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Adherence to Centers for Disease Control and Prevention Gonococcal Treatment Guidelines Among Chicago Health Care Providers, 2011–2012
journal contribution
posted on 2015-11-21, 00:00 authored by IL Tabidze, TF Nicholson, T. Mikati, N. Benbow, SD MehtaBackground: Expansion of antimicrobial resistance in Neisseria
gonorrhoeae requires rapid adaptation of treatment guidelines and responsive
provider practice. We evaluated patient factors associated with
provider adherence to the Centers for Disease Control and Prevention
gonococcal treatment recommendations among Chicago providers in
2011 to 2012.
Methods: Laboratory-confirmed cases of uncomplicated urogenital gonorrhea
were classified via surveillance data as originating from Chicago
Department of Public Health (CDPH) or non-CDPH providers. Recommended
treatment was determined according to the Centers for Disease
Control and Prevention sexually transmitted disease treatment guidelines:
April 2011–July 2012 (period 1) and August–December 2012 (period 2, after
August 2012 revision). Multivariable log-binomial regression identified
factors associated with recommended treatment over time, stratified by
provider type.
Results: April 2011 through December 2012, 16,646 laboratoryconfirmed
gonorrhea cases were identified, of which 9597 (57.7%) had
treatment information: 2169 CDPH cases and 7428 non-CDPH cases.
Documented recommended treatment increased for CDPH (period 1:
71.3%, period 2: 80.8%; P < 0.01) and non-CDPH providers (period
1: 63.5%, period 2: 68.9%; P < 0.01). Among CDPH cases, statistically
significant factors associated with recommended treatment were male
sex (adjusted prevalence rate ratio [aPRR], 1.16) white versus black race
(aPRR, 0.68), same-day treatment (aPRR, 1.07), and period 2 (aPRR,
1.11). Among non-CDPH cases, statistically significant factors were as
follows: male sex (aPRR, 1.10), other versus black race (aPRR, 0.91),
same-day treatment (aPRR, 1.31), greater number of within-facility reported
cases (aPRRs ranging from 1.22 to 1.41), and at least 50% withinfacility
missing treatment data (aPRR, 0.84).
Conclusions: Recommended treatment improved over time, yet remains
suboptimal. Efforts to reduce variability and improve provider adherence
to recommended treatment are urgently needed.