689. Impact of Point of Care Screening for Chlamydia and Gonorrhea on Antimicrobial Stewardship in the Emergency Department
Session: Oral Abstract Session: Antimicrobial Stewardship: Practice Variability and Interventions
Friday, October 9, 2015: 9:30 AM
Room: 32--ABC
Background: Traditional screening methods for chlamydia and gonorrhea (CT/NG) may require up to five days for results. This delay impacts the time to notification and treatment for test-positive patients who do not receive empiric therapy. It may also result in unnecessary antimicrobial use in test-negative patients. The purpose of this investigation was to determine if implementation of a new point-of-care (POC) screening test in an Emergency Department (ED) improved CT/NG treatment appropriateness by decreasing antimicrobial exposure in test-negative patients while increasing treatment rate in test-positive patients.

Methods: A retrospective quasi-experimental study was conducted including all patients ≥ 15 years of age who received traditional vs. POC CT/NG screening in the ED between December 2013-January 2014 (traditional group) and December 2014-January 2015 (POC group). Patients screened at a satellite ED or urgent care facility, requiring inpatient admission, or those diagnosed with pelvic inflammatory disease were excluded. Data collected included patient characteristics, screening characteristics, antimicrobial therapy, and clinical outcomes. Groups were compared based on receipt of appropriate antimicrobial treatment, time to notification of positive result, time to appropriate treatment, and ED length of stay.

Results: 400 patients were included, 200 in the traditional group and 200 in the POC group. Demographics were similar between groups. There was an 11.5% increase in treatment appropriateness in the POC group compared to the traditional group, 61% vs. 72.5%, (p=0.015). In the POC group 40 patients (20%) were provided test results prior to discharge from the ED, with 97.5% treated appropriately. In total, 34 patients were spared unnecessary antimicrobial exposure. Median time to patient notification was significantly shortened in the POC group when compared to the traditional group, 18.6 hr (0.3 – 234) vs. 51.5 hr (26.7 – 79.9), (p=0.008). There was no difference in ED length of stay between groups.

Conclusion: Implementation of ED POC screening for CT/NG was associated with a significant increase in appropriate antimicrobial utilization as well as decreased time to notification of positive results. These results support the use of POC CT/NG screening to promote antimicrobial stewardship efforts within the ED.

Kaitlyn Rivard, PharmD1, Kasey Bucher, PharmD, BCPS1, Heather Draper, PharmD, BCPS1, G. Robert Deyoung, PharmD1, Nnaemeka Egwuatu, MD, MPH2, David Whalen, MD, MPH, FACEP3 and Lisa Dumkow, PharmD, BCPS1, (1)Pharmaceutical Services, Mercy Health Saint Mary's, Grand Rapids, MI, (2)Infectious Diseases, Mercy Health Saint Mary's, Grand Rapids, MI, (3)Emergency Medicine, Mercy Health Saint Mary's, Grand Rapids, MI

Disclosures:

K. Rivard, None

K. Bucher, None

H. Draper, None

G. R. Deyoung, None

N. Egwuatu, None

D. Whalen, None

L. Dumkow, None

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