Correlates of Neisseria gonorrhoeae antimicrobial resistance: cross-sectional results from an open cohort sentinel surveillance network in Québec, Canada, 2016-2019

OBJECTIVES

To examine correlates of Neisseria gonorrhoeae antimicrobial resistance (AMR) to first-line antimicrobials (azithromycin, cefixime and ceftriaxone).

DESIGN AND SETTING

The sentinel surveillance network is an open cohort of gonococcal infection cases from Québec, Canada. Cross-sectional results are reported herein.

PARTICIPANTS

Between 1 January 2016 and 31 December 2019, data from 886 individuals accounting for 941 gonorrhoea cases were included.

METHODS

Epidemiological and clinical data were collected using an auto-administered questionnaire, direct case interviews and chart reviews. Antimicrobial susceptibility testing was performed using the agar dilution method. Generalised estimating equations were used for regression.

RESULTS

The prevalence of azithromycin resistance with a minimal inhibitory concentration (MIC) of ≥2 mg/L was 21.3%. In 2016, men who have sex with men were more likely to be infected with an azithromycin-resistant N. gonorrhoeae isolate (adjusted prevalence ratio (aPR)=4.73, 95% CI 1.48 to 15.19) or with an isolate with increased third-generation cephalosporin (3GC) MIC (aPR=5.32, 95% CI 1.17 to 24.11 for cefixime (MIC≥0.06 mg/L) and aPR=4.38, 95% CI 1.53 to 12.54 for ceftriaxone (MIC≥0.03 mg/L)). However, these associations were not maintained between 2017 and 2019, with increased MIC observed in men who have sex exclusively with women and women. Overall, azithromycin resistance was significantly more likely in cases who self-reported HIV infection (aPR=1.65, 95% CI 1.00 to 2.71). Cefixime increased MIC were more likely in individuals 25-34 years old (aPR=2.23, 95% CI 1.18 to 4.21). Cefixime and ceftriaxone increased MIC were both more likely in cases who reported ≥5 sexual partners (cefixime: aPR=2.10, 95% CI 1.34 to 3.27 and ceftriaxone: aPR=1.62, 95% CI 1.14 to 2.30).

CONCLUSION

Significant correlates of N. gonorrhoeae AMR to first-line antimicrobials were observed. Antimicrobial stewardship may be particularly important for 3GC. Active monitoring and interventions are critical for 3GC non-susceptible strains, especially considering the very low prevalence in Québec.

Improvement of reverse sequence algorithm for syphilis diagnosis using optimal treponemal screening assay signal-to-cutoff ratio

BACKGROUND

Although reverse sequence algorithms (RSA) for syphilis screening are performing well, they still have to rely on treponemal confirmatory tests at least for sera reactive by enzyme immunoassay/chemiluminescence immunoassay (EIA/CIA) and unreactive by rapid plasma reagin (RPR). Quebec's laboratory network previously showed that 3.3% of EIA/CIA reactive and weakly-reactive RPR samples (RPR titer of 1 to 4) would have been misclassified as syphilis cases if a treponemal confirmatory test had not been performed.

OBJECTIVES

To correlate the magnitude of signal-to-cutoff (S/CO) ratios of the 4 most used commercial first-line EIA/CIA kits in Quebec with syphilis confirmation results and establish a S/CO value above which treponemal confirmation would not be required.

METHODS

Serum samples from previously undiagnosed individuals (n = 7 404) obtained between January 2014 and February 2017 that were reactive by EIA/CIA and either negative by RPR or reactive with a low titer (1 to 4) were included in the study. All samples were tested with Treponema pallidum particle agglutination (TP-PA) and, if negative or inconclusive, with a line immunoassay (LIA). Syphilis infection confirmation was defined by a reactive TP-PA or LIA. Logistic regression analysis was used to determine S/CO values (95% CI lower bound = 0.98) above which confirmation would not be required. The four kits studied were Architect TP, BioPlex IgG, Syphilis EIA II, and Trep-Sure.

RESULTS

Of 2609 reactive EIA/CIA specimens tested for the determination of S/CO values, 1730 (66%) were confirmed as true syphilis cases. Confirmation rate was significantly higher in samples with low-titer positive RPR (92%) than with negative RPR samples (54%); p<0.01. A linear probability model (95% CI lower bound = 0.98) predicted the S/CO value above which a confirmation would no longer be needed for the Architect TP (16.4), Bioplex IgG (7.4) and Trep-Sure (24.6). No linearity was observed between the S/CO value of Syphilis EIA II and the confirmation rate. The validity of the predicted S/CO values was investigated using 4 795 specimens. The use of an S/CO value of 16.4 with the Architect TP kit and of 24.6 for the Trep-Sure kit would obviate the need for confirmation of 18.5% and 13.2% of sera from the all RPR subgroup, respectively. For the BioPlex IgG kit, 81.1% of sera would not require confirmation when using the S/CO value of 7.4 in the low titer RPR subgroup.

CONCLUSION

Signal-to-cut-off values could be used to identify sera that do not require extra treponemal confirmation for 3 of the 4 most used first-line EIA/CIA kits in Quebec. Using these values in our current reverse screening algorithm (RSA) would avoid the need for confirmatory tests in 14 to 20% of sera, a proportion that could reach 75% among low-titer RPR.

Interleukin-16 Inhibits Immunoglobulin E Production by B Lymphocytes

BACKGROUND

The increased production of IgE is a hallmark of atopic disorders. CD4+ T cells regulate the production of Immunoglobulin (Ig) E by B cells. Interleukin (IL) 16, a CD4+ specific cytokine, is highly expressed at sites of allergic inflammation. Our aim was to determine the effect of IL-16 on IgE production in atopic subjects.

METHODS

Freshly isolated peripheral blood mononuclear cells (PBMC) from atopic subjects were stimulated with recombinant IL (rIL) 4 and anti-CD40 antibody to promote IgE production in the presence or absence of rIL-16 added at different time intervals prior to stimulation. The levels of IgE in cell culture supernatants collected at day 14 were measured by ELISA. The effect of IL-16 on the expression of the Cepsilon transcript was evaluated by reverse-transcription polymerase chain reaction. To evaluate whether the modulatory effect of IL-16 on IgE production was mediated by interferon-gamma (IFN-gamma), anti-CD40/IL-4-stimulated PBMC were cultured in the presence of rIL-16 and neutralizing concentrations of anti-IFN-gamma antibody.

RESULTS

PBMC stimulated with rIL-4 (400 U/ml) and anti-CD40 monoclonal antibody (0.5 microg/ml) produced significant amounts of IgE (range: 1.3-46.0 ng/ml). The addition of rIL-16 twenty-four hours before stimulation significantly reduced the levels of IgE released by anti-CD40/IL-4-stimulated PBMC (0.5-29.6 ng/ml, p < 0.05). IL-16 reduced the expression of the Cepsilon transcript in stimulated PBMC. IL-16 induced the expression of IFN-gamma mRNA. However, the use of anti-IFN-gamma antibody did not alter the effect of IL-16 on IgE production. Rescue doses of IL-13 did not restore the production of IgE by PBMC treated with IL-16. IL-16 did not alter IgE production in CD14-depleted cell preparations suggesting that the IL-16-mediated effects on IgE production may be related to CD14+ cells.

CONCLUSION

These data show that IL-16 inhibits IgE production and therefore may play an important regulatory role in atopic disorders.