Fellow PGY6 University of Louisville and Norton Children's University of Louisville Louisville, Kentucky, United States
Background: Adolescents are disproportionately affected by sexually transmitted infections, accounting for only 13% of the population but over half of gonorrhea (GC) and chlamydia (CT) cases annually. Results from traditional testing using batched Nucleic Acid Amplification Testing (batched testing) often do not return during an emergency department (ED) visit, and require clinical judgement to determine presumptive treatment. The impact of 90-minute run time polymerase chain reaction testing (rapid testing) on the accuracy of treatment has not yet been described in the pediatric ED setting.
Objective:
Design/Methods: Using a retrospective chart review, we compared accuracy of treatment of GC and CT in adolescents aged 14-18 years in the ED at a large, urban, free-standing children’s hospital. Batched tests run from November 2017-October 2018 was compared to rapid tests run from March 2019-February 2020. Appropriate antibiotic treatment was defined per Centers for Disease Control and Prevention guidelines as mono therapy for CT infections and dual therapy for GC infections. We also looked at resource utilization through phone call made to inform patients of positive test results. Descriptive statistics were used to compare the two groups.
Results: A total of 1464 charts were reviewed: 691 rapid tests and 773 batched tests. 113 (16.5%) rapid tests and 153 (19.8%) batched tests were positive for GC and/or CT (p=0.09). 353 (51.1%) rapid tests resulted prior to patient discharge compared to 12 (1.6%) batched tests (p<0.001). 533 (77.2%) patients tested with rapid tests were treated appropriately compared to 487 (63.0%) patients tested with batched tests (p<0.001). Overtreatment was more common in the batched testing group among patients with negative test results (p<0.001) and inaccurate treatment occurred more frequently in those who tested positive for CT only via batched testing (p<0.001, Table). Among those who tested positive for GC and/or CT, phone calls were made to 54 (47.8%) patients in the rapid testing group and 129 (84.3%) patients in the batched testing group after their ED visit to inform them of positive test results (p<0.001). Conclusion(s): Compared to batched testing, rapid testing improves accuracy of treatment of GC and CT in the pediatric ED setting, and can help improve antimicrobial stewardship. Additionally, rapid testing improves resource utilization with fewer phone calls to patients who test positive.
Table: Accuracy of treatment based on test results and testing modality.
GC=gonorrhea, CT=chlamydia
Authors/Institutions: Elizabeth Lehto, University of Louisville, Louisville, Kentucky, United States; Brit Anderson, University of Louisville, Louisville, Kentucky, United States; Jennifer L. Reed, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States; Michelle D. Stevenson, University of Louisville, Louisville, Kentucky, United States