Impact of rapid diagnostic testing for chlamydia and gonorrhea on appropriate antimicrobial utilization in the emergency department.
Prolonged turnaround time of Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) test results may delay time to notification and treatment of test-positive patients and result in unnecessary antimicrobial use in test-negative patients. This quasi-experimental study evaluated the impact of NG/CT rapid diagnostic testing (RDT) in an urban emergency department (ED) on treatment appropriateness, time to notification, and cost. Patients tested in December 2013-January 2014 (traditional group, n=200) were compared with those in December 2014-January 2015 (RDT group, n=200). There was a significant increase in treatment appropriateness in the RDT group, 72.5% versus 60% (P=0.008) and time to results notification was significantly faster (median 17.4 versus 51.5hours, P=0.010). Availability of test result prior to discharge was associated with increased treatment appropriateness (odds ratio, 22.65 [95% confidence interval, 2.86-179.68]). The RDT would save approximately $37,000 annually. These results support the use of NG/CT RDT to expand antimicrobial stewardship efforts within the ED.
Department of Pharmaceutical Services, Mercy Health Saint Mary's, Grand Rapids, MI 49503, USA.
Kaitlyn R
KR
Rivard
Department of Pharmaceutical Services, Mercy Health Saint Mary's, Grand Rapids, MI 49503, USA. Electronic address: lisa.dumkow@gmail.com.
Lisa E
LE
Dumkow
Department of Pharmaceutical Services, Mercy Health Saint Mary's, Grand Rapids, MI 49503, USA.
Heather M
HM
Draper
Department of Pharmaceutical Services, Mercy Health Saint Mary's, Grand Rapids, MI 49503, USA.
Kasey L
KL
Brandt
Department of Emergency Medicine, Mercy Health Saint Mary's, Grand Rapids, MI 49503, USA.
David W
DW
Whalen
Department of Infectious Diseases, Mercy Health Saint Mary's, Grand Rapids, MI 49503, USA.
Nnaemeka E
NE
Egwuatu
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002692:Chlamydia trachomatis / Q000187:drug effects / Q000302:isolation & purification*; D003365:Costs and Cost Analysis; D003955:Diagnostic Tests, Routine / Q000379:methods*; D018563:Disease Notification; D004363:Drug Utilization / Q000592:standards; D004636:Emergency Service, Hospital; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis* / Q000382:microbiology; D006801:Humans; D008219:Lymphogranuloma Venereum / Q000175:diagnosis* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009344:Neisseria gonorrhoeae / Q000187:drug effects / Q000302:isolation & purification*; D065228:Non-Randomized Controlled Trials as Topic; D013997:Time Factors; D055815:Young Adult
D000900:Anti-Bacterial Agents
Antimicrobial stewardship; Chlamydia; Gonorrhea; Rapid diagnostic testing; Sexually transmitted infections