Wilson Sean P, Vohra Taher, Knych McKenna, Goldberg Jared, Price Christopher, Calo Sean, Mahan Meredith, Miller Joseph
Department of Emergency Medicine, Kaiser Permanente Medical Center, Anaheim, CA, United States.
Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, United States.
Am J Emerg Med. 2017 May;35(5):701-703. doi: 10.1016/j.ajem.2017.01.002. Epub 2017 Jan 3.
Delay in current nucleic acid amplification testing for Neisseria gonorrhoeae and Chlamydia trachomatis has led to recommendations for presumptive treatment in patients with concern for infection and unreliable follow-up. In the urban setting, it is assumed that many patients have unreliable follow-up, therefore presumptive therapy is thought to be used frequently. We sought to measure the frequency of disease and accuracy of presumptive treatment for these infections.
This was an observational cohort study performed at an urban academic Level 1 trauma center ED with an annual census of 95,000 visits per year. Testing was performed using the APTIMA Unisex swab assay (Gen-Probe Incorporated, San Diego, CA). Presumptive therapy was defined as receiving treatment for both infections during the initial encounter without confirmation of diagnosis.
A total of 1162 patients enrolled. Infection was present in 26% of men, 14% of all women and 11% of pregnant women. Despite high frequency of presumptive treatment, >4% of infected patients in each category went untreated.
Inaccuracy of presumptive treatment was common for these sexually transmitted infections. There is an opportunity to improve diagnostic accuracy for treatment.
目前淋病奈瑟菌和沙眼衣原体核酸扩增检测的延迟，导致了对疑似感染且随访不可靠的患者进行经验性治疗的建议。在城市环境中，假定许多患者随访不可靠，因此认为经验性治疗被频繁使用。我们试图测量这些感染的疾病发生率和经验性治疗的准确性。
这是一项在城市一级学术创伤中心急诊科进行的观察性队列研究，每年的就诊人数为95000人次。检测使用APTIMA通用拭子检测法（Gen-Probe Incorporated，加利福尼亚州圣地亚哥）。经验性治疗定义为在初次就诊时接受针对两种感染的治疗，而未确诊。
共有1162名患者入组。男性感染率为26%，所有女性感染率为14%，孕妇感染率为11%。尽管经验性治疗的频率很高，但每类感染患者中仍有超过4%未接受治疗。
这些性传播感染的经验性治疗不准确很常见。有机会提高治疗的诊断准确性。
