Comparison of the Alere i Strep A test and the BD veritor system in the detection of group a streptococcus and the hypothetical impact of results on antibiotic utilization

Gregory J. Berry, Catherine R. Miller, Mariana Moreno Prats, Christopher Marquez, Olajumoke O. Oladipo, Michael J. Loeffelholz, John R. Petersen

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Rapid detection of group A Streptococcus (GAS) is an integral component of treatment decisions in the clinic, especially in the pediatric population. We prospectively collected 216 specimens from symptomatic, predominantly pediatric patients and evaluated the performance of the Alere i Strep A test (Alere i; Alere Inc., Scarborough, ME) and the BD Veritor system (BD Veritor; Becton, Dickinson and Company, Sparks, MD), with culture results being used as a comparator. Real-time PCR (RT-PCR) was performed as an arbiter in discordant cases. Comprehensive chart review was also done to determine the hypothetical impact of the results on antibiotic use. Alere i had a sensitivity and a specificity of 100% and 91.3%, respectively, and BD Veritor had a sensitivity and a specificity of 76.2% and 93.6%, respectively, when the results were compared to those of GAS culture. Further analysis of discordant results using RT-PCR revealed that while BD Veritor missed 13 confirmed positive cases, Alere i detected 100% (n 13) of the same cases. Analysis of assay agreement showed that Alere i and BD Veritor had only moderate agreement (agreement 0.888 [95% confidence interval {CI}, 0.838 to 0.927]; kappa index 0.689 [95% CI, 0.91 to 0.974]). We also found both the underutilization and the over-utilization of antibiotics based on the results of molecular testing. Overall, Alere i showed superior performance over BD Veritor in the detection of GAS pharyngitis and could potentially assist in better antibiotic utilization.

Original languageEnglish (US)
JournalJournal of Clinical Microbiology
Volume56
Issue number3
DOIs
StatePublished - Mar 1 2018

Fingerprint

Streptococcus
Anti-Bacterial Agents
Real-Time Polymerase Chain Reaction
Confidence Intervals
Pediatrics
Sensitivity and Specificity
Pharyngitis
Population
Therapeutics

Keywords

  • Alere i
  • Antibiotic utilization
  • BD veritor
  • Group A streptococcus
  • Point-of-care testing (POCT)

ASJC Scopus subject areas

  • Microbiology (medical)

Cite this

Comparison of the Alere i Strep A test and the BD veritor system in the detection of group a streptococcus and the hypothetical impact of results on antibiotic utilization. / Berry, Gregory J.; Miller, Catherine R.; Prats, Mariana Moreno; Marquez, Christopher; Oladipo, Olajumoke O.; Loeffelholz, Michael J.; Petersen, John R.

In: Journal of Clinical Microbiology, Vol. 56, No. 3, 01.03.2018.

Research output: Contribution to journalArticle

Berry, Gregory J. ; Miller, Catherine R. ; Prats, Mariana Moreno ; Marquez, Christopher ; Oladipo, Olajumoke O. ; Loeffelholz, Michael J. ; Petersen, John R. / Comparison of the Alere i Strep A test and the BD veritor system in the detection of group a streptococcus and the hypothetical impact of results on antibiotic utilization. In: Journal of Clinical Microbiology. 2018 ; Vol. 56, No. 3.
@article{40f7e6b3c7db405baef7de9d795f11bf,
title = "Comparison of the Alere i Strep A test and the BD veritor system in the detection of group a streptococcus and the hypothetical impact of results on antibiotic utilization",
abstract = "Rapid detection of group A Streptococcus (GAS) is an integral component of treatment decisions in the clinic, especially in the pediatric population. We prospectively collected 216 specimens from symptomatic, predominantly pediatric patients and evaluated the performance of the Alere i Strep A test (Alere i; Alere Inc., Scarborough, ME) and the BD Veritor system (BD Veritor; Becton, Dickinson and Company, Sparks, MD), with culture results being used as a comparator. Real-time PCR (RT-PCR) was performed as an arbiter in discordant cases. Comprehensive chart review was also done to determine the hypothetical impact of the results on antibiotic use. Alere i had a sensitivity and a specificity of 100{\%} and 91.3{\%}, respectively, and BD Veritor had a sensitivity and a specificity of 76.2{\%} and 93.6{\%}, respectively, when the results were compared to those of GAS culture. Further analysis of discordant results using RT-PCR revealed that while BD Veritor missed 13 confirmed positive cases, Alere i detected 100{\%} (n 13) of the same cases. Analysis of assay agreement showed that Alere i and BD Veritor had only moderate agreement (agreement 0.888 [95{\%} confidence interval {CI}, 0.838 to 0.927]; kappa index 0.689 [95{\%} CI, 0.91 to 0.974]). We also found both the underutilization and the over-utilization of antibiotics based on the results of molecular testing. Overall, Alere i showed superior performance over BD Veritor in the detection of GAS pharyngitis and could potentially assist in better antibiotic utilization.",
keywords = "Alere i, Antibiotic utilization, BD veritor, Group A streptococcus, Point-of-care testing (POCT)",
author = "Berry, {Gregory J.} and Miller, {Catherine R.} and Prats, {Mariana Moreno} and Christopher Marquez and Oladipo, {Olajumoke O.} and Loeffelholz, {Michael J.} and Petersen, {John R.}",
year = "2018",
month = "3",
day = "1",
doi = "10.1128/JCM.01310-17",
language = "English (US)",
volume = "56",
journal = "Journal of Clinical Microbiology",
issn = "0095-1137",
publisher = "American Society for Microbiology",
number = "3",

}

TY - JOUR

T1 - Comparison of the Alere i Strep A test and the BD veritor system in the detection of group a streptococcus and the hypothetical impact of results on antibiotic utilization

AU - Berry, Gregory J.

AU - Miller, Catherine R.

AU - Prats, Mariana Moreno

AU - Marquez, Christopher

AU - Oladipo, Olajumoke O.

AU - Loeffelholz, Michael J.

AU - Petersen, John R.

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Rapid detection of group A Streptococcus (GAS) is an integral component of treatment decisions in the clinic, especially in the pediatric population. We prospectively collected 216 specimens from symptomatic, predominantly pediatric patients and evaluated the performance of the Alere i Strep A test (Alere i; Alere Inc., Scarborough, ME) and the BD Veritor system (BD Veritor; Becton, Dickinson and Company, Sparks, MD), with culture results being used as a comparator. Real-time PCR (RT-PCR) was performed as an arbiter in discordant cases. Comprehensive chart review was also done to determine the hypothetical impact of the results on antibiotic use. Alere i had a sensitivity and a specificity of 100% and 91.3%, respectively, and BD Veritor had a sensitivity and a specificity of 76.2% and 93.6%, respectively, when the results were compared to those of GAS culture. Further analysis of discordant results using RT-PCR revealed that while BD Veritor missed 13 confirmed positive cases, Alere i detected 100% (n 13) of the same cases. Analysis of assay agreement showed that Alere i and BD Veritor had only moderate agreement (agreement 0.888 [95% confidence interval {CI}, 0.838 to 0.927]; kappa index 0.689 [95% CI, 0.91 to 0.974]). We also found both the underutilization and the over-utilization of antibiotics based on the results of molecular testing. Overall, Alere i showed superior performance over BD Veritor in the detection of GAS pharyngitis and could potentially assist in better antibiotic utilization.

AB - Rapid detection of group A Streptococcus (GAS) is an integral component of treatment decisions in the clinic, especially in the pediatric population. We prospectively collected 216 specimens from symptomatic, predominantly pediatric patients and evaluated the performance of the Alere i Strep A test (Alere i; Alere Inc., Scarborough, ME) and the BD Veritor system (BD Veritor; Becton, Dickinson and Company, Sparks, MD), with culture results being used as a comparator. Real-time PCR (RT-PCR) was performed as an arbiter in discordant cases. Comprehensive chart review was also done to determine the hypothetical impact of the results on antibiotic use. Alere i had a sensitivity and a specificity of 100% and 91.3%, respectively, and BD Veritor had a sensitivity and a specificity of 76.2% and 93.6%, respectively, when the results were compared to those of GAS culture. Further analysis of discordant results using RT-PCR revealed that while BD Veritor missed 13 confirmed positive cases, Alere i detected 100% (n 13) of the same cases. Analysis of assay agreement showed that Alere i and BD Veritor had only moderate agreement (agreement 0.888 [95% confidence interval {CI}, 0.838 to 0.927]; kappa index 0.689 [95% CI, 0.91 to 0.974]). We also found both the underutilization and the over-utilization of antibiotics based on the results of molecular testing. Overall, Alere i showed superior performance over BD Veritor in the detection of GAS pharyngitis and could potentially assist in better antibiotic utilization.

KW - Alere i

KW - Antibiotic utilization

KW - BD veritor

KW - Group A streptococcus

KW - Point-of-care testing (POCT)

UR - http://www.scopus.com/inward/record.url?scp=85042619194&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85042619194&partnerID=8YFLogxK

U2 - 10.1128/JCM.01310-17

DO - 10.1128/JCM.01310-17

M3 - Article

AN - SCOPUS:85042619194

VL - 56

JO - Journal of Clinical Microbiology

JF - Journal of Clinical Microbiology

SN - 0095-1137

IS - 3

ER -