6800 Impact of rapid group A Streptococcus PCR on antimicrobial stewardship in a busy tertiary emergency department

Objectives Pharyngitis is a common presentation in children with most cases having a viral aetiology.¹ Clinical scoring tools such as 'FeverPAIN' can be used to estimate the likelihood of bacterial infection and are often highly sensitive but not very specific as well as not being validated in younger children.²Group A Streptococcus (GAS) is a common and potentially serious pathogen that concerns paediatricians and contributes to many antibiotic prescriptions for pharyngitis.²2022 saw a significant surge in GAS cases including invasive disease. The UK has a 5-year action plan to tackle antimicrobial resistance which includes implementing rapid diagnostic tests to guide prescribing.³ We audited the use of rapid PCR GAS tests in an A&E setting to assess if there was an impact on antibiotic prescriptions. Methods We used the Xpert® Xpress Strep A (Cepheid) in a busy paediatric A&E setting in February – July 2023. A single throat swab was taken for children with signs or symptoms indicative of pharyngitis who had fever within the last 24 hours, no cough or coryza and symptoms for less than 3 days (i.e. scored at least 3 on the FeverPAIN clinical score for Streptococcal pharyngitis). Each swab was processed for both rapid PCR as well as culture. Clinicians were asked to indicate whether they would have given antibiotics if the test results were not available. Data was collected on 90 samples. Results 40/90 (45%) swabs were PCR positive of which 32 (80%) were culture positive. All GAS culture positive swabs were also PCR positive. The highest rate of positive swabs was in 4–7 year olds. 70/90 (78%) children would have been given antibiotics based on clinical examination alone but, due to negative PCR results, 18/70 (26%) did not get antibiotics. Of the 20 children who clinicians were not going to give antibiotics to, there were 6 (30%) who had a positive PCR and so did get antibiotics. Overall there was a 13% decrease in antibiotic prescriptions with the use of the rapid swab. Conclusion Use of rapid GAS testing in A&E reduced antibiotic prescriptions by 13%. Collaborative work between the microbiology laboratories and frontline clinical staff can bring about strategies which begin to tackle antimicrobial resistance. References ESCMID Sore Throat Guideline Group; Pelucchi C, Grigoryan L, Galeone C, Esposito S, Huovinen P, Little P, Verheij T. Guideline for the management of acute sore throat. Clin Microbiol Infect 2012 Apr;18(Suppl 1):1–28. doi: 10.1111/j.1469-0691.2012.03766.x. PMID: 22432746. Malley M, Driver K, Costelloe M, Monaghan I, Jefferson L, Poole L, Lewis C, Salt R, Marlow R. To prescribe or not to prescribe for paediatric sore throat: a retrospective cohort study comparing clinician-led antibiotic prescriptions to FeverPAIN and Centor scoring in a tertiary paediatric emergency department and a national review of practice. Emerg Med J 2021 Aug;38(8):613–616. doi: 10.1136/emermed-2020-210786. Epub 2021 Apr 15. PMID: 33858860. https://www.gov.uk/government/publications/uk-5-year-action-plan-for-antimicrobial-resistance-2019-to-2024