RESUMO
Background During the COVID-19 pandemic, there was a dramatic upsurge in the prevalence of respiratory symptoms, which may have altered the usual pattern of bacterial infections and relevant decision-making. Objectives This study aimed to investigate the prevalence of rapid antigen detection test (RADT) positivity for group A Streptococcus (GAS) in patients with respiratory symptoms and signs during the COVID-19 pandemic. In addition, we evaluated the association between a positive test and the modified Centor criteria in a population of children and adults with upper respiratory tract infections (URTIs). Methods A prospective study was conducted in primary health care centres (PHCCs) and the paediatric emergency department (ED) of the Maternity and Children Hospital in Dammam City, Kingdom of Saudi Arabia (KSA). Trained physicians collected data from patients aged three years and older or their guardian(s) regarding URTI symptoms. The modified Centor score was calculated, and RADT was performed for all patients. Results Data were collected from 469 patients. The prevalence of positive RADT was 19 (4.1%), and the setting was associated with RADT positivity, as 14% of ED visitors tested positive compared with 0.6% of PHCC visitors. The RADT results had an area under the curve of 0.856 (95% confidence interval (CI)=0.774-0.939), with Centor scores of 2 and 3 having a sensitivity of 89.5%/78.9% and specificity of 70.6%/80.8%, respectively. Individuals with a score of 5 had the highest rate of positive RADT (33.3%, P<0.001); a score less than 0 excluded the possibility of GAS infection. Conclusion The Centor score can improve effective antibiotic prescribing; however, Centor scores ≥2 should be supplemented with an additional confirmatory test. The high specificity of RADT makes it a useful tool in preventing the prescription of unneeded antibiotics.
RESUMO
Background Upper respiratory tract infections (URTIs) represent the most common diagnosis in ambulatory care settings. Some of these infections are properly treated with antibiotics, but evidence points to an inappropriate overuse of antibiotics in URTI management. This overuse is linked to antibiotic resistance, drug-related adverse effects, and increased costs. Objective This study evaluated the prevalence and predictors of antibiotic prescription for patients with URTI symptoms at the primary healthcare centers (PHCCs) and pediatric emergency department (ED) of the Maternity and Children Hospital (MCH) in Dammam, Saudi Arabia. Methods A prospective study was conducted in the PHCCs and pediatric ED of MCH. Trained physicians collected data on patients with URTI symptoms aged three years and older. Scores based on modified Centor criteria were calculated, and rapid antigen detection tests (RADTs) were conducted for all study participants. Results Out of 469 patients with a URTI, 141 (30.1%) received a prescription for an antibiotic, with a smaller proportion in the PHCCs (n=85; 24.4%) than in the pediatric ED (n=56; 46.3%). The main significant predictors of antibiotic prescription in terms of odds ratio (OR) and 95% confidence interval (95%CI) were a positive RADT result (OR=41.75, 95%CI=4.76-366.28), the presence of tonsillar exudate (OR=5.066, 95%CI=3.08-8.33), tender and/or swollen anterior cervical lymph nodes (OR=4.537, 95%CI=1.96-10.54), and fever (OR=3.519, 95%CI=2.33-5.31). A higher Centor score was also a predictor (2 to 5 vs. -1 to 1) (OR=2.72, 95%CI=1.8-4.12). The absence of a cough was not a significant predictor (OR=1.13, 95%CI=0.74-1.72). Conclusions Although a positive RADT increased the likelihood that a patient would be prescribed an antibiotic at the time of assessment, most antibiotic prescriptions were not justified. To control expenses, prevent adverse effects, and limit the spread of antibiotic resistance, efforts should be made to reduce unnecessarily high antibiotic usage.
