Loading ...

TOPLINE:

A 90-minute nucleic acid amplification test (NAAT) in the emergency department (ED) showed significant reductions in both undertreatment and overtreatment rates among women with Chlamydia trachomatis and Neisseria gonorrheae (CT/NG) infections, according to a real-world study.

METHODOLOGY:

• This two-site, retrospective, before-after study included women tested for CT/NG across two 70-week periods from 2017 to 2020.
• Researchers analyzed endocervical samples at an urban academic tertiary referral center using the NAAT test (intervention ED; n = 10,064 tests) and compared the outcomes with those at a suburban community ED using the standard test (control ED; n = 1990 tests).
• The primary outcomes were undertreatment and overtreatment rates, and the secondary outcomes included length of stay, rates of test positivity, and overall testing.

TAKEAWAY:

• Undertreatment rates in the intervention ED decreased significantly (18% decrease; 95% CI, −17% to −20%) compared with those in the control ED (2% decrease; 95% CI, −7% to 2%).
• Overtreatment rates in the intervention ED decreased significantly (10% decrease; 95% CI, −8% to −11%) compared with those in the control ED (4% decrease; 95% CI, −8% to 1%).
• Test positivity rates and length of stay remained stable across the two EDs during the study period.

IN PRACTICE:

"The implementation of a rapid NAAT demonstrated decreased under- and overtreatment of CT/NG in the ED," the authors wrote. "This real-world study can benefit EM physicians and leadership in considering whether the public health and antibiotic stewardship improvements in transitioning to this test from standard NAAT/empiric therapy can provide a better standard of care for their patient population," they added.

SOURCE:

The study was led by Brian Chinnock, MD, Department of Emergency Medicine UCSF-Fresno Medical Education Program, Fresno, California. It was published online on March 24, 2025, in The Journal of Emergency Medicine.

LIMITATIONS:

This single-site study was conducted at a high-burden urban academic ED, limiting its generalizability. Patients who did not receive same-visit treatment were classified as undertreated. Overtreatment may have been slightly over- or underestimated due to potential misclassification of untested but high-risk patients. The quasi-experimental design limited causal inference, though trends were sustained post-intervention. The control ED's low volume hampered trend analysis. Additionally, the study could not identify reasons behind specific undertreatment or overtreatment events.

DISCLOSURES:

The study did not receive any funding. The authors reported no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.