Three in 4 patients who were treated with antibiotics in the emergency department for suspected chlamydia or gonorrhea actually tested negative for these sexually transmitted infections (STIs), according to a study presented during the 43rd Annual Conference of the Association for Professionals in Infection Control and Epidemiology (APIC).1
Researchers from St. John Hospital and Medical Center in Detroit, Michigan, examined records of more than 1103 patients who underwent STI testing in the emergency department to identify the extent of unnecessary antibiotic use.
Genital cultures are commonly collected from patients with signs and symptoms of STIs; however, results are not immediately available, and antibiotics are often prescribed without a confirmatory diagnosis.
Of the 1103 patients tested, 40% were treated with antibiotics for gonorrhea and/or chlamydia; of those treated, 76.6% ultimately tested negative for having the STI. Of the 60% who went untreated, only 7% ultimately tested positive for either or both STIs.
“We have to find the appropriate balance between getting people tested and treated for STIs but not prescribing antibiotics to patients who don’t need them,” Karen Jones, MPH, BSN, RN, infection preventionist at St. John Hospital and Medical Center, said in a press release.2 “There is a tricky balance between not furthering antibiotic resistance by overprescribing, but also still getting people treatment for STDs they might have.”
The study also examined how certain symptoms were associated with positive STI cultures. For example, in male patients, 60.3% with penile discharge and 57.5% with inflammation of the urethra tested positive for gonorrhea and/or chlamydia. In female patients, 25% with inflammation of the cervix and 27% with cervical motion tenderness tested positive for gonorrhea and/or chlamydia. Thirty-five percent of patients who disclosed they had more than one sex partner also tested positive for gonorrhea and/or chlamydia. “Focusing on these clinical predictors may improve unnecessary antibiotic prescribing in patients without true disease,” Ms. Jones added.
Jones KM, Babcock C, Szpunar SM, et al. Antimicrobial stewardship in emergency departments: improving treatment accuracy for suspected sexually transmitted diseases. Amer J Infect Control. 2016;44(6):S28. doi:10.1016/j.ajic.2016.04.004.