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More than 75% of ED patients who receive antibiotics are STD-negative
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New study results suggest that approximately three-quarters of ED patients who presented with symptoms of gonorrhea or chlamydia were treated with antibiotics even though they ultimately tested negative for these infections.
Since culture results are not readily available, ED clinicians are forced to either offer treatment to patients without a confirmatory diagnosis of an STD, which can lead to unnecessary antibiotic use, or wait for the results, risking further spread of the disease, according to Karen Jones, MPH, BSN, RN, infection preventionist at the St. John Hospital and Medical Center in Detroit.
Karen Jones
Jones, who had been an ED nurse for almost 15 years, said it is common to “automatically” treat patients presenting with symptoms of STDs in this setting.
“There would be very little follow up,” she said. “As ER nurses, we never heard about any sort of results because it would take about 48 hours to get those results back.”
To determine the extent of unnecessary antibiotic use in the ED, Jones and colleagues examined records of more than 1,100 patients with genital cultures collected over 2 months at St. John Hospital and Medical Center. Results of their study, presented at APIC 2016, showed that approximately 40% of these patients were treated with antibiotics, and of those, 76.6% tested negative through culture.
“That means there are a lot of patients who are prescribed antibiotics who don’t need them,” Jones said.
The CDC recently estimated that up to 30% of antibiotic prescriptions in the outpatient setting are unnecessary, and the agency is urging more judicious use of the drugs to preserve their efficacy.
On the other hand, Jones said, it can be challenging to follow up with patients who tested positive for these diseases but did not receive antibiotic therapy. Of the 60% of patients who went untreated in the study, 7% tested positive for gonorrhea, chlamydia or both.
“There is extra time and effort that needs to be taken if a culture comes back positive, when in fact the patient wasn’t treated at the time of contact,” she said. “That’s just another consideration.”
These findings underscore the value of focusing on clinical predictors of STDs, which can help guide clinical decision-making and curb inappropriate antibiotic use, according to the researchers. These include penile discharge and urethritis for males (60.3% for gonorrhea and 57.5% for chlamydia; P < .001), and cervicitis and cervical motion tenderness for females (25% for gonorrhea and 27.3% for chlamydia; P < .001). In addition, 35% of ED patients who tested positive for STDs disclosed that they had more than one sex partner.
According to Jones, variables that were not associated with positive test results included vaginal discharge and vaginal bleeding for females, and pelvic pain for both males and females. Dysuria also was not associated with a greater likelihood of infection.
Perhaps most importantly, Jones said an “excellent targeted history is key” to identifying patients who require antibiotics in the ED setting. – by John Schoen
References:
Fleming-Dutra KE, et al. JAMA. 2016;doi:10.1001/jama.2016.4151.
Jones K, et al. Abstract 1-101. Presented at: Annual Conference of the Association for Professionals in Infection Control and Epidemiology; June 11-13, 2016; Charlotte, N.C.
Workowski KA, et al. MMWR Morb Mortal Wkly Rep. 2015;64:1-137.
Disclosure: Jones reports no relevant financial disclosures.