{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T03:53:26Z","timestamp":1778644406575,"version":"3.51.4"},"reference-count":35,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2024,11,4]],"date-time":"2024-11-04T00:00:00Z","timestamp":1730678400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>(1) Background: Group A Streptococcal (GAS) pharyngitis is common, resulting in numerous ambulatory visits. Accurate diagnosis is challenging. This study evaluated the clinical utility, cost, and performance of a nucleic acid amplification test (NAAT) for GAS detection, comparing it to a rapid antigen detection test (RADT) and throat culture. Additionally, we assessed the diagnostic stewardship related to these testing methods to ensure appropriate antibiotic use in clinical practice. Methods: Between November 2022 and February 2023, 82 throat swabs were analyzed, with McIsaac clinical scores calculated for each. The Abbott ID NOW STREP A 2 NAAT and Sekisui Diagnostics\u2019 OSOM\u00ae STREP A RADT were performed, followed by bacterial culture. Diagnostic performance was compared using culture as the gold standard. Results: Of the 82 samples, 28 (34.14%) tested positive for pathogenic germs, primarily Streptococcus pyogenes (92.85%). RADTs showed a sensitivity of 80.76% and a specificity of 100%, while NAATs demonstrated a sensitivity of 100% and specificity of 96.42%. Cost analysis indicated the need for reimbursement adjustments to optimize NAAT\u2019s economic benefits. Clinical data indicated that symptoms alone were insufficient for reliable diagnosis. Conclusions: This study confirmed the superior sensitivity of Abbott\u2019s Strep A2 NAAT over RADT. Given the Belgian guidelines against routine antibiotic treatment for pharyngitis and considering local treatment recommendations and cost, implementing NAAT for GAS detection in Belgian laboratories is less beneficial. However, the role of NAAT in supporting antimicrobial stewardship by ensuring appropriate antibiotic use remains significant.<\/jats:p>","DOI":"10.3390\/jcm13216627","type":"journal-article","created":{"date-parts":[[2024,11,4]],"date-time":"2024-11-04T10:57:20Z","timestamp":1730717840000},"page":"6627","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Molecular Diagnostics for Group A Streptococcal Pharyngitis: Clinical and Economic Benefits in the Belgian Healthcare Context"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-3982-9161","authenticated-orcid":false,"given":"Mohammad Hossein","family":"Panahandeh","sequence":"first","affiliation":[{"name":"Microbiology Laboratory, Department of Laboratory Medicine, Clinique Notre-Dame De Gr\u00e2ce, 6041 Gosselies, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3618-668X","authenticated-orcid":false,"given":"Reza","family":"Soleimani","sequence":"additional","affiliation":[{"name":"Microbiology Laboratory, Department of Laboratory Medicine, Centre Hospitalier Universitaire Ambroise Par\u00e9 (HELORA\u2014Site Kennedy), 7000 Mons, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasmine","family":"Nezzar","sequence":"additional","affiliation":[{"name":"Microbiology Laboratory, Department of Laboratory Medicine, Clinique Notre-Dame De Gr\u00e2ce, 6041 Gosselies, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3041-1591","authenticated-orcid":false,"given":"Hector","family":"Rodriguez-Villalobos","sequence":"additional","affiliation":[{"name":"Microbiology Laboratory, Departement of Laboratory Medicine, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0284-5210","authenticated-orcid":false,"given":"Beno\u00eet","family":"Kabamba-Mukadi","sequence":"additional","affiliation":[{"name":"Microbiology Laboratory, Departement of Laboratory Medicine, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandre","family":"Grimmelprez","sequence":"additional","affiliation":[{"name":"Microbiology Laboratory, Department of Laboratory Medicine, Clinique Notre-Dame De Gr\u00e2ce, 6041 Gosselies, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia","family":"Schatt","sequence":"additional","affiliation":[{"name":"Microbiology Laboratory, Department of Laboratory Medicine, Clinique Notre-Dame De Gr\u00e2ce, 6041 Gosselies, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Schappert, S.M., and Rechtsteiner, E.A. (2008). Ambulatory Medical Care Utilization Estimates for 2006, National Health Statistics Reports.","DOI":"10.1037\/e587152010-001"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1542\/peds.2006-3368","article-title":"Burden of acute sore throat and group A streptococcal pharyngitis in school-aged children and their families in Australia","volume":"120","author":"Danchin","year":"2007","journal-title":"Pediatrics"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"506","DOI":"10.7326\/0003-4819-134-6-200103200-00018","article-title":"Principles of appropriate antibiotic use for acute pharyngitis in adults","volume":"134","author":"Snow","year":"2001","journal-title":"Ann. Intern. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1587","DOI":"10.1001\/jama.291.13.1587","article-title":"Empirical validation of guidelines for the management of pharyngitis in children and adults","volume":"291","author":"McIsaac","year":"2004","journal-title":"JAMA"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"113","DOI":"10.7326\/0003-4819-139-2-200307150-00011","article-title":"Diagnosis and management of adults with pharyngitis. A cost-effectiveness analysis","volume":"139","author":"Neuner","year":"2003","journal-title":"Ann. Intern. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1097\/01.inf.0000078835.72497.ab","article-title":"Extrapharyngeal group A Streptococcus infection: Diagnostic accuracy and utility of rapid antigen testing","volume":"22","author":"Clegg","year":"2003","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_7","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":"ref_8","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1093\/cid\/cis847","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":"ref_9","doi-asserted-by":"crossref","first-page":"2413","DOI":"10.1128\/JCM.01472-16","article-title":"Point-Counterpoint: A Nucleic Acid Amplification Test for Streptococcus pyogenes Should Replace Antigen Detection and Culture for Detection of Bacterial Pharyngitis","volume":"54","author":"Pritt","year":"2016","journal-title":"J. Clin. Microbiol."},{"key":"ref_10","unstructured":"Abbott (2023, May 10). ID NOW\u2122 Strep A 2: Package Insert. Maine: Abbott. Available online: https:\/\/www.globalpointofcare.abbott\/us\/en\/product-details\/id-now-strep-a-2.html."},{"key":"ref_11","unstructured":"(2022). National Reference Center for Invasive \u03b2-Hemolytic Streptococci No Group B. Report 2012\u20132022 [Internet], University of Antwerpen. Available online: https:\/\/www.sciensano.be\/sites\/default\/files\/rapport_2012_-_2022_streptococcen_final.pdf."},{"key":"ref_12","unstructured":"Matthys, J., and De Meyere, M. (2017). Acute Keelpijn [Internet], WOREL. Available online: https:\/\/ebpnet.be\/nl\/ebsources\/1241."},{"key":"ref_13","unstructured":"BAPCOC (2022). Belgische Gids Voor Anti-Infectieuze Behandeling in de Ambulante Praktijk [Internet], FPS Public Health, Food Chain Safety and Environment. Available online: https:\/\/tinyurl.com\/bapcoc."},{"key":"ref_14","first-page":"12","article-title":"Mise \u00e0 jour de recommandations de bonne pratique existantes","volume":"43B","author":"Dirven","year":"2006","journal-title":"Belg. Health KCE"},{"key":"ref_15","unstructured":"Sekisui Diagnostics (2016). OSOM Strep A Test: Product Insert, Sekisui Diagnostics."},{"key":"ref_16","unstructured":"Cepheid (2020). Xpert Xpress Strep A: Package Insert, Cepheid."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1586\/14737159.2016.1133297","article-title":"The Simplexa\u2122 Group A Strep Direct Assay: A sample-to-answer molecular assay for the diagnosis of group A streptococcal pharyngitis","volume":"16","author":"Tabb","year":"2016","journal-title":"Expert Rev. Mol. Diagn."},{"key":"ref_18","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":"ref_19","doi-asserted-by":"crossref","first-page":"e01310-17","DOI":"10.1128\/JCM.01310-17","article-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","volume":"56","author":"Berry","year":"2018","journal-title":"J. Clin. Microbiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1093\/ajcp\/aqy038","article-title":"Comparison of Alere i Strep A Rapid Molecular Assay With Rapid Antigen Testing and Culture in a Pediatric Outpatient Setting","volume":"150","author":"Weinzierl","year":"2018","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1007\/s10096-012-1809-1","article-title":"Effect of clinical spectrum, inoculum size and physician characteristics on sensitivity of a rapid antigen detection test for group A streptococcal pharyngitis","volume":"32","author":"Cohen","year":"2013","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1128\/JCM.41.1.242-249.2003","article-title":"Comparison of LightCycler PCR, rapid antigen immunoassay, and culture for detection of group A streptococci from throat swabs","volume":"41","author":"Uhl","year":"2003","journal-title":"J. Clin. Microbiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1097\/INF.0000000000002293","article-title":"Highly Sensitive Molecular Assay for Group A Streptococci Over-identifies Carriers and May Impact Outpatient Antimicrobial Stewardship","volume":"38","author":"Tanz","year":"2019","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/s41512-023-00150-4","article-title":"Diagnostic accuracy of a rapid nucleic acid test for group A streptococcal pharyngitis using saliva samples: Protocol for a prospective multicenter study in primary care","volume":"7","author":"Touitou","year":"2023","journal-title":"Diagn. Progn. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.diagmicrobio.2017.10.003","article-title":"Duration of Group A Streptococcus PCR positivity following antibiotic treatment of pharyngitis","volume":"90","author":"Homme","year":"2018","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1542\/peds.87.5.598","article-title":"Community-wide outbreak of group G streptococcal pharyngitis","volume":"87","author":"Gerber","year":"1991","journal-title":"Pediatrics"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e13879","DOI":"10.1111\/ijcp.13879","article-title":"Worldwide comparison of treatment guidelines for sore throat","volume":"75","author":"Coutinho","year":"2021","journal-title":"Int. J. Clin. Pract."},{"key":"ref_28","first-page":"422","article-title":"NHG-Standaard Acute Keelpijn (Derde Herziening)","volume":"58","author":"Dagnelie","year":"2015","journal-title":"Huisarts Wet"},{"key":"ref_29","first-page":"CD000023","article-title":"Antibiotics for sore throat","volume":"2013","author":"Spinks","year":"2013","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Robertson, K.A., Volmink, J.A., and Mayosi, B.M. (2005). Antibiotics for the primary prevention of acute rheumatic fever: A meta-analysis. BMC Cardiovasc. Disord., 5.","DOI":"10.1186\/1471-2261-5-11"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1920","DOI":"10.1161\/CIRCULATIONAHA.118.035900","article-title":"Management of Pharyngitis","volume":"138","author":"Berkley","year":"2018","journal-title":"Circulation"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/s13613-024-01249-7","article-title":"Clinical and molecular epidemiological features of critically ill patients with invasive group A Streptococcus infections: A Belgian multicenter case-series","volume":"14","author":"Peetermans","year":"2024","journal-title":"Ann. Intensive Care"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/s13756-015-0065-4","article-title":"An antimicrobial stewardship program initiative: A qualitative study on prescribing practices among hospital doctors","volume":"4","author":"Skodvin","year":"2015","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/s13756-019-0480-z","article-title":"Use of microbiology tests in the era of increasing AMR rates\u2014A multicentre hospital cohort study","volume":"8","author":"Skodvin","year":"2019","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2666","DOI":"10.1093\/jac\/dkx163","article-title":"Addressing the key communication barriers between microbiology laboratories and clinical units: A qualitative study","volume":"72","author":"Skodvin","year":"2017","journal-title":"J. Antimicrob. Chemother"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/21\/6627\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:26:14Z","timestamp":1760113574000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/21\/6627"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,4]]},"references-count":35,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["jcm13216627"],"URL":"https:\/\/doi.org\/10.3390\/jcm13216627","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,4]]}}}