Methods: Retrospective review of 1261 patients referred (2000-2013) for concern of Lyme disease. Patients were assessed for symptoms, clinical history, testing, and antibiotic therapy before referral as well as diagnostic conclusions.
Results: LDTs were identified in 257/1261 (20.4%). These patients compared to those without LDTs had median findings of longer symptom duration (986d vs 482d, P<0.0001), longer prior antibiotic duration (63d vs 42d, P<0.0001), more frequent infection-related testing (4 times vs 2 times, P<0.0001), higher prior co-infection diagnoses (25% vs 8%, P<0.0001) and less likely to result in a final Lyme disease diagnosis at our facility (14% vs 31%, P<0.0001). Among all patients with FDA-approved testing who received prior antibiotics, mean treatment durations were longer with negative serologies (131.8d) than those with positive Lyme IgG Western blot (WB) serologies (74.9d).
Conclusion: Prior LDTs correlated with substantially longer antibiotic use and greater testing burden and inversely with true Lyme disease diagnoses. This suggests some community practice patterns for this population are considerably distant from accurate diagnosis or recommended treatment for Lyme disease. Enhanced educational efforts for clinicians and patients alike are needed to avoid LDTs, missteps in diagnosis and unnecessary and prolonged antibiotic therapy for patients with and without Lyme disease.
R. Samuels, None
A. Moaven, None
P. Lantos, None
M. T. Melia, None
P. Auwaerter, Biomerieux: Consultant , Consulting fee
Johnson & JOhnson: Shareholder , equity holding
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