即时检测在急诊科进行淋病和衣原体检测对降低过度治疗率的影响。

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

机构信息

Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA.

The Ohio State University Wexner Medical Center, Columbus, OH, USA.

出版信息

Am J Emerg Med. 2024 Sep;83:64-68. doi: 10.1016/j.ajem.2024.06.040. Epub 2024 Jul 1.

DOI:10.1016/j.ajem.2024.06.040

PMID:38968852

Abstract

BACKGROUND

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.

METHODS

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).

RESULTS

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).

CONCLUSIONS

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.

摘要

背景

沙眼衣原体（CT）和淋病奈瑟菌（NG）在美国的感染持续增加。即时检测（POC）技术的进步可以通过缩短检测结果的时间和提供准确的治疗来改善急诊科（ED）中性传播感染（STI）的整体治疗效果。本研究的目的是评估与标准护理（SOC）检测相比，POC 检测是否降低了 CT 和/或 NG 的过度治疗率。

方法

这是一项回顾性队列研究，纳入了 2020 年 8 月至 2022 年 10 月期间在两家城市 ED 接受 CT 和 NG 检测的成年患者。该队列排除了住院患者、逃跑患者、妊娠患者、直肠和口腔样本患者、性侵犯受害者以及与 CT/NG 治疗重叠的诊断患者。主要结局评估过度治疗，定义为在 ED 接受治疗或在患者 CT 和/或 NG 检测结果为阴性时出院前开具处方。次要结局包括治疗不足率、特定人群的过度治疗率、检测周转时间和 ED 住院时间（LOS）。

结果

在筛选的 327 名患者中，97 名患者纳入 SOC 组，100 名患者纳入 POC 组。POC 组中没有 CT 过度治疗患者，而 SOC 组中有 29 例（29.9%）（p<0.001）。POC 组有 1 例（1%）NG 过度治疗，SOC 组有 23 例（23.7%）（p<0.001）。与 SOC 检测相比，POC 检测在两名患者中发现 CT 和/或 NG 治疗不足，而在 SOC 检测中发现四名患者治疗不足。总体而言，与接受 SOC 检测的 35 名患者（36%）相比，接受 POC 检测的 5 名患者（5%）的治疗被认为不合适（p<0.001）。ED LOS 无差异（2.7 与 3.01 小时，p=0.41）。