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3A3 The Clinical Impact of Rapid Diagnostics on Improving Appropriate Treatment of STIs in Women in the Emergency Department

Thursday, September 22, 2016: 11:15 AM
Salon C
Michele-Corinne Ako, BS1, Mitra Lewis, MS1, Stephen Peterson, BS1, Charlotte Gaydos, MS, MPH, DrPH2, Richard Rothman, MD, PhD1 and Andrea Dugas, MD, PhD1, 1School of Medicine, Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, 2Department of Medicine, Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD

     

Background:  Diagnosis and appropriate treatment of Chlamydia trachomatis (CT) and Neisseria Gonorrhea (NG) in the Emergency Department (ED) is challenging, with inefficient tests and long result times propagating empiric antibiotic treatment. We assessed the mitigating effects of rapid CT/NG testing on overtreatment and undertreatment of women evaluated for sexually transmitted infections (STI) in the ED.  

Methods:  Women undergoing pelvic examinations and STI testing in the ED (n = 221) were consented and randomized to either a control or rapid testing group (2015-ongoing). The control group received the standard of care (SOC) testing, consisting of PCR CT/NG testing with a 2-3 day turnaround time. Patients in the rapid testing group provided an additional vaginal swab used for rapid Xpert CT/NG testing (100-minute turnaround). Results from the rapid tests were presented to providers and patients were treated according to clinical judgment. 

Results:  Preliminary results via chi square analysis indicate improved antibiotic treatment rates for positive CT/NG patients in the rapid testing group. From this rapid POC testing group, 100% of CT positive (n=7, p<0.017) and NG positive (n=5, p<0.061) patients received antibiotic treatment. In the control group, only 41.7% of CT positive patients and 33.3% of NG positive patients received antibiotic treatment. Additionally, 28.6% (n=28) of CT and 30.8% (n=32) of NG negative patients in the control group were overtreated.  

Conclusions:  Our analyses reflect undertreatment of patients positive for CT/NG and overtreatment of patients negative for CT/NG in the standard of care practice in ED. Patients with positive results in the rapid test group were appropriately treated. This study demonstrates the potential clinical impact of rapid CT/NG testing on antibiotic treatment for STIs in the ED.

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