", 7, pp.847~54 (1988)
- "Rapid diagnosis of pharyngitis caused by group A streptococci", 17, pp.571~580 (2004)
- "Antigen detection test for streptococal pharyngitis:evaluation of sensitivity with respect to true infections", 108, pp.654~8 (1986)
- "Clinical application of a scoring system in the diagnosis of group A streptococcal pharyngitis", 41, pp.1365~1371 (1998)
- "Evaluation of rapid streptococcal detection tests", 16, pp.1099~1100 (1997)
- "Pharyngitis-principles of judicious use of antimicrobial agents", 101, pp.171~174 (1998)
- "Susceptibility of group A beta- hemolytic streptococci to thirteen antibiotics:examination of 301 strains isolated in the United States between 1994 and 1997", 18, pp.1069~1072 (1999)
- "Penicillin therapy in scarlet fever and complicating otitis", i, pp.671~673 (1948)
- "Rapid diagnosis of pharyngitis caused by group A streptococci", 17, pp.571~580 (2004)
- "Are follow-up cultures necessary when rapid antigen detection tests are negative for group A streptococci", 40, pp.191~195 (2001)
- "Diagnosis of strep throat in adults:are clinical criteria really good enough", 35, pp.126~129 (2002)
- "Trends in antimicrobial prescribing rates for children and adolescents", 287, pp.3096~3102 (2002)
- "Treatment failures and carriers:perception or problems", 13, pp.576~9 (1994)
- "Effect of penicillin and auromycin on the natural course of streptococcal tonsillitis and pharyngits", 10, pp.300~8 (1951)