Subject(s)
Anti-Bacterial Agents/therapeutic use , Anticoagulants/therapeutic use , Lemierre Syndrome/diagnosis , Lemierre Syndrome/therapy , Adolescent , Adult , Aged , Bacteroides Infections/diagnosis , Bacteroides Infections/therapy , Child , Drainage/methods , Female , Fusobacterium Infections/diagnosis , Fusobacterium Infections/therapy , Humans , Lemierre Syndrome/microbiology , Length of Stay/statistics & numerical data , Male , Methicillin-Resistant Staphylococcus aureus , Michigan , Middle Aged , Mortality , Pharyngitis , Retrospective Studies , Staphylococcal Infections/diagnosis , Staphylococcal Infections/therapy , Streptococcal Infections/diagnosis , Streptococcal Infections/therapy , Young AdultSubject(s)
Cardiopulmonary Resuscitation , Out-of-Hospital Cardiac Arrest , Adult , Aged , Cardiopulmonary Resuscitation/methods , Cardiopulmonary Resuscitation/mortality , Cross-Sectional Studies , Female , Health Knowledge, Attitudes, Practice , Health Surveys , Humans , Male , Middle Aged , Motion Pictures , Out-of-Hospital Cardiac Arrest/mortality , Out-of-Hospital Cardiac Arrest/therapy , Prospective Studies , Public Opinion , Survival Rate , Television , Young AdultABSTRACT
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.
Subject(s)
Chlamydia trachomatis/isolation & purification , Diagnostic Tests, Routine/methods , Emergency Service, Hospital , Gonorrhea/diagnosis , Lymphogranuloma Venereum/diagnosis , Neisseria gonorrhoeae/isolation & purification , Adolescent , Adult , Aged , Anti-Bacterial Agents/therapeutic use , Chlamydia trachomatis/drug effects , Costs and Cost Analysis , Disease Notification , Drug Utilization/standards , Female , Gonorrhea/microbiology , Humans , Lymphogranuloma Venereum/microbiology , Male , Middle Aged , Neisseria gonorrhoeae/drug effects , Non-Randomized Controlled Trials as Topic , Time Factors , Young AdultABSTRACT
BACKGROUND: Adolescent patients comprise the highest rate of Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) in the United States. These patients often initially present to the emergency department (ED) with vague symptoms. OBJECTIVES: 1) Quantify the frequency of underrecognized GC and CT cervical infections in adolescent women tested in the ED; 2) describe and compare the characteristics of those treated and not treated during the initial visit; and 3) quantify the delay interval until treatment was provided. METHODS: This was a retrospective, cohort analysis of consecutive females (ages 13-19 years) seen at four academic medical centers over a 36-month period with positive results for GC/CT. Our key outcome measures were the proportion of adolescent females being untreated in the ED, the time to subsequent treatment, and the proportion lost to follow-up. RESULTS: During the study period, 382 female adolescents had positive polymerase chain reaction studies for GC or CT or both; 266 (70%) were not treated in the ED. Untreated patients were significantly more likely to have a discharge diagnosis of urinary tract infection (23% vs. 11%, p < 0.008), new pregnancy (29% vs. 8%, p < 0.001), and vaginitis (24.8% vs. 5%, p < 0.001). Subsequently, only 11.7% (31/266) of the untreated patients fit the Centers for Disease Control and Prevention guidelines for empiric treatment of pelvic inflammatory disease. After telephone, mail, and public health follow-up, treatment could be documented for only 59% of the patients. CONCLUSION: The majority of adolescent women found to have GC or CT or both in the ED were not treated at presentation.
Subject(s)
Chlamydia Infections/drug therapy , Emergency Service, Hospital/statistics & numerical data , Gonorrhea/drug therapy , Lost to Follow-Up , Time-to-Treatment/statistics & numerical data , Abdominal Pain/microbiology , Adolescent , Anti-Bacterial Agents/therapeutic use , Chlamydia Infections/diagnosis , Chlamydia Infections/microbiology , Chlamydia trachomatis/isolation & purification , DNA, Bacterial/analysis , Female , Gonorrhea/diagnosis , Humans , Neisseria gonorrhoeae/isolation & purification , Pregnancy , Retrospective Studies , Time Factors , United States , Urinary Tract Infections/diagnosis , Urinary Tract Infections/microbiology , Uterine Hemorrhage/microbiology , Vaginitis/diagnosis , Vaginitis/microbiology , Young AdultABSTRACT
STUDY OBJECTIVES: The purposes of this study were to (1) quantify the frequency of underrecognized Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) infections in pregnant women tested in the emergency department (ED), (2) describe the characteristics of those not treated during the initial visit, and (3) determine how many pregnant women with acute cervicitis were lost to follow-up. METHODS: This was a retrospective, cohort analysis of consecutive women seen in the ED of 3 academic medical centers during a 36-month study period, with positive results for GC/CT. Our key outcome measures were the proportion of pregnant women being untreated in the ED, the time to subsequent treatment, and the proportion lost to follow-up. RESULTS: During the study period, 735 female patients had positive polymerase chain reaction study results for GC and/or CT; 179 (24%) were pregnant. Overall, 143 of these pregnant patients with cervicitis (80%) were not treated in the ED. Presenting symptoms included abdominal pain (71%), nausea (45%), vaginal discharge (35%), vaginal bleeding (34%), and urinary complaints (22%). The most common discharge diagnoses were vaginitis (37%), urinary infection (33%), threatened abortion (19%), nonspecific abdominal pain (9%), and rule-out ectopic pregnancy (6%). Of the 143 patients with sexually transmitted infection not treated in the ED, 114 (80%) were contacted by telephone and/or mail. Twenty-nine (20%) were subsequently lost to follow-up. CONCLUSIONS: Further study is warranted to enhance point-of-contact testing and identify better mechanismsfor contact and follow-up after ED discharge and more liberal policies to treat less symptomatic patients empirically.
