{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T14:27:35Z","timestamp":1789050455565,"version":"build-2803163510"},"reference-count":35,"publisher":"American Society for Microbiology","issue":"6","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2026,6,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      In Canada, Group A streptococcal (GAS) pneumonia is a severe invasive GAS (iGAS) condition reportable to public health for consideration of chemoprophylaxis for close contacts. It is often complicated by parapneumonic effusion. Sterile site culture from pleural fluid is the diagnostic gold standard but is insensitive, particularly given that many patients will have received antibiotics prior to sample collection. Xpert Xpress Strep A (Cepheid, Sunnyvale, CA) is a quantitative real-time (qPCR) assay targeting the\n                      <jats:italic toggle=\"yes\">speB<\/jats:italic>\n                      gene designed to rapidly detect\n                      <jats:italic toggle=\"yes\">Streptococcus pyogenes<\/jats:italic>\n                      from throat swabs. We evaluated its performance compared to bacterial culture for pediatric pleural fluids. A convenience sample of 36 specimens (21 positive, 15 negative) obtained January 2023 to April 2025 was included. Results were compared to a composite reference standard consisting of positive culture and a laboratory-developed (LD) qPCR targeting the\n                      <jats:italic toggle=\"yes\">spy1258<\/jats:italic>\n                      gene. Limit of detection (LoD) for LD qPCR was determined by testing a dilution series of negative pleural fluids spiked with a predefined concentration (copies\/mL) of\n                      <jats:italic toggle=\"yes\">S. pyogenes<\/jats:italic>\n                      ATCC 19615 and using 95% hit rate analysis for Xpert. All 21 positive samples tested (100%) were detected by Xpert and the composite reference standard, while only 8\/21 (38%) were culture positive. Xpert demonstrated 100% positive percent agreement, negative percent agreement, and overall categorical agreement (\u0138 = 1) with the composite reference standard and individual LD qPCR. There was 64% categorical agreement between Xpert and culture alone (\u0138 = 0.3). Xpert was more sensitive for detecting\n                      <jats:italic toggle=\"yes\">S. pyogenes<\/jats:italic>\n                      than culture from pleural fluid. Faster turnaround time shortened the window to optimal therapy, supporting its diagnostic utility.\n                    <\/jats:p>\n                    <jats:sec>\n                      <jats:title>IMPORTANCE<\/jats:title>\n                      <jats:p>Group A streptococcal (GAS) pneumonia, a predominant pathogen in pediatric complicated pneumonia and a severe form of invasive GAS infection, requires prompt diagnosis, both for clinical patient management and identification of close contacts for public health evaluation. Pleural effusion is a common complication. Recovery of GAS from a sterile site like pleural fluid is a key criterion to categorize disease as invasive. However, microbiological yield is often low and may be improved by applying molecular diagnostic techniques. In our study, we demonstrate the utility of Xpert Xpress Strep A for Cepheid GeneXpert for rapid detection of GAS in pediatric pleural fluids. We demonstrated excellent sensitivity with Xpert detecting all 21\/21 (100%) positive specimens, compared to culture alone, which was only positive for 8\/21 (38%).<\/jats:p>\n                    <\/jats:sec>\n                  <\/jats:sec>","DOI":"10.1128\/spectrum.03703-25","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T13:01:19Z","timestamp":1776690079000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":3,"title":["Performance of the Xpert Xpress Strep A for detection of\n                    <i>Streptococcus pyogenes<\/i>\n                    from pediatric pleural fluids"],"prefix":"10.1128","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-5697-2909","authenticated-orcid":true,"given":"Genevi\u00e8ve","family":"Amaral","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03rmrcq20","id-type":"ROR","asserted-by":"publisher"}],"name":"Department 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Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulrahman","family":"Almodahka","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03rmrcq20","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia","place":["Vancouver, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0835-9504","authenticated-orcid":true,"given":"David M.","family":"Goldfarb","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03rmrcq20","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia","place":["Vancouver, Canada"]},{"name":"Division of Medical Microbiology, Virology and Infection Control, Department of Pathology and Laboratory Medicine, BC Children\u2019s and Women\u2019s Hospital and Health Centre","place":["Vancouver, Canada"]},{"id":[{"id":"https:\/\/ror.org\/01xesb955","id-type":"ROR","asserted-by":"publisher"}],"name":"Division of Infectious Diseases, Department of Pediatrics, BC Children\u2019s Hospital","place":["Vancouver, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Penny","sequence":"additional","affiliation":[{"name":"Division of Medical Microbiology, Virology and Infection Control, Department of Pathology and Laboratory Medicine, BC Children\u2019s and Women\u2019s Hospital and Health Centre","place":["Vancouver, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Watson","sequence":"additional","affiliation":[{"name":"Division of Medical Microbiology, Virology and Infection Control, Department of Pathology and Laboratory Medicine, BC Children\u2019s and Women\u2019s Hospital and Health Centre","place":["Vancouver, 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Group A streptococcal diseases: for health professionals. Government of Canada. Available from: https:\/\/www.canada.ca\/en\/public-health\/services\/diseases\/group-a-streptococcal-diseases\/health-professionals.html. Retrieved 21 Jul 2025."},{"key":"e_1_3_5_5_2","unstructured":"Antimicrobial resistance: seasonal update: Streptococcus pyogenes. 2024. Canadian Antimicrobial Resistance Surveillance System. Government of Canada. https:\/\/health-infobase.canada.ca\/carss\/amr\/results.html?ind=16."},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00603-12"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(23)00008-7"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofad188"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2023.28.1.2200942"},{"key":"e_1_3_5_10_2","unstructured":"Public Health Agency of Canada. 2006. Guidelines for the prevention and control of invasive group A streptococcal disease. Can Commun Dis Rep 32S2:1-26.11. Available from: https:\/\/www.phac-aspc.gc.ca\/publicat\/ccdr-rmtc\/06pdf\/32s2_e.pdf. Retrieved 1 Oct 2025."},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12887-023-04004-2"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-8-129"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1111\/apa.16768"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.01494-19"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0b013e3182002d14"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.toxicon.2016.03.019"},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/femsle\/fnv148"},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.1128\/IAI.00989-15"},{"key":"e_1_3_5_19_2","unstructured":"Cepheid Innovation. 2020. 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