(P42) Impact of the COVID-19 Pandemic on a Near Point of Care STI Management & Treatment

Tuesday, July 25, 2023

16:00 – 18:00 CST

Primary Presenter(s)

Jessica S. Li, BSc (she/her/hers)

Medical Student
Washington State University Elson S. Floyd College of Medicine
Shoreline, Washington, United States

Co-author(s)

Hilary Reno, MD, PhD

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

Stephen Liang, MD, MPHS

Associate Professor of Medicine at Washington University in St. Louis Division of Infectious Disease
Washington University in St. Louis, United States
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

Background: Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) rates continue to increase in the US. Near point of care (nPOC) testing can improve proper treatment of STIs in Emergency Departments (ED), but the COVID-19 pandemic disrupted the US healthcare system for non-emergent care like sexual health. This study details the impact on antimicrobial stewardship for GC and CT in a large, academic ED.

Methods: Via electronic medical records from January 2019 through March 2022, we assessed GC and CT testing results in monthly increments. Rates of antibiotic treatment including proper treatment of GC and CT were examined and compared before and after the initiation of an nPOC testing protocol (The Cepheid Gene Infinity returned NAAT results on ED patients in 2-3 hours starting in August 2019). Antibiotic treatment of GC and CT was also examined through COVID-19 (March 2020 forward).

Results: From January through July of 2019 the average rate of proper antibiotic treatment was 85.2% (Figure 1). Via nPOC testing, proper antibiotic treatment of GC and CT increased by 5.8% (85.2% to 91%) and overtreatment decreased by 5% (9.9% to 4.9%). However, from March through June 2020 (COVID-19 disruption), proper treatment declined immediately by 2.1%. This decline in proper treatment rates is 35.1% of the growth of proper treatment rates in the former 6-month period. The prevalence of GC and CT increased from 12.2% to 13.8% at the same time.

Conclusions: We observed a disproportionate decline in proper antibiotics use for GC/ CT management in the COVID-19 pandemic in one large ED. The pandemic and supply shortages disrupted the nPOC testing protocol and improved antibiotic stewardship for GC and CT. There was an initial increase in positive test rates between March 2020 to June 2020 indicating that patients were unable to access routine STI testing and likely only presented for STI testing in the ED with symptoms, so antibiotic treatment was more likely. This study will inform changes needed to improve antimicrobial stewardship in the ED’s care of STIs.