Impact of point-of-care gonorrhea and chlamydia testing in the emergency department on reducing overtreatment rates

Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections continue to increase in the United States. Advancement in technology with point-of-care (POC) testing can improve the overall treatment of sexually transmitted infections (STI) in the emergency department (ED) by shortening the tim...

Full description

Saved in:

Bibliographic Details
Published in:	The American journal of emergency medicine Vol. 83; pp. 64 - 68
Main Authors:	Feltes, Alaina, Combs, Julie, Reynolds, Maegan, Conroy, Mark, Lindsey, Sommer, Dick, Michael, Li, Junan, Reichert, Erin
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-09-2024 Elsevier Limited
Subjects:	Adult Antibiotics Chlamydia Chlamydia Infections - diagnosis Chlamydia Infections - drug therapy Chlamydia trachomatis - isolation & purification Data collection Drug dosages Electronic health records Emergency medical care Emergency Service, Hospital Female Gonorrhea Gonorrhea - diagnosis Gonorrhea - drug therapy Humans Hypotheses Length of stay Male Medical Overuse - prevention & control Medical Overuse - statistics & numerical data Middle Aged Neisseria gonorrhoeae - isolation & purification Patients Pharmacists Point-of-care Point-of-Care Testing Retrospective Studies Sex crimes Sexual assault Sexually transmitted diseases Sexually transmitted infections STD United States > US Ohio Sexually transmitted diseases Gonorrhea Point-of-care chlamydia Sexually transmitted infections
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections continue to increase in the United States. Advancement in technology with point-of-care (POC) testing can improve the overall treatment of sexually transmitted infections (STI) in the emergency department (ED) by shortening the time to test result and administration of accurate treatment. The purpose of this study was to assess if the POC test reduced the rate of overtreatment for CT and/or NG compared to the standard-of-care (SOC) test. This retrospective cohort study included adult patients tested for CT and NG at two urban EDs between August 2020 and October 2022. This cohort excluded hospital admissions, elopement, pregnancy, rectal and oral samples, victims of sexual assault, and diagnoses for which antimicrobial treatment overlapped that of CT/NG. The primary outcome assessed overtreatment, defined as receiving treatment in the ED or a prescription prior to discharge for patients who tested negative for CT and/or NG. Secondary outcomes included undertreatment rates, overtreatment rates in select populations, test turnaround time, and ED length of stay (LOS). Of 327 patients screened, 97 patients were included in the SOC group and 100 in POC. Overtreatment for CT was provided in zero POC patients and 29 (29.9%) SOC patients (p < 0.001). NG was overtreated in 1 (1%) POC and 23 (23.7%) SOC (p < 0.001). POC was associated with undertreatment of CT and/or NG in two patients, compared to four patients tested with SOC. Overall, treatment was deemed inappropriate for 5 (5%) of those tested with POC, compared to 35 (36%) tested with SOC (p < 0.001). There was no difference in ED LOS (2.7 vs 3.01 h, p = 0.41). POC testing facilitated the return of results prior to patients being discharged from the ED. Compared to standard testing, POC improved appropriateness of CT and NG treatment by reducing the rates of overtreatment.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0735-6757 1532-8171 1532-8171
DOI:	10.1016/j.ajem.2024.06.040