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Clinical Science

Category: Gonorrhoea - general

(P85) Patient-level and system-level factors related to delayed adoption of CDC Neisseria gonorrhoeae treatment guidelines

Tuesday, July 25, 2023
16:00 – 18:00 CST

    Primary Presenter(s)

  • Hilary Reno, MD, PhD

    Professor, Division of Infectious Diseases
    Washington University in St. Louis, School of Medicine
    Saint Louis, Missouri, United States

    • Co-Author(s)

  • CF

    Catherine Finneran

    Washington University in St. Louis, United States

    • Co-author(s)

  • NC

    Nicholas Cardoza, BS

    Developer, Public Health Training and Data Center
    Institute for Public Health, Washington University in St. Louis, United States

  • AT

    Anne Trolard, MPH

    Center for Dissemination & Implementation Institute for Public Health Washington University in St. Louis, United States

  • BC

    Benjamin Cooper

    Washington University in St. Louis, United States

Background

In December 2020, due to antimicrobial resistance to N. gonorrhea (GC), CDC published updated treatment guidelines for GC, increasing the recommended dose of ceftriaxone (CTX) from 250mg to 500mg. This study uses Electronic Health Record (EHR) data from a large Midwestern health system to examine the adoption of these guidelines, including patient-level and system-level factors potentially related to delayed adoption of guidelines.

Methods

All prescriptions of CTX linked to a diagnosis of GC or C. trachomatis between Jan. 2020 and Jun. 2022 were captured, with patient-level characteristics (sex, race, age) and system-level characteristics (encounter setting [ED, other outpatient, inpatient], encounter location [urban v. rural]). Prescriptions were classified as correct if the dosage was congruent with the CDC guideline for the year it was written. Bivariate analysis and Chi-square testing were performed to identify significant differences in guideline adoption. A regression model was fitted to elucidate factors related to non-adoption of CDC guidelines.

Results

A total of 6,495 prescriptions met inclusion criteria, creating a largely young (65.9% aged 18-29), male (57.5%), urban (87.8%), Black (85.0%) cohort. The majority of encounters occurred in Emergency Departments (92.4%). Adoption of guidelines occurred rapidly: 2.3% of prescriptions from Nov. 2020 were 500mg CTX, versus 90.1% in Jan. 2021, with 97.2% of prescriptions meeting criteria for correct dosage. Regression modelling indicated that compared to white patients, Black patients had increased odds of receipt of correct CTX dosing (OR: 0.03, 95% CI 0.01, 0.04). However, encounters that occurred in non-ED outpatient settings or in inpatient settings both had lower odds of correct CTX dosage (OR: -0.11, 95% CI: -0.13, -0.08; OR: -0.07, 95% CI: -0.09, -0.05).

Discussion

This study describes adoption of CDC guidelines for CTX dosing using a large, retrospective cohort of CTX prescriptions linked to GC/CT diagnosis within 2.5 years across a large, demographically diverse health system. While overall adoption rates were high, differences of adoption rates were identified in both patient- and system-level characteristics, suggesting overtreatment of some groups (Black) and undertreatment of others (non-ED patients). Studies of the causes of these differences may increase guideline adoption and mitigate risk of MDRO GC.