Introduction In the Emergency Department (ED), accurate diagnosis and appropriate treatment of Chlamydia trachomatis (CT) and Neisseria gonorrhoea (NG) is a challenge. Lengthy routine result times for CT/NG tests often lead to empiric antibiotic over treatment or lack of treatment of infections. A randomised clinical trial was conducted to determine how use of rapid diagnostics could improve clinical management. The objective was to assess the effects of rapid CT/NG testing on over treatment and under treatment of women being evaluated for sexually transmitted infections (STIs) in the ED.
Methods Women undergoing pelvic examinations and STI testing in the ED (n=253) were consented and randomised to either a control or rapid testing group. The control group received standard of care (SOC), with CT/NG testing by nucleic acid amplification tests (NAAT) with a 2–3 day turnaround time. Patients in the rapid testing group provided an additional vaginal swab used for rapid Gene Xpert CT/NG testing with a 100 min turnaround time. Results from the rapid tests were presented to providers and patients were treated according to clinical judgment. Following discharge there was a 2 week phone follow-up and chart review.
Results 100% of CT positive (n=9) and 100% NG positive (n=5) patients in the rapid testing group received appropriate antibiotic treatment as compared to 54% (7/13) CT positive patients (p=0.046) and 43% (3/7) NG positive patients (p=0.081) in the control group. Additionally, in the control group, 36.8% (42/114) of CT negative and 38.3%, (46/120) of NG negative patients were over treated.
Conclusions Both under- and over treatment for CT/NG was observed in the SOC control group. Patients with positive results in the rapid test group were more appropriately treated. This study demonstrated the potential clinical impact and subsequent antibiotic stewardship of using rapid CT/NG testing the ED.
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