Overtreatment of gonorrhea and chlamydial infections in 2 inner-city emergency departments

• Published in: The American journal of emergency medicine 2015-09, Vol.33 (9), p.1265-1268
• Main Authors: Holley, Colleen E., MD, Van Pham, Thuy, MD, Mezzadra, Heather M., MD, Willis, George C., MD, Witting, Michael D., MD, MS
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Antibiotics; Chlamydia Infections - diagnosis; Chlamydia Infections - drug therapy; Chlamydia trachomatis; Confidence intervals; Data analysis; Data collection; Decision making; Departments; Disease transmission; Emergency; Emergency medical care; Emergency medical services; Emergency Service, Hospital; Female; Gonorrhea; Gonorrhea - diagnosis; Gonorrhea - drug therapy; Hospitals; Hospitals, Urban; Humans; Inappropriate Prescribing; Infections; Inflammatory diseases; Inner city; Medical Overuse; Medical records; Middle Aged; Neisseria gonorrhoeae; Patients; Retrospective Studies; Sexually transmitted diseases; STD; Variables; Young Adult
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2015.06.009

Abstract Background Infections with Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) are the most commonly reported sexually transmitted diseases in the United States. Objectives The primary objective of this study was to estimate the incidence of overtreatment of GC and CT infections in the emergency department (ED). The secondary objective was to determine if there are clinical variables that predict infection with GC and CT. Methods A retrospective medical record review was performed at 2 inner-city hospitals. Records were obtained from the evaluation of female patients who presented to the ED between January 1, 2012, and December 31, 2012, who were tested for GC and CT infection. A standardized form was used to extract specific information from each medical record. Results Data were extracted from 538 medical records. Of the 522 ED visits, 32 (6%) yielded test results positive for either GC or CT, including 3 that were positive for both. Treatment was administered to 101 patients (19%) and declined by an additional 9 (2%). Of those receiving antibiotics, 87 of 101 (0.86; 95% confidence interval, 0.77-0.92) had negative test results. Of those not offered antibiotics, 17 of 412 (0.04; 95% confidence interval, 0.02-0.07) had positive test results. The overtreatment proportion was similar at hospitals (55/66 [0.83] and 32/35 [0.91], respectively). Of clinical variables that were considered, only age less than 19 years was statistically associated with a positive test result for GC and CT. Conclusion The rate of overtreatment for GC and CT was 86%. The practice of empirical treatment should be reconsidered.