Antimicrobial stewardship, rapid PCR and STI

Significant improvement to patient care and antimicrobial stewardship with appropriate use of antibiotics may be achieved through the use of rapid point-of-care PCR STI testing.

Challenge

Accurate same-day sexually transmitted infections (STI) diagnostic test results are generally unavailable, leading to syndromic management with high rates of over- and under-treatment, which contributes to antibiotic resistance.
Hypothesis: Might a rapid molecular diagnostic test help clinicians deliver the right treatment to women with STI during a single visit?

Action

Conduct a cross-sectional single-visit study to evaluate the Visby Medical Sexual Health Click Test with respect to:

Ease of integration into clinical practice,
Acceptance by patients and clinic personnel, and
Potential to inform correct treatment decisions.

Result

If integrated efficiently into the clinical workflow, the test would have minimal impact on staff time and visit duration for patients.
Patients strongly agreed that self-collecting the vaginal swab was easy, and they were comfortable waiting up to 30-minutes to get results. Operators reported the device was easy to use. Clinicians valued the rapid results.
Importantly, in 13 of 15 undertreated cases, the Visby Medical test correctly identified the causative pathogen. The test also correctly identified all 33 incidences of over-treatment. This suggests that clinical adoption of the Visby Medical test into primary care clinics could reduce over- and under-treatment of STIs, contributing to improved antimicrobial stewardship.

In addition, the following were observed:

Reduced test turnaround time (TAT) from an average of 6 days for Standard of Care (SOC) down to ± 45 minutes for Visby Medical Sexual Health Click test
Potential to reduce antibiotic overuse and associated effects on emerging antibiotic-resistant bacteria
Potential to reduce delays in correctly identifying infected individuals by delivering test results in a single visit
Improved physician and patient satisfaction

Conclusion

The biggest potential benefit of using a point of care molecular / polymerase chain reaction (PCR) test was the rapid turnaround time for delivery of the test results in a single visit. This would allow clinicians to treat patients based on the test results as opposed to empiric (presumptive) treatment, thereby reducing over- and under- treatment and reduced misuse of antibiotics.

Rate of patients over- or under-treated

Rate of patients over- or under-treated