A study of emergency department (ED) patients with symptoms of gonorrhea or chlamydia found that three in four patients who were treated with antibiotics actually tested negative for these sexually transmitted diseases (STDs), according to a new study presented at the 43rd Annual Conference of the Association for Professionals in Infection Control and Epidemiology (APIC).
Researchers from St. John Hospital & Medical Center in Detroit, Michigan, examined records of more than 1,103 patients who underwent STD testing in the ED to identify the extent of unnecessary antibiotic use. Genital cultures are commonly collected from patients with signs and symptoms of STDs; however, results are not immediately available, and antibiotics are often prescribed without a confirmatory diagnosis.
Of the 1,103 patients tested, 40 percent were treated with antibiotics for gonorrhea and/or chlamydia; of those treated, 76.6 percent ultimately tested negative for having the STD. Of the 60 percent who went untreated, only 7 percent ultimately tested positive for either or both STDs.
“We have to find the appropriate balance between getting people tested and treated for STDs, but not prescribing antibiotics to patients who don’t need them,” said Karen Jones, MPH, BSN, RN, infection preventionist, St. John Hospital & Medical Center. “There is a tricky balance between not furthering antibiotic resistance by over-prescribing, but also still getting people treatment for STDs they might have.”
The study also examined how certain symptoms were associated with positive STD cultures. For example, in male patients, 60.3 percent with penile discharge and 57.5 percent with inflammation of the urethra tested positive for gonorrhea and/or chlamydia. In female patients, 25 percent with inflammation of the cervix and 27 percent 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,” said Jones.
“According to the Centers for Disease Control and Prevention, nearly a third of antibiotics prescribed in doctors’ offices, emergency rooms, and hospital-based clinics in the U.S. are not needed,” said APIC 2016 President Susan Dolan RN, MS, CIC, hospital epidemiologist, Children’s Hospital Colorado. “Improving the use of antibiotics is a national and international priority to help prevent antibiotic resistance which would threaten our ability to treat even the simplest of infections.”
Association for Professionals in Infection Control. “More than 75 percent of STD-negative patients receive antibiotics.” ScienceDaily, 9 June 2016.
Karen M. Jones, Charlene Babcock, Susanna M. Szpunar. Antimicrobial Stewardship in Emergency Departments: Improving Treatment Accuracy for Suspected Sexually Transmitted Diseases. American Journal of Infection Control, 2016; 44 (6): S28 DOI: 10.1016/j.ajic.2016.04.004