Empiric treatment of gonorrhea and chlamydia in the emergency department

This study evaluated the adequacy of testing, empiric treatment and referral for further evaluation of adult male emergency department (ED) patients with possible chlamydia and/or gonorrhoea urethritis. Of 968 adult male ED patients, 84% were tested for chlamydia and gonorrhoea, 16% for HIV and 27% for syphilis; 92% received empiric treatment for chlamydia and gonorrhoea and 71% were referred for further evaluation; of those tested, 29% were infected with chlamydia, gonorrhoea or both; and 3% of those tested had a positive syphilis test. The results of logistic regression modelling indicated that testing, treatment and referral were not related to a history of sexual contact with someone known to have a sexually transmitted disease or to the patient's ultimate diagnosis of a laboratory-confirmed infection. Compliance with Centers for Disease Control and Prevention (CDC) recommendations for chlamydia and gonorrhoea testing and treatment regimens was high, but was poor for HIV testing. More explicit guidance from CDC regarding syphilis testing and referral for further evaluation is needed.

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Effect of Provider Type and Sex on Empiric Treatment of Sexually Transmitted Infections in Adolescent Emergency Department Patients

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2013.07.476 ◽

2013 ◽

Vol 62 (4) ◽

pp. S70 ◽

Cited By ~ 1

Author(s):

J. Law ◽

E. Bicker ◽

T. Joseph ◽

J. Zhan ◽

C. Ardary ◽

...

Keyword(s):

Emergency Department ◽

Sexually Transmitted Infections ◽

Provider Type ◽

Sexually Transmitted ◽

Empiric Treatment ◽

Emergency Department Patients

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Sensitivity and Specificity of Empiric Treatment for Sexually Transmitted Infections in a Pediatric Emergency Department

The Journal of Pediatrics ◽

10.1016/j.jpeds.2017.05.050 ◽

2017 ◽

Vol 189 ◽

pp. 48-53 ◽

Cited By ~ 9

Author(s):

Kristen Breslin ◽

Lisa Tuchman ◽

Katie L. Hayes ◽

Gia Badolato ◽

Monika K. Goyal

Keyword(s):

Emergency Department ◽

Sexually Transmitted Infections ◽

Sensitivity And Specificity ◽

Pediatric Emergency ◽

Pediatric Emergency Department ◽

Sexually Transmitted ◽

Empiric Treatment

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Antimicrobial resistance of bacteraemia in the emergency department of a German university hospital (2013–2018): potential carbapenem-sparing empiric treatment options in light of the new EUCAST recommendations

BMC Infectious Diseases ◽

10.1186/s12879-019-4721-9 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Kathrin Rothe ◽

Nina Wantia ◽

Christoph D. Spinner ◽

Jochen Schneider ◽

Tobias Lahmer ◽

...

Keyword(s):

Emergency Department ◽

Staphylococcus Aureus ◽

Antimicrobial Resistance ◽

Antimicrobial Susceptibility ◽

Susceptibility Testing ◽

Blood Cultures ◽

University Hospital ◽

High Dose ◽

Empiric Treatment ◽

Positive Results

Abstract Background This study investigated predominant microorganisms causing community-onset bacteraemia at the medical emergency department (ED) of a tertiary-care university hospital in Germany from 2013 to 2018 and their antimicrobial susceptibility patterns. Methods Antimicrobial resistance patterns in patients with positive blood cultures presenting to an internal medicine ED were retrospectively analysed. Results Blood cultures were obtained at 5191 of 66,879 ED encounters, with 1013 (19.5%) positive results, and true positive results at 740 encounters (diagnostic yield, 14.3%). The most frequently isolated relevant microorganisms were Enterobacterales (n = 439, 59.3%), Staphylococcus aureus (n = 92, 12.4%), Streptococcus pneumoniae (n = 34, 4.6%), Pseudomonas aeruginosa (n = 32, 4.3%), Streptococcus pyogenes (n = 16, 2.2%), Enterococcus faecalis (n = 18, 2.4%), and Enterococcus faecium (n = 12, 1.6%). Antimicrobial susceptibility testing revealed a high proportion of resistance against ampicillin-sulbactam in Enterobacterales (42.2%). The rate of methicillin-resistant Staphylococcus aureus was low (0.4%). Piperacillin-tazobactam therapy provided coverage for 83.2% of all relevant pathogens using conventional breakpoints. Application of the new European Committee on Antimicrobial Susceptibility Testing (EUCAST) recommendations increased the percentage of susceptible isolates to high-dose piperacillin-tazobactam to 92.8% (p < 0.001). Broad-spectrum carbapenems would only cover an additional 4.8%. The addition of vancomycin or linezolid extended coverage by just 1.7%. Conclusions Using an ureidopenicillin-beta-lactamase inhibitor combination at the high dose suggested by the new EUCAST recommendations provided nearly 93% coverage for relevant pathogens in patients with suspected bloodstream infection in our cohort. This might offer a safe option to reduce the empiric use of carbapenems. Our data support the absence of a general need for glycopeptides or oxazolidinones in empiric treatment.

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