{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T18:08:25Z","timestamp":1763748505054,"version":"3.41.2"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2021,11,16]],"date-time":"2021-11-16T00:00:00Z","timestamp":1637020800000},"content-version":"vor","delay-in-days":15,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["1-R01-AI141810-01"],"award-info":[{"award-number":["1-R01-AI141810-01"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"name":"UF Office of the Provost"},{"name":"UF Office of Research"},{"DOI":"10.13039\/100008275","name":"UF Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008275","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008276","name":"UF College of Medicine","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008276","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100018488","name":"UF Clinical and Translational Science Institute","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100018488","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Acute pharyngitis is a frequent illness presenting in outpatient settings. Antibiotics are only recommended for bacterial pharyngitis caused by group A \u03b2-hemolytic streptococci (GAS); however, infections with non\u2013group A \u03b2-hemolytic streptococci (NGAS) have similar clinical presentations and are common in young adult populations. The objective of this study was to analyze the performance of a current (expert) diagnostic algorithm for GAS pharyngitis, the Centor score, and compare it to alternative models developed to predict GAS and NGAS in a college student population.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Electronic health records were obtained for all patients who received a streptococcal rapid antigen detection test (RADT) and\/or a bacterial throat culture (n\u2005=\u20053963) at a southeastern US university in 2014. Bivariate and multivariable regression models (least absolute shrinkage and selection operator [LASSO] and stepwise-selected) were fitted to assess and compare their diagnostic performances for GAS-positive and NGAS-positive infections.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Prevalence of GAS was 18.8%. In the subset of RADT-negative patients who received bacterial throat cultures (n\u2005=\u2005313), growth of NGAS occurred in 34.8%, with group C streptococci the most frequent isolate. Mean Centor score was higher for NGAS (3.2) vs GAS (2.9) infections (P\u2005=\u2005.0111). The area under the curve (AUC) for GAS prediction was 0.64 using the Centor score and 0.70 using the LASSO model. For NGAS, the most important features were cough, pharyngeal erythema, tonsillar exudate, and gastrointestinal symptoms (AUC = 0.63).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>GAS and NGAS pharyngitis were indistinguishable among college students in this study utilizing a commonly applied decision score. Alternative models using additional clinical criteria may be useful for supporting diagnosis of this common illness.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofab482","type":"journal-article","created":{"date-parts":[[2021,11,18]],"date-time":"2021-11-18T07:36:06Z","timestamp":1637220966000},"source":"Crossref","is-referenced-by-count":5,"title":["Evaluating the Diagnostic Paradigm for Group A and Non\u2013Group A Streptococcal Pharyngitis in the College Student Population"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1203-2443","authenticated-orcid":false,"given":"Shannan N","family":"Rich","sequence":"first","affiliation":[{"name":"Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9021-5595","authenticated-orcid":false,"given":"Mattia","family":"Prosperi","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily M","family":"Klann","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pavel T","family":"Codreanu","sequence":"additional","affiliation":[{"name":"Student Health Care Center, University of Florida, Gainesville, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert L","family":"Cook","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa K","family":"Turley","sequence":"additional","affiliation":[{"name":"Student Health Care Center, University of Florida, Gainesville, Florida, USA"},{"name":"School of Physician Assistant Studies, College of Medicine, University of Florida, Gainesville, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,11,16]]},"reference":[{"key":"2021111805065361100_CIT0001","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1001\/jamainternmed.2013.11673","article-title":"Antibiotic prescribing to adults with sore throat in the United States, 1997-2010","volume":"174","author":"Barnett","year":"2014","journal-title":"JAMA Intern Med"},{"key":"2021111805065361100_CIT0002","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1086\/340949","article-title":"Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis","volume":"35","author":"Bisno","year":"2002","journal-title":"Clin Infect Dis"},{"key":"2021111805065361100_CIT0003","article-title":"Pharyngitis (strep throat)","volume-title":"Group A streptococcal (GAS) disease","author":"Centers for Disease Control and Prevention.","year":"2018"},{"key":"2021111805065361100_CIT0004","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1093\/cid\/ciu400","article-title":"Reflexive culture in adolescents and adults with group A streptococcal pharyngitis","volume":"59","author":"Dingle","year":"2014","journal-title":"Clin Infect Dis"},{"key":"2021111805065361100_CIT0005","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1177\/0272989X8100100304","article-title":"The diagnosis of strep throat in adults in the emergency room","volume":"1","author":"Centor","year":"1981","journal-title":"Med Decis Making"},{"key":"2021111805065361100_CIT0006","first-page":"75","article-title":"A clinical score to reduce unnecessary antibiotic use in patients with sore throat","volume":"158","author":"McIsaac","year":"1998","journal-title":"CMAJ"},{"key":"2021111805065361100_CIT0007","doi-asserted-by":"crossref","first-page":"e86","DOI":"10.1093\/cid\/cis629","article-title":"Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America","volume":"55","author":"Shulman","year":"2012","journal-title":"Clin Infect Dis"},{"key":"2021111805065361100_CIT0008","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1080\/07448481.2010.519014","article-title":"Non-group A streptococci as common isolates from throat culture among college students with pharyngitis","volume":"59","author":"Ramirez","year":"2011","journal-title":"J Am Coll Health"},{"key":"2021111805065361100_CIT0009","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1177\/0009922811409571","article-title":"Adolescent pharyngitis: a review of bacterial causes","volume":"50","author":"Mitchell","year":"2011","journal-title":"Clin Pediatr (Phila)"},{"key":"2021111805065361100_CIT0010","doi-asserted-by":"crossref","first-page":"812","DOI":"10.7326\/0003-4819-151-11-200912010-00011","article-title":"Expand the pharyngitis paradigm for adolescents and young adults","volume":"151","author":"Centor","year":"2009","journal-title":"Ann Intern Med"},{"key":"2021111805065361100_CIT0011","doi-asserted-by":"crossref","first-page":"2644","DOI":"10.1001\/jama.1990.03450200052030","article-title":"Association of group C beta-hemolytic streptococci with endemic pharyngitis among college students","volume":"264","author":"Turner","year":"1990","journal-title":"JAMA"},{"key":"2021111805065361100_CIT0012","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1128\/jcm.35.1.1-4.1997","article-title":"Epidemiologic evidence for Lancefield group C beta-hemolytic streptococci as a cause of exudative pharyngitis in college students","volume":"35","author":"Turner","year":"1997","journal-title":"J Clin Microbiol"},{"key":"2021111805065361100_CIT0013","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.jemermed.2014.12.057","article-title":"Group C Streptococcus causing rheumatic heart disease in a child","volume":"49","author":"Chandnani","year":"2015","journal-title":"J Emerg Med"},{"key":"2021111805065361100_CIT0014","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1007\/s12223-018-0595-2","article-title":"Detection of Streptococcus pyogenes virulence genes in Streptococcus dysgalactiae subsp. equisimilis from Vellore, India","volume":"63","author":"Babbar","year":"2018","journal-title":"Folia Microbiol (Praha)"},{"key":"2021111805065361100_CIT0015","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1016\/j.ijporl.2010.02.020","article-title":"The sensitivity and the specificity of rapid antigen test in streptococcal upper respiratory tract infections","volume":"74","author":"Gurol","year":"2010","journal-title":"Int J Pediatr Otorhinolaryngol"},{"year":"2019","author":"R Core Team.","key":"2021111805065361100_CIT0016"},{"key":"2021111805065361100_CIT0017","doi-asserted-by":"crossref","first-page":"3940","DOI":"10.1093\/bioinformatics\/bti623","article-title":"ROCR: visualizing classifier performance in R","volume":"21","author":"Sing","year":"2005","journal-title":"Bioinformatics"},{"key":"2021111805065361100_CIT0018","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1093\/fampra\/cmx072","article-title":"Signs and symptoms of group A versus non-group A strep throat: a meta-analysis","volume":"35","author":"Thai","year":"2018","journal-title":"Fam Pract"},{"key":"2021111805065361100_CIT0019","doi-asserted-by":"crossref","first-page":"241","DOI":"10.7326\/M14-1305","article-title":"The clinical presentation of Fusobacterium-positive and streptococcal-positive pharyngitis in a university health clinic: a cross-sectional study","volume":"162","author":"Centor","year":"2015","journal-title":"Ann Intern Med"}],"container-title":["Open Forum Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/8\/11\/ofab482\/41159983\/ofab482.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/8\/11\/ofab482\/41159983\/ofab482.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,18]],"date-time":"2021-11-18T07:36:31Z","timestamp":1637220991000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ofid\/article\/doi\/10.1093\/ofid\/ofab482\/6429503"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,1]]},"references-count":19,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2021,11,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ofid\/ofab482","relation":{},"ISSN":["2328-8957"],"issn-type":[{"type":"electronic","value":"2328-8957"}],"subject":[],"published-other":{"date-parts":[[2021,11,1]]},"published":{"date-parts":[[2021,11,1]]},"article-number":"ofab482"}}