| Autor: |
Mokashi NV; Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina., Brown Marusiak A; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina., Giandomenico D; Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina., Cleinmark M; McLendon Clinical Laboratories, University of North Carolina, Chapel Hill, North Carolina., Schmitz JL; McLendon Clinical Laboratories, University of North Carolina, Chapel Hill, North Carolina.; Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina., Boyce RM; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.; Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina.; Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina. |
| Abstrakt: |
Delayed treatment of Rocky Mountain spotted fever is associated with increased morbidity and mortality. Because the diagnosis cannot be established from a single serological test, guidelines recommend empirical antibiotic initiation in suspect patients. We evaluated a policy used by UNC Health of paging clinicians when acute testing for Rickettsia returned with a titer ≥1:256. Our objective was to assess the potential effect of paging on routine treatment practices. Notably, we found that a high proportion of cases (N = 28, 40%) were not prescribed antibiotics until the results were available. The vast majority of these cases did not have evidence of compatible symptoms or disease progression. These findings suggest that paging may have prompted unnecessary treatment. Overall, the policy, which has now been discontinued, appears to have had limited benefit. Efforts are urgently needed to improve adherence to testing and treatment guidelines. |
