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Journal of Clinical Microbiology, January 2000, p. 279-281, Vol. 38, No. 1
0095-1137/0/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.

Importance of Inoculum Size and Sampling Effect in Rapid Antigen Detection for Diagnosis of Streptococcus pyogenes Pharyngitis

Bradley Kurtz,1 Michael Kurtz,2 Martha Roe,3 and James Todd3,4,*

Texas College of Osteopathic Medicine, Fort Worth, Texas1; Aurora Pediatric Associates, Aurora, Colorado2; and Pathology, Children's Hospital,3 and Pediatrics and Microbiology, University of Colorado School of Medicine,4 Denver, Colorado

Received 27 May 1999/Returned for modification 19 July 1999/Accepted 25 October 1999

Current recommendations suggest that negative rapid Streptococcus pyogenes antigen tests be backed up with a culture, reflecting evidence that culture may have a higher sensitivity and also that testing of a second swab may yield a different (i.e., a positive) result because of variation in sample size or distribution. If the latter is common, the sensitivities of current antigen detection tests might be improved by simply increasing the amount of sample tested. The present study assessed the effect of antigen testing of two swabs extracted together compared to independent testing of each swab extracted separately for children with clinical pharyngitis. S. pyogenes grew from one or both swabs for 198 (37%) of 537 children. The combined culture was significantly (P < 0.05) more sensitive than culture of either swab alone. Compared to combined culture, antigen testing of two swabs extracted and tested together was significantly more sensitive than two single swab extractions (94.1 versus 80%; P = 0.03); however, the specificity was decreased (81.5 versus 89.8 to 92.7%; P < 0.05). This study suggests that sample size and/or uneven sample distribution may have influenced the apparent sensitivities of prior studies that compared antigen tests to a single plate culture. A strategy, such as the one used in the present study, that increases the sample size available for antigen testing (i.e., extraction of samples from both swabs) may improve detection rates to a level that will better approximate true disease status and obviate the need for backup cultures if specificity can be improved.

* Corresponding author. Mailing address: Childrens Hospital, 1056 E. 19th Ave., Denver, CO 80218. Phone: (303) 861-6983. Fax: (303) 837-2631. E-mail: todd.james{at}tchden.org.

Journal of Clinical Microbiology, January 2000, p. 279-281, Vol. 38, No. 1
0095-1137/0/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.


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