(P112) IMPROVING ANTIMICROBIAL STEWARDSHIP: THE IMPLEMENTATION OF POINT OF CARE CHLAMYDIA AND GONORRHEA NUCLEIC ACID AMPLIFICATION TESTING (NAAT) IN AN URBAN STI CLINIC

Background:
The Centers for Disease Control and Prevention (CDC) has named drug-resistant Neisseria gonorrhea as an urgent antibiotic resistance threat in the United States. This study evaluated the implementation of on-site point of care NAAT gonorrhea and chlamydia testing at a public, urban STI clinic and its subsequent effects on antimicrobial stewardship.

Methods:
Point of care urine NAAT chlamydia and gonorrhea testing was done for men presenting with symptoms of urethritis and/or testicular pain. If test results were positive for either infection, patients were treated according to CDC’s STI treatment guidelines. If chlamydia and gonorrhea were both negative, the patient was treated for non-gonococcal urethritis (NGU) with doxycycline 100 mg BID for 7 days or no treatment. We then analyzed the relative reduction in doses of ceftriaxone administered compared to the routine standard of care of providing empirical urethritis treatment.

Results:
Chlamydia and gonorrhea NAAT point of care testing was performed on 40 males with symptoms of urethritis and/or testicular pain from January - March 2024. 3 of the patients tested positive for gonorrhea and were treated with one dose of intramuscular ceftriaxone 500 mg. 2 of the patients tested positive for chlamydia and were treated with oral doxycycline 100 mg BID x 7 days. 35 of the patients tested negative for both chlamydia and gonorrhea. Of those patients, 22 were treated with only doxycycline 100 mg BID x 7 days for NGU. One patient was treated with azithromycin 1 g for NGU. 14 patients were not treated with any antibiotics. The relative reduction of ceftriaxone doses administered was 93% when compared to the standard of care practice.

Conclusion:
Point of care NAAT chlamydia and gonorrhea testing for symptomatic urethritis in male patients in an urban STI clinic improves antimicrobial stewardship by minimizing empiric administration of intramuscular ceftriaxone.