Implementation of a 90-Minute Gonorrhea/Chlamydia Test Decreases Antibiotic Under- and Overtreatment in Female Emergency Department Patients.

BACKGROUND

Nucleic acid amplification testing (NAAT) of Chlamydia trachomatis and Neisseria gonorrhoeae (CT/NG) in emergency departments (EDs) with prolonged turnaround time (TAT) has resulted in high rates of under- and overtreatment in female patients.

OBJECTIVE

The aim of this study was to determine whether under- and overtreatment rates in an ED using a newer NAAT with a 90-min TAT would be decreased compared with an ED not using this test.

METHODS

We conducted a retrospective study examining female patients tested for CT/NG in the ED and compared under- and overtreatment rates during two different 70-week time periods before and after transition to the 90-min TAT in the intervention ED (ED-I) and no transition in the control ED (ED-C). We used an interrupted time series analysis of the data to determine the intervention effect.

RESULTS

There were 10,064 and 1990 CT/NG tests, respectively, in the ED-I and ED-C during the study period. Preintervention to postintervention, undertreatment went from 37% to 19% (18% decrease; 95% CI -17% to -20%) in ED-I, and from 42% to 40% (2% decrease; 95% CI -7% to 2%) in ED-C, respectively. Overtreatment rates changed from 27% to 17% (10% decrease; 95% CI -8% to -11%) in ED-I and from 37% to 33% (4% decrease; 95% CI -8% to 1%) in ED-C, respectively.

CONCLUSIONS

Results of this real-world ED study showed that a 90-min TAT decreased under- and overtreatment rates for female patients tested for CT/NG. Future innovations that decrease TAT and process changes that decrease time to collection may improve these rates even further.