본문 바로가기
KERD
논문KCI 등재

일차의료기관에서 세균성 인두염의 진단검사 비교 및 제언

Comparison and Recommendation of Diagnostic Tools for Bacterial Pharyngitis at Primary Care Clinics

김선주|조선아
대한진단검사의학회 (Korean Society For Laboratory Medicine)|2020.10|Laboratory Medicine Online|제10권 제4호|pp. 307-313|DOI 10.47429/lmo.2020.10.4.307

2

조회

0

다운로드

0

인용

0

참고문헌

키워드

PharyngitisStreptococcus pyogenesGroup A streptococciSore throatTonsillitisRapid test

초록

우리나라에서 매년 1천만명 이상이 인후염 혹은 편도선염을 주소로 1차 의료기관을 방문하고 있으며, 이 중 50% 이상이 항균제를 처방받고 있다. 항균제 오남용을 줄이기 위해서는 먼저 올바른 진단이 전제되어야 한다. 저자들은 세균성 인두염을 진단하기 위해 사용하는 세균배양, 신속항원검사 및 분자진단검사 3가지의 장단점을 비교하였다. 또한 국내외 세균성 인두염 진단 지침을 비교하였다. 세균배양은 표준검사로 사용되어 왔지만, 숙련도와 배양 시설이 필요하다. 또한 동정에 1-2일이 소요되므로, 이 기간 동안 정확한 항균제 처방이 어렵고 결과를 알기 위해 재방문이 필요하다. 반면 신속항원검사는 배양시설이 필요 없고, 검사소요시간이 5-10분으로 매우 짧으며, 민감도가 개선되었다. 최신 분자유전검사는 아직까지 임상적 자료가 불충분하다. 따라서 일차의료기관에서는 신속항원검사를 사용하여 세균성 인두염을 진단하고 항균제를 올바로 사용할 것을 제안한다.

Abstract

There are more than 10 million visits to primary care clinics annually due to pharyngitis or tonsillitis. The antibiotic prescription rate for these patients is more than 50%. An optimal diagnosis is necessary to avoid antibiotic misuse or overuse. Here, we compared the benefits and pitfalls of three currently available laboratory methods, such as throat culture, rapid antigen detection test (RADT), and molecular tests. We also reviewed the current American and Korean guidelines for bacterial pharyngitis. Although throat culture is regarded as a gold standard, it requires high technical expertise and culture facilities. In addition, the turn-around time (TAT) is 1 day-2 days causing possible inadequate prescription as well as the inconvenience of a second clinical visit to check results. The RADT does not require culture facilities and the TAT is noticeably short (5-10 min). The initial low sensitivity of the RADT has been improved these days. Though molecular tests are the most advanced, there remains a lack of clinical data. Therefore, we recommend judicious use of the RADT for diagnosing bacterial pharyngitis as well as effective antibiotic prescriptions at primary care clinics.

참고문헌 (37)

  1. Wessels MR, "Clinical practice. Streptococcal pharyngitis", N Engl J Med, 364, pp.648~655 (2011)
  2. Little P, "Antibiotic prescription strategies for acute sore throat : a prospective observational cohort study", Lancet Infect Dis, 14, pp.213~219 (2014)
  3. Shulman ST, "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, pp.1279~1282 (2012)
  4. Kalra MG, "Common Questions About Streptococcal Pharyngitis", Am Fam Physician, 94, pp.24~31 (2016)
  5. Shaikh N, "Accuracy and precision of the signs and symptoms of streptococcal pharyngitis in children : a systematic review", J Pediatr, 160, pp.487~493 (2012)
  6. Damoiseaux RA, "Primary care based randomised, double blind trial of amoxicillin versus placebo for acute otitis media in children aged under 2 years", BMJ, 320, pp.350~354 (2000)
  7. "Respiratory bacteria and viruses in the etiology of acute pharyngitis in Korea"[URL]
  8. 김지애, "건강보험청구자료를 이용한 외래 급성 호흡기계 질환 방문과 항생제 처방률 변화 분석", 한국임상약학회지, 27(3), pp.186~194 (2017), 한국임상약학회[DOI]
  9. Gerber MA, "Rapid diagnosis of pharyngitis caused by group A streptococci", Clin Microbiol Rev, 17, pp.571~580 (2004)
  10. Ebell MH, "The rational clinical examination. Does this patient have strep throat", JAMA, 284, pp.2912~2918 (2000)
  11. Maltezou HC, "Evaluation of a rapid antigen detection test in the diagnosis of streptococcal pharyngitis in children and its impact on antibiotic prescription", J Antimicrob Chemother, 62, pp.1407~1412 (2008)
  12. Little P, "Clinical score and rapid antigen detection test to guide antibiotic use for sore throats : randomised controlled trial of PRISM(primary care streptococcal management)", BMJ, 347, pp.f5806~ (2013)
  13. Kim SJ, "Bacteriologic characteristics and serotypings of Streptococcus pyogenes isolated from throats of school children", Yonsei Med J, 41, pp.56~60 (2000)
  14. Fine AM, "Participatory medicine : A home score for streptococcal pharyngitis enabled by real-time biosurveillance : a cohort study", Ann Intern Med, 159, pp.577~583 (2013)
  15. Kim SJ, "Optimal site of throat swab for the isolation of beta-hemolytic streptococci", J Korean Med Sci, 8, pp.453~457 (1993)
  16. Windfuhr JP, "Clinical practice guideline : tonsillitis I. Diagnostics and nonsurgical management", Eur Arch Otorhinolaryngol, 273, pp.973~987 (2016)
  17. Lean WL, "Rapid diagnostic tests for group A streptococcal pharyngitis : a meta-analysis", Pediatrics, 134, pp.771~781 (2014)
  18. Bisno AL, "Acute pharyngitis", N Engl J Med, 344, pp.205~211 (2001)
  19. Cohen JF, "Rapid antigen detection test for group A streptococcus in children with pharyngitis", Cochrane Database Syst Rev, 7, pp.CD010502~ (2016)
  20. 마상혁, "Evaluation of the SD Bioline Strep A Ultra Test in Relation With Number of Colony Forming Units and Color Intensity", Annals of Laboratory Medicine, 39(1), pp.31~35 (2019), 대한진단검사의학회[DOI]
  21. Edmonson MB, "Relationship between the clinical likelihood of group A streptococcal pharyngitis and the sensitivity of a rapid antigen-detection test in a pediatric practice", Pediatrics, 115, pp.280~285 (2005)
  22. Chow AW, "IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults", Clin Infect Dis, 54, pp.e72~e112 (2012)
  23. Fox JW, "Performance of rapid streptococcal antigen testing varies by personnel", J Clin Microbiol, 44, pp.3918~3922 (2006)
  24. Van Limbergen J, "Streptococcus A in paediatric accident and emergency : Are rapid streptococcal tests and clinical examination of any help", Emerg Med J, 23, pp.32~34 (2006)
  25. ESCMID Sore Throat Guideline Group, "Guideline for the management of acute sore throat", Clin Microbiol Infect, 18(S1), pp.1~28 (2012)
  26. Teratani Y, "Association between rapid antigen detection tests and antibiotics for acute pharyngitis in Japan : A retrospective observational study", J Infect Chemother, 25, pp.267~272 (2019)
  27. Linder JA, "Antibiotic treatment of children with sore throat", JAMA, 294, pp.2315~2322 (2005)
  28. Michel-Lepage A, "Factors associated with the use of rapid antigen diagnostic tests in children presenting with acute pharyngitis among French general practitioners", Eur J Clin Microbiol Infect Dis, 33, pp.723~728 (2014)
  29. Luo R, "Diagnosis and management of group A streptococcal pharyngitis in the United States, 2011-2015", BMC Infect Dis, 19, pp.193~ (2019)
  30. Uhl JR, "Fifteen-minute detection of Streptococcus pyogenes in throat swabs by use of a commercially available point-of-care PCR assay", J Clin Microbiol, 54, pp.815~ (2016)
  31. Arbefeville S, "Prospective postimplementation study of Solana group A streptococcal nucleic acid amplication Ttst vs conventional throat culture", Am J Clin Pathol, 150, pp.333~337 (2018)
  32. Johnson DR, "The human immune response to streptococcal extracellular antigens : clinical, diagnostic, and potential pathogenetic implications", Clin Infect Dis, 50, pp.481~490 (2010)
  33. Kim SJ, "Distribution of antistreptolysin O concentrations and results of throat cultures of school children in Chungnam province and Seoul", Korean J Clin Pathol, 14, pp.101~108 (1994)
  34. Centor RM, "The diagnosis of strep throat in adults in the emergency room", Med Decis Making, 1, pp.239~246 (1981)
  35. McIsaac WJ, "Empirical validation of guidelines for the management of pharyngitis in children and adults", JAMA, 291, pp.1587~1595 (2004)
  36. "Guidelines for the antibiotic use in children with acute upper respiratory tract infections"[URL]
  37. 윤영경, "Guidelines for the Antibiotic Use in Adults with Acute Upper Respiratory Tract Infections", Infection and Chemotherapy, 49(4), pp.326~352 (2017), 대한감염학회

관련 논문AI추천

세균성 인두염 진단을 위한 신속항원 검사김선주, 김주영대한내과학회 · 대한내과학회지2019 · 제94권 제4호일차진료 항생제 치료기간과 비인두 항생제 내성률에 대한 연구 고찰신향화, 윤성중, 이선행, 장규태대한한방소아과학회 · 대한한방소아과학회지2018 · 제32권 제2호소아의 급성 인두염에서 연쇄구균 신속항원검사의 유용성양승, 김미진, 김영호, 이혜란, 임기현, 정지아, 최우진, 황일태대한 소아알레르기 호흡기학회 · Allergy Asthma & Respiratory Disease2006 · 제16권 제1호외래 호흡기계 질환에서 항생제 사용에 대한 의사 태도 조사김동숙, 배그린대한임상건강증진학회 · Korean Journal of Health Promotion2013 · 제13권 제3호A군 연쇄구균 인두염의 임상양상과 두 가지 신속항원검사의 유용성 비교강은경, 김인욱, 양무열, 정혜령, 허희진대한진단검사의학회 · Laboratory Medicine Online2016 · 제6권 제2호1차 의료기관에서 코감기에 처방한 항균제김은실, 이진수, 이훈재, 정문현, 정형준대한감염학회 · Infection and Chemotherapy2007 · 제39권 제3호

이 간행물의 다른 논문 (11건)

국내 임상검사실의 반코마이신과 아미노글리코사이드 항생제 약물농도 결과값 비교 평가권원경, 박형두, 오종원, 이수연pp. 265-275국내 30개 기관의 Turnaround Time (TAT) 설정 상황과 TAT 관리 및 향상을 위한 고찰조선영, 이용화, 김영진, 김정호, 김솔잎, 조하은pp. 276-282Comparison of IRIS Iq200, UF-1000i, and Cobas u701 Module Automated Urine Sediment Analyzers황현용, 김태윤, 박하성, 강푸름, 양다해, 최현지, 권선자pp. 283-294HLA Class II 항체 검출 시 C3d 검사법과 SAB 검사법의 상관관계 평가강혜인, 이원목, 류남희, 하정숙, 전동석, 김도훈pp. 295-300Comparison of Clinical Utility between Phadiatop Assay and AdvanSureTM AlloScreen김민경, 우희연, 박효순, 권민정pp. 301-306
원문 보기