May Larissa, Ware Chelsea E, Jordan Jeanne A, Zocchi Mark, Zatorski Catherine, Ajabnoor Yasser, Pines Jesse M
From the *Emergency Department Antibiotic Stewardship, University of California-Davis, Sacramento, CA; †Department of Emergency Medicine; ‡Department of Epidemiology and Biostatistics School of Public Health; and §Office for Clinical Practice Innovation, The George Washington University, Washington, DC.
Sex Transm Dis. 2016 May;43(5):290-5. doi: 10.1097/OLQ.0000000000000438.
We tested the effect of a rapid molecular test for Chlamydia trachomatis (CT)/Neisseria gonorrhoeae (NG) diagnosis on clinical emergency department decision making compared with standard care. The new test presents an opportunity to improve antibiotic management and patient outcomes.
We conducted a randomized controlled trial of 70 consenting patients 18 years or older presenting to an urban emergency department with sexually transmitted infections complaints (vaginal/penile discharge, dysuria, vaginal/penile itching/pain, dyspareunia). Participants were randomized to rapid testing or standard care if a sexually transmitted infection was suspected. Follow-up phone calls were performed 7 to 10 days postdischarge. The primary outcomes included: antibiotic overtreatment rates, partner notification, and health care utilization.
A total of 12.9% tested positive for CT or NG and received antibiotics. Test patients with negative results were less likely to receive empirical antibiotic treatment than control patients, absolute risk difference [RD], 33.4 (95% confidence interval [CI], 7.9%-58.9%), risk ratio [RR], 0.39 (95% CI, 0.19-0.82). Thirty-seven participants (53%) were contacted for follow-up 7 to 10 days postdischarge. Test patients were less likely to report missed antibiotic doses (RD, -51.3%; 95% CI, -84.4% to -18.2%; RR, 0.23; 95% CI, 0.06-0.88). Test patients were more likely to be notified of their results (RD, 50.6%; 95% CI, 22.7%-78.5%; RR, 2.72; 95% CI, 1.26-5.86). There were no significant differences in charges or health care utilization measures.
We found a significant reduction in unnecessary antibiotic treatment for CT/NG in subjects receiving the rapid molecular test compared with those receiving nucleic acid amplification test.
我们测试了一种用于沙眼衣原体（CT）/淋病奈瑟菌（NG）诊断的快速分子检测方法与标准护理相比对临床急诊科决策的影响。这种新检测方法为改善抗生素管理和患者预后提供了契机。
我们对70名年龄在18岁及以上、因性传播感染症状（阴道/阴茎分泌物、排尿困难、阴道/阴茎瘙痒/疼痛、性交困难）前往城市急诊科就诊的患者进行了一项随机对照试验。如果怀疑患有性传播感染，参与者被随机分配接受快速检测或标准护理。出院后7至10天进行随访电话。主要结局包括：抗生素过度治疗率、性伴侣通知情况和医疗保健利用情况。
共有12.9%的患者CT或NG检测呈阳性并接受了抗生素治疗。检测结果为阴性的患者比对照患者接受经验性抗生素治疗的可能性更小，绝对风险差[RD]为33.4（95%置信区间[CI]，7.9%-58.9%），风险比[RR]为0.39（95%CI，0.19-0.82）。37名参与者（53%）在出院后7至10天接受了随访。检测患者漏服抗生素剂量的报告可能性更小（RD，-51.3%；95%CI,-84.4%至-18.2%；RR，0.23；95%CI，0.
