Does Paging Clinicians about Tick-Borne Disease Serological Results Impact Clinical Care? A Retrospective Analysis of 70 Cases in North Carolina

Am J Trop Med Hyg. 2024 Feb 27;110(4):815-818. doi: 10.4269/ajtmh.23-0251. Print 2024 Apr 3.

Abstract

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.

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Humans
  • North Carolina / epidemiology
  • Retrospective Studies
  • Rickettsia*
  • Rocky Mountain Spotted Fever* / drug therapy
  • Tick-Borne Diseases* / diagnosis
  • Tick-Borne Diseases* / drug therapy
  • Tick-Borne Diseases* / epidemiology

Substances

  • Anti-Bacterial Agents