The feasibility of measuring calprotectin from a throat swab as a marker of infections caused by group A streptococcus: a case-control feasibility study.

Behnaz Schofield,Micaela Gal,David Gillespie,Clive Gregory,Gurudutt Naik,Alastair Hay,Nick Francis

doi:10.3399/bjgpopen20x101006

Behnaz Schofield, Micaela Gal + Show 5 more

Open Access

https://doi.org/10.3399/bjgpopen20x101006

Copy DOI

Abstract

BackgroundMost people with sore throat do not benefit from antibiotic treatment, but nearly three-quarters of those presenting in primary care are prescribed antibiotics. A test that is predictive of bacterial infection could help guide antibiotic prescribing. Calprotectin is a biomarker of neutrophilic inflammation, and may be a useful marker of bacterial throat infections.AimTo assess the feasibility of measuring calprotectin from throat swabs, and assess whether individuals with sore throats likely to be caused by streptococcal infections have apparently higher throat calprotectin levels than other individuals with sore throat and healthy volunteers.Design & settingA proof of concept case–control study was undertaken, which compared primary care patients with sore throats and healthy volunteers.MethodBaseline characteristics and throat swabs were collected from 30 primary care patients with suspected streptococcal sore throat, and throat swabs were taken from 10 volunteers without sore throat. Calprotectin level determination and rapid antigen streptococcal testing were conducted on the throat swab eluents. Calprotectin levels in the following groups were compared: volunteers without a sore throat; all patients with a sore throat; patients with a sore throat testing either negative or positive for streptococcal antigen; and those with lower and higher scores on clinical prediction rules for streptococcal sore throat.ResultsCalprotectin was detected in all throat swab samples. Mean calprotectin levels were numerically higher in patients with sore throat compared with healthy volunteers, and sore throat patients who had group A streptococci antigen detected compared with those who did not.ConclusionCalprotectin can be measured from throat swab samples and levels are consistent with the hypothesis that streptococcal infection leads to higher throat calprotectin levels. This hypothesis will be tested in a larger study.

Highlights

Sore throat is a common reason for patients to consult their GP in primary care.[1,2] Individuals frequently consult because of a belief that antibiotics are needed to treat their infection, and sore throat accounts for nearly a third of all antibiotics prescribed in primary care.[3]
Calprotectin can be measured from throat swab samples and levels are consistent with the hypothesis that streptococcal infection leads to higher throat calprotectin levels
Sore throat is a common reason for antibiotics to be prescribed, even though most are caused by viral infections

Summary

Introduction

Sore throat is a common reason for patients to consult their GP in primary care.[1,2] Individuals frequently consult because of a belief that antibiotics are needed to treat their infection, and sore throat accounts for nearly a third of all antibiotics prescribed in primary care.[3]. There is still a wide variation (10th–90th percentile range 45%– 78%) in prescribing rates among primary care practices.[7,8]. Most people with sore throat do not benefit from antibiotic treatment, but nearly three- quarters of those presenting in primary care are prescribed antibiotics. A test that is predictive of bacterial infection could help guide antibiotic prescribing. Calprotectin is a biomarker of neutrophilic inflammation, and may be a useful marker of bacterial throat infections

Objectives

Methods

Results

Discussion

Conclusion