Portal de Periódicos da CAPES

1072: Evaluating the clinical impact of implementing reverse syphilis screening at a large public hospital

2019; Elsevier BV; Volume: 222; Issue: 1 Linguagem: Inglês

10.1016/j.ajog.2019.11.1085

1097-6868

Emily H. Adhikari, Rachel C. Schell, Angela R. Seasely, Amanda C. Zofkie, Donald D. McIntire, Scott W. Roberts, Vanessa Rogers,

Reproductive tract infections research

To compare the frequency, staging, and treatment of maternal syphilis cases and infant evaluations before and after implementing a reverse screening algorithm (using a treponemal-specific antibody assay) at a high-volume public hospital. On May 16, 2018, our hospital laboratory switched from a Traditional to a Reverse Sequence Screening algorithm. We prospectively identified deliveries to women with reactive syphilis screening tests between May 16-Dec 31, 2018, and compared these to a retrospective cohort of deliveries identified one year prior, May 16-Dec 31, 2017. We compared the number of women with reactive screening tests according to study week in each cohort. We evaluated maternal demographics, syphilis staging and treatment, and infant outcomes in 2017 and 2018. The number of women with reactive screening tests was higher throughout the study period following implementation of the reverse algorithm (Figure 1). The total number of women with reactive screening tests more than doubled, from 45 (2017) to 122 (2018); total deliveries were similar. There was no difference in age, parity, mode of delivery, or gestational age at delivery. There were more Black women with reactive treponemal antibodies in the 2018 cohort (57% in 2018 vs 36% in 2017, p=0.02). Compared with 2017, the proportion of women with previously treated syphilis increased in 2018 (43% from 20%), the frequency of untreated syphilis remained relatively unchanged (51% in 2017 vs 47% in 2018), and the frequency of false positive tests declined (29% in 2017 vs 13% in 2018) (overall p=0.003) (Table 1). Relative to 2017, the proportion with nonreactive RPR increased (61% vs 16%, p< 0.001). Although the proportion of treated women remained similar, absolute numbers requiring treatment doubled. Similarly, absolute numbers of infants undergoing lumbar puncture and receiving treatment increased two to three-fold. Implementation of the reverse syphilis screening algorithm results in a three to four-fold increase in the frequency of RPR-nonreactive maternal cases requiring evaluation and possible treatment.View Large Image Figure ViewerDownload Hi-res image Download (PPT)