背景:综合征方法是在资源匮乏的国家中管理性传播感染的一种简单且负担得起的策略。然而,由于缺乏特异性和准确性,过度使用和滥用抗生素的风险非常高。这里,与目前用于3种常见性传播病原体综合征病例管理的算法相比,我们提出了一种更具体,更准确的算法,并将其精度与实验室检测进行了比较.
目的:本研究旨在比较主流医院现行的综合征病例管理指南的准确性,照顾非病毒性性传播感染的病人,关于一种涉及我们实验室制定的替代算法的方法,然后进行聚合酶链反应测试。
方法:这是一项观察性研究,根据诊断准确性和治疗方法比较了两个类别之间的数据。在第一类中,根据现有的国家艾滋病控制组织和国家艾滋病控制计划指南对感染症状进行评分,患者在检测前接受聚合酶链反应治疗。在第二类中,根据国家艾滋病控制组织和国家艾滋病控制计划指南以及其他替代综合征病例管理参数招募患者.所有样本均通过聚合酶链反应检测沙眼衣原体,淋病奈瑟菌,和阴道毛滴虫和临床相关的治疗前。
结果:在第一类中,在646例有症状感染的妇女中,只有46(7.82%)通过聚合酶链反应检测至少一种病原体呈阳性,和600(92.87%)的3种病原体中的任何一种的感染测试均为阴性。抗生素过度使用和误用的总估计百分比分别为92.87%和8.69%,分别。与国家艾滋病控制计划指南相比,根据实验室结果进行的正确和完整的治疗为46例(91.30%)中的42例。估计阿奇霉素和头孢克肟(灰色试剂盒)的过度使用为29.69%,多西环素组合的估计过度使用,头孢克肟,甲硝唑(黄色试剂盒)为29.87%,以及多西环素组合的估计过度使用,头孢克肟,甲硝唑,阿奇霉素(灰色黄色试剂盒)为11.45%。在第二类中,其中患者使用替代综合征方法和聚合酶链反应诊断进行治疗,319例患者中有243例(76.15%)感染了两种病原体(沙眼衣原体,淋病奈瑟菌,和阴道毛滴虫),而319例患者中有76例(23.82%)3种病原体均为阴性.在243名感染患者中,243人中有99人(40.74%)感染了单一病原体,而243人中有144人(59.20%)共感染。在144名合并感染的患者中,沙眼衣原体+淋病奈瑟菌感染率最高(51.38%),其次是与所有3种病原体合并感染(30%)。沙眼衣原体+阴道毛滴虫共感染9.72%,淋病奈瑟菌+阴道毛滴虫合并感染率为9.03%。估计抗生素的过度使用仅为23.82%。
结论:提出的综合征病例管理替代策略可以将滥用和过度使用抗生素的百分比从92.87%降低到23.82%。此外,仅综合征病例管理不足以进行疾病管理.
BACKGROUND: The syndromic approach is a simple and affordable strategy for the management of sexually transmitted infections in countries with low-resource settings. However, because of the lack of specificity and accuracy, the risk of overuse and misuse of antibiotics is very high. Here, we proposed a more specific and accurate algorithm compared with the current algorithm used for syndromic case management of 3 common sexually transmitted pathogens and compared its precision with laboratory-based tests.
OBJECTIVE: This study aimed to report a comparative account of the accuracy of existing syndromic case management guidelines followed in mainstream hospitals, for taking care of patients with nonviral sexually transmitted infections, concerning an approach involving an alternative algorithm formulated in our laboratory followed by polymerase chain reaction testing.
METHODS: This was an observational study that compared the data between 2 categories based on diagnostics accuracy and treatment. In category I, symptoms of infection were scored on the basis of the existing National AIDS Control Organization and National AIDS Control Programme guidelines, and patients were treated before testing by polymerase chain reaction. In category II, patients were recruited on the basis of the National AIDS Control Organization and National AIDS Control Programme guidelines with additional alternative syndromic case management parameters. All samples were tested by polymerase chain reaction for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis and clinically correlated before giving the treatment.
RESULTS: In category I, among 646 women with symptomatic infection, only 46 (7.82%) tested positive by polymerase chain reaction assay for at least 1 of the pathogens, and 600 (92.87%) tested negative for infection by any of the 3 pathogens. The total estimated percentages of the overuse and misuse of antibiotics were 92.87% and 8.69%, respectively. Correct and complete treatment based on laboratory outcome compared with National AIDS Control Programme guidelines was 42 of 46 (91.30%). The estimated overuse of azithromycin and cefixime (Gray Kit) was 29.69%, the estimated overuse of a combination of doxycycline, cefixime, and metronidazole (Yellow Kit) was 29.87%, and the estimated overuse of a combination of doxycycline, cefixime, metronidazole, and azithromycin (Gray with Yellow Kit) was 11.45%. In category II, wherein patients were treated using an alternative syndromic approach and polymerase chain reaction diagnostics, 243 of 319 patients (76.15%) were infected with either of the pathogens (Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis), whereas 76 of 319 patients (23.82%) were negative for any of the 3 pathogens. Among 243 patients with infection, 99 of 243 (40.74%) were infected with a single pathogen, whereas 144 of 243 (59.20%) were coinfected. Of 144 coinfected patients, the percentage of Chlamydia trachomatis + Neisseria gonorrhoeae infection was the highest (51.38%), followed by coinfection with all 3 pathogens (30%). Coinfection with Chlamydia trachomatis + Trichomonas vaginalis was 9.72%, and coinfection with Neisseria gonorrhoeae + Trichomonas vaginalis was 9.03%. The estimated overuse of antibiotics was found to be 23.82% only.
CONCLUSIONS: The proposed alternative strategies of syndromic case management can reduce the percentage of misuse and overuse of antibiotics from 92.87% to 23.82%. Moreover, syndromic case management alone was insufficient for disease management.