Real-world Use of Molecular Point-of-care Testing for Sexually Transmitted Infections (STIs) in the Emergency Department: Why It Matters for Acute Care Management

Le résumé fourni par la source

Abstract Background Point-of-care (POC) polymerase chain reaction (PCR) tests for sexually transmitted infections (STIs) represent a potential paradigm shift for emergency department (ED) management of patients with suspected STIs, given there are now Food and Drug Administration–cleared POC tests that permit definite rapid diagnosis and result-driven care. Methods A quasi-experimental real-world implementation study was conducted in an urban ED, comparing two approaches for female STI testing for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV): (1) central laboratory testing (August–November 2022) with batched nucleic acid amplification testing (CT/NG) and wet prep for TV; (2) POC PCR Testing Integration (ED POC) (January–April 2023) in an ED POC laboratory for all three STIs. We compared proportions of appropriate treatment and ED length of stay (LOS) between the two testing modalities using chi-square test and log-transformed multivariable linear regression, respectively. Results Of 627 patients, 340 received central laboratory testing and 287 received ED POC; ED POC resulted in a significant decrease in LOS by 76 minutes or 9.3% (95% confidence interval [CI], −16.3% to −1.7%; P = .017). ED POC also significantly lowered overtreatment rates for CT (n = 595) and NG (n = 607) by 73% (95% CI, 44–87; P < .001) and 63% (95% CI, 28–81; P = .002), respectively. ED POC testing was associated with 67% lower rate of undertreatment (95% CI, −19% to 91%; P = .093) for any CT/NG/TV-positive (n = 78), but not statistically significant due to relatively small number of undertreated cases . Discussion Compared to traditional STI testing, POC PCR testing significantly shortened ED LOS, allowed for organism-specific targeted treatment, and reduced overtreatment of CT and NG infections.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.