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Pitt-Kendall R, Sun S, Hughes S, Merrick R, Donaldson H, Rayment M, Ivanov Z, Day M, Bari A, Rebec M, Callan E, Mohammed H, Sinka K, Cole M, Fifer H. Investigating the cause of increased tetracycline-resistant Neisseria gonorrhoeae in England, 2016-20. J Antimicrob Chemother 2024; 79:1060-1068. [PMID: 38517444 PMCID: PMC11062939 DOI: 10.1093/jac/dkae073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/29/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Antimicrobial resistance in Neisseria gonorrhoeae is a global public health concern. Tetracycline resistance (TetR) increased from 39.4% to 75.2% between 2016 and 2021 in N. gonorrhoeae isolates collected through national surveillance in England, despite the absence of use of tetracyclines for the treatment of gonorrhoea. OBJECTIVES We investigated whether there was correlation between bacterial sexually transmitted infection (STI) tests performed and treatment with antimicrobials, with increased TetR in N. gonorrhoeae. METHODS We examined correlations between bacterial STI tests, antimicrobial treatment and TetR in N. gonorrhoeae, using national surveillance data from three large sexual health services (SHS) in London during 2016-20. Doxycycline prescribing data and antibiograms of a non-STI pathogen from distinct patient groups (sexual health, obstetric and paediatric), at a large London hospital, were analysed to identify if doxycycline use in SHS was associated with resistance in a non-STI organism. RESULTS A substantial increase in TetR was observed, particularly in isolates from gay, bisexual and other MSM (GBMSM). Strong positive correlations were observed exclusively in GBMSM between N. gonorrhoeae TetR and both bacterial STI tests (r = 0.97, P = 0.01) and antimicrobial treatment (r = 0.87, P = 0.05). Doxycycline prescribing increased dramatically during the study period in SHS. Prevalence of TetR in Staphylococcus aureus was higher in isolates sourced from SHS attendees than those from other settings. CONCLUSIONS Frequent screening of GBMSM at higher risk of STIs, such as those on pre-exposure prophylaxis (PrEP) leading to/and increased use of doxycycline for the treatment of diagnosed infections, may account for the increase in TetR in N. gonorrhoeae.
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Affiliation(s)
| | - Suzy Sun
- UK Health Security Agency, London, UK
| | | | | | | | - Michael Rayment
- Chelsea & Westminster NHS Foundation Trust, London, UK
- Imperial College London, London, UK
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Milligan AL, Randag AC, Lekkerkerk S, Fifer H. Increased incidence of adult gonococcal keratoconjunctivitis at two tertiary eye hospitals in Western Europe: clinical features, complications and antimicrobial susceptibility. Br J Ophthalmol 2024:bjo-2023-324750. [PMID: 38365428 DOI: 10.1136/bjo-2023-324750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/19/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Gonorrhoea is on the rise: between 2021 and 2022, a 50% and a 33% increase in diagnoses was seen, respectively, in England and the Netherlands. A concurrent rise in gonococcal keratoconjunctivitis (GKC) is a serious concern due to the potentially devastating visual complications. METHODS This is a retrospective case series of adult GKC from two Western European tertiary ophthalmology centres between 2017 and July 2023. The clinical features, ocular complications and antimicrobial susceptibilities are reported within. RESULTS An increased incidence was recorded at both centres, with 11 confirmed cases in the first 7 months of 2023, compared with ≤3 per year in 2017-2022. CONCLUSION The notable increase of GKC cases in our centres in 2023 may indicate a rise across Western Europe. Enhanced, sustained, national surveillance of GKC is essential to establish incidence and antimicrobial susceptibility, to inform treatment guidelines and guide appropriate public health response.
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Affiliation(s)
- Alice L Milligan
- Corneal and External Diseases Department and Emergency Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Anna C Randag
- Corneal and External Diseases Department, Eye Hospital Rotterdam, Rotterdam, The Netherlands
| | - Sybren Lekkerkerk
- Department of Medical Microbiology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Helen Fifer
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
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3
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Ladhani SN, White PJ, Campbell H, Mandal S, Borrow R, Andrews N, Bhopal S, Saunders J, Mohammed H, Drisdale-Gordon L, Callan E, Sinka K, Folkard K, Fifer H, Ramsay ME. Use of a meningococcal group B vaccine (4CMenB) in populations at high risk of gonorrhoea in the UK. Lancet Infect Dis 2024:S1473-3099(24)00031-8. [PMID: 38521080 DOI: 10.1016/s1473-3099(24)00031-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/09/2024] [Accepted: 01/15/2024] [Indexed: 03/25/2024]
Abstract
The meningococcal group B vaccine, 4CMenB, is a broad-spectrum, recombinant protein vaccine that is licensed for protection against meningococcal group B disease in children and adults. Over the past decade, several observational studies supported by laboratory studies have reported protection by 4CMenB against gonorrhoea, a sexually transmitted infection caused by Neisseria gonorrhoeae. Gonorrhoea is a major global public health problem, with rising numbers of diagnoses and increasing resistance to multiple antibiotics. In England, more than 82 000 cases of gonorrhoea were diagnosed in 2022, with nearly half of the cases diagnosed among gay, bisexual, and other men who have sex with men. There are currently no licensed vaccines against gonorrhoea but 4CMenB is estimated to provide 33-47% protection against gonorrhoea. On Nov 10, 2023, the UK Joint Scientific Committee on Vaccination and Immunisation agreed that a targeted programme should be initiated using 4CMenB to prevent gonorrhoea among individuals at higher risk of infection attending sexual health services in the UK. This decision was made after reviewing evidence from retrospective and prospective observational studies, laboratory and clinical data, national surveillance reports, and health economic analyses. In this Review, we summarise the epidemiology of invasive meningococcal disease and gonorrhoea in England, the evidence supporting the use of 4CMenB for protection against gonorrhoea, and the data needed to inform long-term programme planning and extension to the wider population.
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Affiliation(s)
- Shamez N Ladhani
- Immunisation Division, UK Health Security Agency, London, UK; Centre for Neonatal and Paediatric Infection, St George's, University of London, London, UK.
| | - Peter J White
- Modelling and Economics Unit, UK Health Security Agency, London, UK; MRC Centre for Global Infectious Disease Analysis, Imperial College School of Public Health, London, UK
| | - Helen Campbell
- Immunisation Division, UK Health Security Agency, London, UK
| | - Sema Mandal
- Immunisation Division, UK Health Security Agency, London, UK
| | - Ray Borrow
- Meningococcal Reference Unit, UK Health Security Agency, Manchester Royal Infirmary, Manchester, UK
| | - Nick Andrews
- Statistics, Modelling, and Economics Department, UK Health Security Agency, London, UK
| | - Sunil Bhopal
- Immunisation Division, UK Health Security Agency, London, UK
| | - John Saunders
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
| | - Hamish Mohammed
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
| | - Lana Drisdale-Gordon
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
| | - Emma Callan
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
| | - Katy Sinka
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
| | - Kate Folkard
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
| | - Helen Fifer
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
| | - Mary E Ramsay
- Immunisation Division, UK Health Security Agency, London, UK
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4
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Allan-Blitz LT, Fifer H, Klausner JD. Managing treatment failure in Neisseria gonorrhoeae infection: current guidelines and future directions. Lancet Infect Dis 2024:S1473-3099(24)00001-X. [PMID: 38367636 DOI: 10.1016/s1473-3099(24)00001-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/26/2023] [Accepted: 01/04/2024] [Indexed: 02/19/2024]
Abstract
Due to the continued emergence of resistance to extended-spectrum cephalosporin antibiotics, clinicians are increasingly more likely to encounter cases of Neisseria gonorrhoeae treatment failure. The current international treatment guidelines offer few regimens for cases of N gonorrhoeae infection that do not respond to first-line therapy, and there are many complexities that should be considered with such regimens; these include regional variations in resistance to alternative agents, access to different antibiotics, and penetration of those antibiotics within different tissues. Further, such regimens do not account for the challenges of treating pharyngeal infections; many patients who have not responded to treatment with extended-spectrum cephalosporin antibiotics to date have had pharyngeal involvement. In addition, pharyngeal infections play a pivotal role in the emergence and spread of antimicrobial resistance in N gonorrhoeae and are more difficult to treat than urogenital infections because of the unfavourable pharmacokinetics of cephalosporins in pharyngeal tissues. Here, we summarise the current guidelines, provide additional approaches and considerations for clinicians, and highlight knowledge gaps that should be addressed to ensure appropriate therapy in cases of treatment failure.
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Affiliation(s)
- Lao-Tzu Allan-Blitz
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| | - Helen Fifer
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
| | - Jeffrey D Klausner
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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5
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Fountain H, Migchelsen SJ, Charles H, Ram T, Fifer H, Mohammed H, Sinka K. Rebound of Gonorrhea after Lifting of COVID-19 Preventive Measures, England. Emerg Infect Dis 2024; 30:329-332. [PMID: 38167386 PMCID: PMC10826777 DOI: 10.3201/eid3002.231148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
After lifting of all COVID-19 preventive measures in England in July 2021, marked, widespread increases in gonorrhea diagnoses, but not testing numbers, were observed, particularly in persons 15-24 years of age. Continued close surveillance and public health messaging to young persons are needed to control and prevent gonorrhea transmission.
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Affiliation(s)
| | | | | | - Tika Ram
- UK Health Security Agency, London, UK
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6
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Pitt-Kendall R, Foster C, Rayment M, Orzechowska B, Mammadov R, Soni S, Mortlock S, Owen J, Uglow L, Day MJ, Rai Gurung R, Savary-Trathen A, Jenkins R, McGuire E, Gordon N, Day SL, Kelly AM, Goward C, Folkard K, Charles H, Mohammed H, Brown CS, Fifer H. Retrospective testing for mpox virus in routine STI screens from men who have sex with men in England, August-October 2022. Sex Transm Infect 2023; 99:548-551. [PMID: 37536929 DOI: 10.1136/sextrans-2023-055841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/15/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVES A global outbreak of mpox (monkeypox) has been ongoing since 2022, with most cases in the UK detected in gay, bisexual and other men who have sex with men (GBMSM). Asymptomatic and pauci-symptomatic mpox infection has been reported outside of the UK. We aimed to investigate whether mpox could be detected in specimens from GBMSM in England who were attending sexual health services (SHSs) for asymptomatic sexually transmitted infection screening. METHODS Anonymised, residual clinical specimens from GBMSM undertaking routine asymptomatic screening for gonorrhoea (Neisseria gonorrhoeae (NG)) and chlamydia (Chlamydia trachomatis (CT)) infection were tested for the presence of mpox virus. Specimens were collected between 1 August and 7 October 2022 from three SHSs in high-mpox incidence areas in England. Testing was performed using a dual-clade, mpox virus-specific real-time PCR. RESULTS During the collection period, 2927 clinical specimens (951 pharyngeal swabs, 1022 urine specimens and 954 rectal swabs) were obtained from 1159 GBMSM. Mpox virus was detected in four specimens from two participants who attended the same SHS at different times (the first during the week 8-12 of August, the second during the week 19-23 of September). One participant was positive in the urine specimen only, while the other tested positive at all three sites. CONCLUSIONS A very low prevalence (2 of 1159, 0.17%) of mpox infection was detected in GBMSM attending SHS in England for asymptomatic NG/CT screening, suggesting that undetected infection in this population was unlikely to be a main driver of transmission. Confirmed mpox cases in the UK declined from over 1100 per month in June and July to 764 cumulatively during the collection period. These data give reassurance that the observed reduction in cases during the collection period was not due to undetected infection or changes in presentation among SHS attendees. Currently, there is insufficient evidence to support routine testing of asymptomatic GBMSM for mpox infection in England.
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Affiliation(s)
| | | | - Michael Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | | | - Suneeta Soni
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | | | - Jodie Owen
- UK Health Security Agency - Porton, Salisbury, UK
| | | | | | | | | | - Rhian Jenkins
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | | | | | | | - Adrian M Kelly
- Lead Commissioner Sexual Health e-Service, City of London Corporation, London, UK
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7
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Beale MA, Thorn L, Cole MJ, Pitt R, Charles H, Ewens M, French P, Guiver M, Page EE, Smit E, Vera JH, Sinka K, Hughes G, Marks M, Fifer H, Thomson NR. Genomic epidemiology of syphilis in England: a population-based study. Lancet Microbe 2023; 4:e770-e780. [PMID: 37722404 PMCID: PMC10547597 DOI: 10.1016/s2666-5247(23)00154-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Syphilis is a sexually transmitted bacterial infection caused by Treponema pallidum subspecies pallidum. Since 2012, syphilis rates have risen dramatically in many high-income countries, including England. Although this increase in syphilis prevalence is known to be associated with high-risk sexual activity in gay, bisexual, and other men who have sex with men (GBMSM), cases are rising in heterosexual men and women. The transmission dynamics within and between sexual networks of GBMSM and heterosexual people are not well understood. We aimed to investigate if whole genome sequencing could be used to supplement or enhance epidemiological insights around syphilis transmission. METHODS We linked national patient demographic, geospatial, and behavioural metadata to whole T pallidum genome sequences previously generated from patient samples collected from across England between Jan 1, 2012, and Oct 31, 2018, and performed detailed phylogenomic analyses. FINDINGS Of 497 English samples submitted for sequencing, we recovered 240 genomes (198 from the UK Health Security Agency reference laboratory and 42 from other laboratories). Three duplicate samples (same patient and collection date) were included in the main phylogenies, but removed from further analyses of English populations, leaving 237 genomes. 220 (92·8%) of 237 samples were from men, nine (3·8%) were from women, and eight (3·4%) were of unknown gender. Samples were mostly from London (n=118 [49·8%]), followed by southeast England (n=29 [12·2%]), northeast England (n=24 [10·1%]), and southwest England (n=15 [6·3%]). 180 (76·0%) of 237 genomes came from GBMSM, compared with 25 (10·5%) from those identifying as men who have sex with women, 15 (6·3%) from men with unrecorded sexual orientation, nine (3·8%) from those identifying as women who have sex with men, and eight (3·4%) from people of unknown gender and sexual orientation. Phylogenomic analysis and clustering revealed two dominant T pallidum sublineages in England. Sublineage 1 was found throughout England and across all patient groups, whereas sublineage 14 occurred predominantly in GBMSM older than 34 years and was absent from samples sequenced from the north of England. These different spatiotemporal trends, linked to demography or behaviour in the dominant sublineages, suggest they represent different sexual networks. By focusing on different regions of England we were able to distinguish a local heterosexual transmission cluster from a background of transmission in GBMSM. INTERPRETATION These findings show that, despite extremely close genetic relationships between T pallidum genomes globally, genomics can still be used to identify putative transmission clusters for epidemiological follow-up. This could be of value for deconvoluting putative outbreaks and for informing public health interventions. FUNDING Wellcome funding to the Sanger Institute, UK Research and Innovation, National Institute for Health and Care Research, European and Developing Countries Clinical Trials Partnership, and UK Health Security Agency.
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Affiliation(s)
- Mathew A Beale
- Parasites and Microbes Programme, Wellcome Sanger Institute, Hinxton, UK.
| | - Louise Thorn
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
| | - Michelle J Cole
- HCAI, Fungal, AMR, AMU and Sepsis Division, UK Health Security Agency, London, UK
| | - Rachel Pitt
- HCAI, Fungal, AMR, AMU and Sepsis Division, UK Health Security Agency, London, UK
| | - Hannah Charles
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
| | - Michael Ewens
- Brotherton Wing Clinic, Brotherton Wing, Leeds General Infirmary, Leeds, UK
| | - Patrick French
- The Mortimer Market Centre, Central and North West London NHS Trust, London, UK
| | - Malcolm Guiver
- Laboratory Network, Manchester, UK Health Security Agency, Manchester Royal Infirmary, Manchester, UK
| | - Emma E Page
- Virology Department, Old Medical School, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Erasmus Smit
- Clinical Microbiology Department, Queen Elizabeth Hospital, Birmingham, UK; Institute of Environmental Science and Research, Wellington, New Zealand
| | - Jaime H Vera
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Katy Sinka
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
| | - Gwenda Hughes
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Michael Marks
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK; Division of Infection and Immunity, University College London, London, UK
| | - Helen Fifer
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK.
| | - Nicholas R Thomson
- Parasites and Microbes Programme, Wellcome Sanger Institute, Hinxton, UK; Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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Bristowe H, Day M, Fifer H, Arias M. Gonococcal pericarditis with tamponade - use of molecular technology to improve diagnosis and management. Int J Infect Dis 2023; 134:150-152. [PMID: 37329948 DOI: 10.1016/j.ijid.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/12/2023] [Accepted: 06/12/2023] [Indexed: 06/19/2023] Open
Abstract
We report a case of gonococcal pericarditis, which was unexpected due to its extremely unusual occurrence. A 42-year-old man presented with fever, chest pain, dyspnea, and tachycardia. He was initially stable but rapidly deteriorated, developing pericardial effusion with tamponade requiring a pericardial window. Incompletely decolorized gram stain of the pericardial fluid initially suggested the presence of gram-positive diplococci, which wrongly directed treatment toward possible pneumococcal infection. Because cultures were negative, identification of the causative organism was attempted by molecular and genotyping analysis. These techniques identified Neisseria gonorrhoeae-multi-antigen sequence type 14994 (por 5136/tbpB 33) as the etiology, which has been associated with disseminated gonococcal disease. Real-time polymerase chain reaction showed no evidence of mutations within the N. gonorrhoeae penA gene responsible for causing ceftriaxone resistance. This was crucial in guiding antibiotic treatment, in light of the high prevalence of multi-drug-resistant N. gonorrhoeae. This case highlights the utility of diagnostic molecular techniques in identifying N. gonorrhoeae as the etiology of an exceedingly rare case of pericarditis.
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Affiliation(s)
- Henrietta Bristowe
- Department of Infection Sciences, King's College Hospital, Denmark Hill, SE5 9RS, London, UK
| | - Michaela Day
- UK Health Security Agency, Colindale, London, UK
| | - Helen Fifer
- UK Health Security Agency, Colindale, London, UK
| | - Mauricio Arias
- Department of Infection Sciences, King's College Hospital, Denmark Hill, SE5 9RS, London, UK.
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Allen H, Merrick R, Ivanov Z, Pitt R, Mohammed H, Sinka K, Hughes G, Fifer H, Cole MJ. Is there an association between previous infection with Neisseria gonorrhoeae and gonococcal AMR? A cross-sectional analysis of national and sentinel surveillance data in England, 2015-2019. Sex Transm Infect 2023; 99:1-6. [PMID: 35246477 DOI: 10.1136/sextrans-2021-055298] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/06/2022] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Quarterly STI screening is recommended for high-risk gay, bisexual and other men who have sex with men (MSM) in the UK, but frequent antibiotic exposure could potentially increase the risk of antimicrobial resistance (AMR) developing in Neisseria gonorrhoeae. We investigated whether repeat diagnosis of gonorrhoea in those attending sexual health services (SHS) was associated with reduced antimicrobial susceptibility. METHODS Antimicrobial susceptibility data relating to the most recent gonorrhoea diagnosis for each individual included in the Gonococcal Resistance to Antimicrobials Surveillance Programme (2015-2019) were matched to their historical records in the national GUMCAD STI surveillance data set (2012-2019). The number of gonorrhoea diagnoses in the previous 3 years was calculated for each SHS attendee. Logistic regression was used to examine the associations between the number of diagnoses and reduced susceptibility to ceftriaxone (minimum inhibitory concentration (MIC) >0.03 mg/L), cefixime (MIC >0.06 mg/L) and azithromycin (MIC >0.25 mg/L) at the time of the latest diagnosis. RESULTS Of 6161 individuals included in the analysis, 3913 (63.5%) were MSM, 1220 (19.8%) were heterosexual men and 814 (13.2%) were women. Among MSM, 2476 (63.3%) had 1 past gonorrhoea diagnosis, 1295 (33.1%) had 2-4, 140 (3.6%) 5-9, and 2 (0.1%) ≥10. Most women and heterosexual men (91.7%) had one past gonorrhoea diagnosis; none had more than four. Reduced ceftriaxone and cefixime susceptibility was more common among MSM with two to four gonorrhoea diagnoses (3.8% and 5.8%, respectively) compared with those with one (2.2% and 3.9%, respectively). After adjusting for potential confounding, this association remained (adjusted OR: 1.59, 95% CI 1.07 to 2.37, p=0.02; adjusted OR: 1.54, 95% CI 1.11 to 2.14, p=0.01). No evidence was found for any other associations. CONCLUSIONS Among MSM, repeat diagnosis of gonorrhoea may be associated with reduced ceftriaxone and cefixime susceptibility. As these are last-line therapies for gonorrhoea, further research is needed to assess the impact of intensive STI screening on AMR.
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Affiliation(s)
- Hester Allen
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, UK Health Security Agency, London, UK
| | - Rachel Merrick
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, UK Health Security Agency, London, UK
| | - Zdravko Ivanov
- Antimicrobial Resistance and Healthcare Associated Infections Reference Laboratory, UK Health Security Agency, London, UK
| | - Rachel Pitt
- Antimicrobial Resistance and Healthcare Associated Infections Reference Laboratory, UK Health Security Agency, London, UK
| | - Hamish Mohammed
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, UK Health Security Agency, London, UK
| | - Katy Sinka
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, UK Health Security Agency, London, UK
| | - Gwenda Hughes
- UK Public Health Rapid Support Team, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen Fifer
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, UK Health Security Agency, London, UK
| | - Michelle Jayne Cole
- Antimicrobial Resistance and Healthcare Associated Infections Reference Laboratory, UK Health Security Agency, London, UK
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10
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Day M, Pitt R, Mody N, Saunders J, Rai R, Nori A, Church H, Mensforth S, Corkin H, Jones J, Naicker P, Khan WM, Thomson Glover R, Mortimer K, Hylton C, Moss E, Pasvol TJ, Richardson A, Sun S, Woodford N, Mohammed H, Sinka K, Fifer H. Detection of 10 cases of ceftriaxone-resistant Neisseria gonorrhoeae in the United Kingdom, December 2021 to June 2022. Euro Surveill 2022; 27:2200803. [PMID: 36398578 PMCID: PMC9673238 DOI: 10.2807/1560-7917.es.2022.27.46.2200803] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/16/2022] [Indexed: 08/09/2023] Open
Abstract
Between December 2021 and June 2022, 10 cases of ceftriaxone-resistant Neisseria gonorrhoeae (ST8123; n = 8) were detected in the United Kingdom, compared with nine cases during the previous 6 years. Most of these cases were associated with travel from the Asia-Pacific region; all were heterosexual people, with most in their 20s. Although all cases were successfully treated, not all partners of cases could be traced, and there is a risk of further transmission of ceftriaxone-resistant gonococcal infection within the UK.
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Affiliation(s)
- Michaela Day
- National Incident Management Team, United Kingdom Health Security Agency, London, United Kingdom
| | - Rachel Pitt
- National Incident Management Team, United Kingdom Health Security Agency, London, United Kingdom
| | - Nisha Mody
- National Incident Management Team, United Kingdom Health Security Agency, London, United Kingdom
| | - John Saunders
- National Incident Management Team, United Kingdom Health Security Agency, London, United Kingdom
| | - Rupa Rai
- National Incident Management Team, United Kingdom Health Security Agency, London, United Kingdom
| | - Achyuta Nori
- National Incident Management Team, United Kingdom Health Security Agency, London, United Kingdom
| | - Hannah Church
- National Incident Management Team, United Kingdom Health Security Agency, London, United Kingdom
| | - Sarah Mensforth
- National Incident Management Team, United Kingdom Health Security Agency, London, United Kingdom
| | - Helen Corkin
- National Incident Management Team, United Kingdom Health Security Agency, London, United Kingdom
| | - Jacqueline Jones
- Sexual Health Department Singleton Hospital, Swansea Bay University Health Board, Swansea, Wales, United Kingdom
| | - Preneshni Naicker
- Public Health Wales Microbiology Swansea, Singleton Hospital, Swansea, Wales, United Kingdom
| | - Wazirzada M Khan
- National Incident Management Team, United Kingdom Health Security Agency, London, United Kingdom
| | - Rebecca Thomson Glover
- National Incident Management Team, United Kingdom Health Security Agency, London, United Kingdom
| | - Kalani Mortimer
- National Incident Management Team, United Kingdom Health Security Agency, London, United Kingdom
| | - Chloe Hylton
- National Incident Management Team, United Kingdom Health Security Agency, London, United Kingdom
| | - Elizabeth Moss
- National Incident Management Team, United Kingdom Health Security Agency, London, United Kingdom
| | - Thomas Joshua Pasvol
- National Incident Management Team, United Kingdom Health Security Agency, London, United Kingdom
| | - Ania Richardson
- National Incident Management Team, United Kingdom Health Security Agency, London, United Kingdom
| | - Suzy Sun
- National Incident Management Team, United Kingdom Health Security Agency, London, United Kingdom
| | - Neil Woodford
- National Incident Management Team, United Kingdom Health Security Agency, London, United Kingdom
| | - Hamish Mohammed
- National Incident Management Team, United Kingdom Health Security Agency, London, United Kingdom
| | - Katy Sinka
- National Incident Management Team, United Kingdom Health Security Agency, London, United Kingdom
| | - Helen Fifer
- National Incident Management Team, United Kingdom Health Security Agency, London, United Kingdom
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11
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Merrick R, Cole M, Pitt R, Enayat Q, Ivanov Z, Day M, Sun S, Sinka K, Woodford N, Mohammed H, Fifer H. Antimicrobial-resistant gonorrhoea: the national public health response, England, 2013 to 2020. Euro Surveill 2022; 27. [PMID: 36205171 PMCID: PMC9540523 DOI: 10.2807/1560-7917.es.2022.27.40.2200057] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Neisseria gonorrhoeae has developed resistance to all antimicrobials used to treat gonorrhoea, and the emergence of ceftriaxone-resistant strains threatens the last-line option for empirical treatment. The 2013 Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) Action Plan recommended measures to delay the spread of antimicrobial resistance (AMR) in N. gonorrhoeae in England. We reviewed trends in gonococcal AMR since then and the experience of implementing the Action Plan’s recommendations to respond to incidents of resistant N. gonorrhoeae. Between 2013 and 2019, diagnoses of gonorrhoea in England rose by 128% to 70,922, the largest annual number ever reported. Over this period, N. gonorrhoeae isolates have become less susceptible to azithromycin (minimum inhibitory concentration > 0.5 mg/L), increasing from 4.7% in 2016 to 8.7% in 2020; this led to a change in first-line treatment for gonorrhoea in the United Kingdom (UK) from dual therapy (ceftriaxone/azithromycin) to ceftriaxone monotherapy in 2019. We also detected the first global treatment failure for pharyngeal gonorrhoea with a dual-therapy regimen (ceftriaxone/azithromycin), followed by an additional six ceftriaxone-resistant strains. Continued engagement of sexual health clinicians and laboratories with the UK Health Security Agency (UKHSA) is essential for the timely detection of N. gonorrhoeae strains with ceftriaxone resistance and to rapidly contain transmission of these strains within England.
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Affiliation(s)
- Rachel Merrick
- United Kingdom Health Security Agency, London, United Kingdom
| | - Michelle Cole
- United Kingdom Health Security Agency, London, United Kingdom
| | - Rachel Pitt
- United Kingdom Health Security Agency, London, United Kingdom
| | - Qudsia Enayat
- United Kingdom Health Security Agency, London, United Kingdom
| | - Zdravko Ivanov
- United Kingdom Health Security Agency, London, United Kingdom
| | - Michaela Day
- United Kingdom Health Security Agency, London, United Kingdom
| | - Suzy Sun
- United Kingdom Health Security Agency, London, United Kingdom
| | - Katy Sinka
- United Kingdom Health Security Agency, London, United Kingdom
| | - Neil Woodford
- United Kingdom Health Security Agency, London, United Kingdom
| | - Hamish Mohammed
- United Kingdom Health Security Agency, London, United Kingdom
| | - Helen Fifer
- United Kingdom Health Security Agency, London, United Kingdom
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12
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Hammett F, Saha A, Hurley A, Fifer H, Moran E, Patel B. EP-235 Improving working conditions of junior surgeons. Br J Surg 2022. [DOI: 10.1093/bjs/znac245.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Aims
Significant exception reporting is reflective of difficult working conditions though well-recognised barriers exist to reporting which may reflect the culture within a unit. This study used exception reporting data to understand and improve the working conditions of juniors.
Methods
Junior surgeons were surveyed in December 2019 to evaluate additional hours worked, reasons for this work and whether exception reports were completed; where they were not, doctors were asked why.
After data analysis, rota structures and surgical teams were changed and formal education about exception reporting given at departmental induction. The main changes involved greater opportunities to take leave and enhanced staffing on evenings and weekends.
Surgical juniors were re-surveyed in September 2021.
Results
In December 2019, 49.2 additional hours were worked between 18 juniors. No exception reports were completed with the main reasons being a personal decision to stay late (for training opportunities), lack of understanding on how to report and cultural issues that made juniors unsure about how exception reports would be viewed.
In September 2021, only 30 additional hours were worked between 17 respondents. Again, no exception reports were completed with over 95% of respondents citing a personal decision to stay late. Cultural issues within the department were no longer cited and knowledge of how to exception report was greatly increased.
Conclusions
A positive and open culture, where consultants and surgical leaders engage with juniors about rotas and working conditions can lead to a reduction in additional hours and improve the understanding of exception reporting.
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Affiliation(s)
| | - Arin Saha
- Calderdale and Huddersfield NHS Foundation Trust
| | - Anna Hurley
- Calderdale and Huddersfield NHS Foundation Trust
| | - Helen Fifer
- Calderdale and Huddersfield NHS Foundation Trust
| | - Emily Moran
- Calderdale and Huddersfield NHS Foundation Trust
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13
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Charles H, Prochazka M, Thorley K, Crewdson A, Greig DR, Jenkins C, Painset A, Fifer H, Browning L, Cabrey P, Smith R, Richardson D, Waters L, Sinka K, Godbole G, Corkin H, Abrahams A, LeBlond H, Lo J, Holgate A, Saunders J, Plahe G, Vusirikala A, Green F, King M, Tewolde R, Jajja A. Outbreak of sexually transmitted, extensively drug-resistant Shigella sonnei in the UK, 2021–22: a descriptive epidemiological study. The Lancet Infectious Diseases 2022; 22:1503-1510. [DOI: 10.1016/s1473-3099(22)00370-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 12/23/2022]
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14
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Sánchez-Busó L, Cole MJ, Spiteri G, Day M, Jacobsson S, Golparian D, Sajedi N, Yeats CA, Abudahab K, Underwood A, Bluemel B, Aanensen DM, Unemo M, Pleininger S, Indra A, De Baetselier I, Vanden Berghe W, Hunjak B, Blažić TN, Maikanti-Charalambous P, Pieridou D, Zákoucká H, Žemličková H, Hoffmann S, Cowan S, Schwartz LJ, Peetso R, Epstein J, Viktorova J, Ndeikoundam N, Bercot B, Bébéar C, Lot F, Buder S, Jansen K, Miriagou V, Rigakos G, Raftopoulos V, Balla E, Dudás M, Ásmundsdóttir LR, Sigmundsdóttir G, Hauksdóttir GS, Gudnason T, Colgan A, Crowley B, Saab S, Stefanelli P, Carannante A, Parodi P, Pakarna G, Nikiforova R, Bormane A, Dimina E, Perrin M, Abdelrahman T, Mossong J, Schmit JC, Mühlschlegel F, Barbara C, Mifsud F, Van Dam A, Van Benthem B, Visser M, Linde I, Kløvstad H, Caugant D, Młynarczyk-Bonikowska B, Azevedo J, Borrego MJ, Nascimento MLR, Pavlik P, Klavs I, Murnik A, Jeverica S, Kustec T, Vázquez Moreno J, Diaz A, Abad R, Velicko I, Unemo M, Fifer H, Shepherd J, Patterson L. Europe-wide expansion and eradication of multidrug-resistant Neisseria gonorrhoeae lineages: a genomic surveillance study. The Lancet Microbe 2022; 3:e452-e463. [DOI: 10.1016/s2666-5247(22)00044-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 02/07/2023] Open
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15
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Scobie A, Brown CS, French P, Donati M, Muir P, Templeton K, Higgins SP, Patel H, Alexander S, Fifer H. The dark art of syphilis serology - an analysis of testing algorithms at a UK reference laboratory. J Med Microbiol 2022; 71. [PMID: 35451942 DOI: 10.1099/jmm.0.001479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Due to the complex nature of treponemal serology interpretation, testing algorithms vary across the UK.Gap statement. There is currently no gold standard method for interpretation of discordant serology results.Aim. To analyse serological response in early infection and to determine the best approach for discordant total antibody EIA and TPPA samples.Methodology. National reference laboratory serology and PCR (genital ulcer swabs) results from 2010 to 2017 were extracted from an electronic laboratory database.Results. A total of 24149 sera underwent analysis. Of syphilis PCR positive cases with contemporaneous sera, 33% (17/52) were IgM positive/equivocal, whilst all were EIA and TPPA positive. No sera with isolated IgM positivity (0/90) demonstrated seroconversion consistent with early treponemal infection, in contrast to 17% (2/12) of sera with isolated TPPA positivity. Isolated EIA positivity was observed in 6.2% (1499/24149) samples with the same result on repeat testing in 73% (154/211). In 100 samples with discordant EIA/TPPA results, IgG Immunoblot was more commonly positive (12/41, 29%) or equivocal (24/41, 59%), in those with a higher EIA antibody index, compared to those with a low antibody index, of which none tested positive and 2/3 (67 %) were equivocal.Conclusion. Isolated IgM positivity was not helpful in identifying early infection; isolated total antibody EIA positivity is unlikely to be a significant finding. IgG immunoblot testing was unable to determine clear treponemal antibody status in nearly half of all EIA/TPPA discordant samples.
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Affiliation(s)
- Antonia Scobie
- Reference Microbiology, UK Health Security Agency, 61, Colindale Avenue, NW9 5EQ, UK
| | - Colin S Brown
- Reference Microbiology, UK Health Security Agency, 61, Colindale Avenue, NW9 5EQ, UK
| | - Patrick French
- The Mortimer Market Centre, Central and North West London NHS Trust, London WC1 6JB, UK
| | - Matthew Donati
- Bristol Public Health Laboratory, UK Health Security Agency, Bristol BS10 5NB, UK
| | - Peter Muir
- Bristol Public Health Laboratory, UK Health Security Agency, Bristol BS10 5NB, UK
| | - Kate Templeton
- Department of Laboratory Medicine, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, EH16 4TJ, UK
| | - Stephen P Higgins
- Department of Sexual Health and HIV, North Manchester General Hospital, Manchester, M5 8RB, UK
| | - Hemanti Patel
- Reference Microbiology, UK Health Security Agency, 61, Colindale Avenue, NW9 5EQ, UK
| | - Sarah Alexander
- Reference Microbiology, UK Health Security Agency, 61, Colindale Avenue, NW9 5EQ, UK
| | - Helen Fifer
- Reference Microbiology, UK Health Security Agency, 61, Colindale Avenue, NW9 5EQ, UK
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16
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Kohli M, Medland N, Fifer H, Saunders J. BASHH updated position statement on doxycycline as prophylaxis for sexually transmitted infections. Sex Transm Infect 2022; 98:235-236. [PMID: 35414633 PMCID: PMC9016249 DOI: 10.1136/sextrans-2022-055425] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Manik Kohli
- Institute for Global Health, University College London, London, UK .,Department of Sexual Health and HIV, Central and North West London NHS Foundation Trust, London, UK
| | - Nicholas Medland
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.,Melbourne Sexual Health Centre, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Helen Fifer
- Blood Safety, Hepatitis, STIs and HIV Division, UK Health Security Agency, London, UK
| | - John Saunders
- Institute for Global Health, University College London, London, UK.,Blood Safety, Hepatitis, STIs and HIV Division, UK Health Security Agency, London, UK
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17
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Michel M, Fifer H, Moran E, Hammett F, Kronberga M, Khawgali M, Bonner C, Saab A, Balbola M, Saha A. P-EGS20 Safe emergency laparoscopic cholecystectomy in the first 12 months of the Covid-19 pandemic. Br J Surg 2021. [PMCID: PMC9383090 DOI: 10.1093/bjs/znab430.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
The World Health Organisation declared a global pandemic on the 11th March 2020 regarding the COVID-19 infection. This has had a dramatic impact on both acute and elective hospital services that will take a considerable time to recover from. Initial emergency intercollegiate surgical guidance released in March 2020 raised concern regarding laparoscopic surgery and advised to pursue alternative non-surgical or radiological treatment options for the safety of patients and theatre teams. The aim of this study was to assess the safety of emergency laparoscopic cholecystectomy (ELC) for patients presenting to our centre with acute gallstone pathology during the pandemic.
Methods
Retrospective analysis of all cholecystectomies undertaken in the department during the first year of the pandemic from 11th March 2020 to 11th March 2021. This period encapsulated two recognised peaks of the pandemic in the United Kingdom. Demographic data, elective/emergency, operative time, postop ITU admissions due to COVID and COVID related mortality was collected. Operative numbers and times were compared with historical data (HD) from the previous five years over the same time frame.
Results
399 laparoscopic cholecystectomies were performed during the first year of the pandemic which was less than the previous five-year average of 570 cholecystectomies per annum (30% reduction). 247 (61.9%) were performed as an emergency on patients presenting with acute gallstone pathology compared to 35% (HD) performed acutely on average historically. Average age was 56 yrs (16-88 range). Average operative time for ELC during the pandemic was 69 minutes compared to 78 minutes HD (NS). No patients were admitted to ITU with post-operative Covid infections and there were no 30 day post-operative deaths.
Conclusions
We performed more ELC’s in the first year of the pandemic compared to the previous five-year average as we were conscious of the inevitable long waiting lists, we would certainly be faced with in the coming months. The Covid-19 pandemic was a global healthcare crisis and one the NHS had never encountered before. At the time there was no high-quality evidence on the safety of laparoscopy on patients presenting acutely. This study adds to the growing body of evidence that with consistent preoperative testing, PPE and appropriate patient flow pathways that emergency laparoscopic cholecystectomies are safe to perform in the current climate.
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Affiliation(s)
- Martin Michel
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | - Helen Fifer
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | - Emily Moran
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | - Felix Hammett
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | | | | | - Clare Bonner
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | - Ala Saab
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | | | - Arin Saha
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
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18
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Michel M, Saab A, Kronberga M, Bonner C, Fifer H, Moran E, Hammett F, Saha A. P-O09 Development of a non face-to-face pre-operative assessment pathway for laparoscopic cholecystectomy. Br J Surg 2021. [PMCID: PMC9383085 DOI: 10.1093/bjs/znab430.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background The Covid-19 pandemic has led to markedly reduced capacity in almost all areas of normal face-to-face activity in our hospitals. Prior to the pandemic, the standard pre-operative pathway for all patients included an initial appointment in the outpatients clinic and formal examination before recommending surgery. With the reality of limited clinic capacity, our unit developed a non face-to-face assessment pathway alongside a parallel green operating area in our local Independent Sector (IS) hospitals for laparoscopic cholecystectomy. This study describes and methodology and outcomes of this approach Methods A non face-to-face (telephone) proforma for all new referrals for consideration of laparoscopic cholecystectomy was prepared in April 2020 with the first operations carried out in June 2020. All consultations were carried out by consultant surgeons and included thorough history, careful documentation of previous surgery and duration of symptoms and, where appropriate, patients were told to send images of their abdominal wall if they were unable to describe their scars. The first stage of the consent process was completed at initial appointment and all patients were sent written information about surgery. Patients who had BMI<40, uncomplicated biliary disease (biliary colic, mild cholecystitis, ERCP for CBD stones) and ASA of 1/2 were deemed suitable for surgery in the IS and sent across accordingly. A telephone pre-assessment was completed by the hospital and patients were sent blood tests forms in the post, as well as a Covid test to be completed at home followed by a period of self isolation before surgery. All patients were examined on the day of surgery by the operating surgeon and formal consent taken on the day. Primary outcomes that were recorded were cancellation on the day, transfer to the NHS hospital after surgery and complications. Results From June 2020 to December 2020, when the contract with the IS changed, 218 patients attended the IS hospitals for planned elective laparoscopic cholecystectomy. Four patients (2%) did not have surgery (one cancelled as inappropriate for the Independent Sector, two patients whose Covid swab result was not complete and one patient who no longer wished to have surgery). Three patients required transfer to the NHS hospital for post-operative care (drains inserted after unanticipated difficult surgery). All patients were given details of the surgical SDEC unit at the NHS hospital to allow ease of admission in the event of any problems or complications. 28 patients (13%) attended SDEC within 30 days after surgery; most had blood tests and clinical assessment alone. One patient (<1%) required re-laparoscopy for abdominal pain three days after their initial surgery (washout alone) and 5 patients developed umbilical wound infections after surgery (antibiotics alone). Two patients were found to have CBD stones on MRCP. The waiting time from initial assessment to surgery for patients on this pathway was less than 18 weeks for 168 patients though patients who were not suitable for the Independent Sector have had waiting times that are considerably longer. Conclusions These results demonstrate that it is possible to plan surgery for laparoscopic cholecystectomy without a face-to-face appointment at all which has considerable implications for resource allocation in the future; indeed, this approach has been continued within our unit even as clinic capacity has increased and been rolled out to patients with inguinal or para-umbilical hernia. Use of a green site away from the acute NHS hospital allowed elective surgery for non-urgent pathology to continue with acceptable waiting times even during the worst of the Covid-19 pandemic though patients who were not suitable have had markedly worse experiences and waiting times.
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Affiliation(s)
- Martin Michel
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | - Ala Saab
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | | | - Clare Bonner
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | - Helen Fifer
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | - Emily Moran
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | - Felix Hammett
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | - Arin Saha
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
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19
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Michel M, Fifer H, Moran E, Hammett F, Bonner C, Kronberga M, Khawgali M, Balbola M, Saha A. O-BN09 The impact of the Covid-19 pandemic on benign upper GI surgery: The first 12 months at a single centre. Br J Surg 2021. [PMCID: PMC9383084 DOI: 10.1093/bjs/znab429.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background The road to recovery from the Covid-19 pandemic has started but no-one knows when it will end. 18 months on from the World Health Organisation declaring a global pandemic on the 11th March 2020 this has had a dramatic impact on both acute and elective hospital services. Whilst, quite rightly, the focus has been on prioritising cancer resections during the pandemic, many patients awaiting benign operations are facing lengthy waiting times. The aim of this study was to quantify the impact of the COVID-19 pandemic on benign upper GI surgery at a single centre compared to previous operating activity levels. Methods Retrospective analysis of computerised theatre records for the first 12 months of the pandemic (11th March 2020-11th March 2021) were compared to average historical data (HD) over the last five years (2015-2019) over the same time frame. Benign upper Gi operations included were cholecystectomy, anti-reflux/hiatus hernia repairs, cardiomyotomies and bariatric procedures. Results Conclusions The Covid-19 pandemic has dramatically affected benign upper GI surgery at our unit. Overall total operation numbers were down by 31% when compared to HD (440 vs 641). The largest deficit was in bariatrics where no bariatric surgery was performed during the first 12 months of the pandemic, which has restarted as of July 2021. There was also a 30% reduction in the number of cholecystectomies performed likely due to initial guidance recommending non-operative management at the start of the pandemic. Hiatal work numbers remained consistent. This quantitative study can direct future service delivery and help guide the post-pandemic recovery.
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Affiliation(s)
- Martin Michel
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | - Helen Fifer
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | - Emily Moran
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | - Felix Hammett
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | - Clare Bonner
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | | | | | | | - Arin Saha
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
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20
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Michel M, Fifer H, Moran E, Saab A, Hammett F, Kronberga M, Bonner C, Saha A, Salih T, Peter M. P-B04 Restarting bariatric surgery after the Covid-19 pandemic: a template for safe practice. Br J Surg 2021. [PMCID: PMC9383061 DOI: 10.1093/bjs/znab430.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Bariatric surgery virtually ceased with the advent of the Covid-19 pandemic and has been amongst the last sector of operative practice to restart. There have been understandable concerns about restarting bariatric surgery including the risks to patients of contracting Covid infection in the peri-operative period, potential de-skilling of surgeons and theatre teams and the appropriateness of directing scarce and limited resources to bariatric surgery when every surgical specialty is experiencing rapidly rising waiting times and ever lengthening waiting lists. This study describes the restart programme at our NHS bariatric unit and offers a template for safe commencement of complex benign surgeries in the current era. Methods In the months after the pandemic started, our Bariatric MDT reviewed every case on the waiting list and contacted each patient to explain the current waiting times and the importance of not gaining weight to be eligible for surgery when surgical practice resumed. Group education and Support Group sessions were moved from face-to-face appointments to online classrooms and regular input was sought from specialist dieticians, nurses and psychologists. The expected waiting times for patients was pro-actively submitted to the Executive Board of the Trust with details about >104-week waiting patients being clearly articulated. Once approval was given to restart bariatric surgery, every patient was assessed and prioritised in terms of waiting time and clinical need. A bariatric theatre team was brought together and engaged in pre-operative training and a local refresher course on equipment and the planned surgeries. There was engagement with industry to provide on-the-ground support for the first lists to ensure proper and safe use of energy and stapling devices. Each list had two consultant surgeons assigned to it and just two cases per day were planned and patients were managed on an entirely green pathway within the NHS hospital . Results The bariatric restart programme commenced in May 2021; between May 2021 and August 2021, there have been 27 operations carried out (25 Roux-en-Y gastric bypass, 2 sleeve gastrectomy) and two cancellations on the day (both due to patient choice). Each operating list finished between two and three hours before the planned finish time. Formal debrief sessions after each list identified no problems with the operations of the equipment and none of the patients had any post-operative complications. Length of stay was between 1 to 2 days for the entire cohort. Since the restart programme commenced, the requirement for dual consultant operating has ceased and the last 5 cases have been entirely training cases for the operating registrar, again without complication. Each list is now planned to increase to pre-pandemic levels of activity with four cases per list. Conclusions Restarting complex benign surgical practice is complicated and requires engagement with management, theatre and nursing colleagues to ensure that cases are not ‘left behind'. It is important to reduce the risk of complications and of peri-operative covid-19 infection in bariatric patients and development of a pathway that all members of the theatre team have input in to meant that there were few problems or issues with either the planning of the lists or the running of the lists. Such an approach could be considered for restarting any high volume, complex benign surgical practice.
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Affiliation(s)
- Martin Michel
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | - Helen Fifer
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | - Emily Moran
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | - Ala Saab
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | - Felix Hammett
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | | | - Clare Bonner
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | - Arin Saha
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | - Tamir Salih
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | - Mark Peter
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
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21
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Michel M, Fifer H, Moran E, Bonner C, Hammett F, Khawgali M, Kronberga M, Saab A, Balbola M, Saha A. P-O15 “Knife to Skin” time: The invariable variable. Br J Surg 2021. [PMCID: PMC9383075 DOI: 10.1093/bjs/znab430.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
The Covid-19 pandemic has affected all aspects of healthcare globally. Theatre utilisation assumes a substantial proportion of hospital resources, creating a streamlined pathway increases efficiency and productivity. With concerns regarding aerosol generating procedures, viral transmission to health care workers in theatre and patient pathways through the hospitals the covid-19 pandemic has added another dimension to the theatre pathway. The aim of this study was to quantify the impact of Covid-19 on the “knife to skin” (KTS) time and compare it to previous historical data (HD).
Methods
Retrospective analysis of real time theatre data was analysed for the first 12 months of the pandemic from 11th March 2020 to 11th March 2021. To try and minimise variability between different specialities and operations we picked one operation to study: Laparoscopic cholecystectomy (LC). Historical data was also gathered from the same time frame over the last 5 years (2015-2020) for comparison. Data collected included emergency or elective, time sent for patient, anaesthetic start time, knife to skin time and duration of operation. Comparison of means were analysed by One-way ANOVA tests and Student’s T-Test.
Results
399 laparoscopic cholecystectomies were performed during the first year of the pandemic. KTS time was calculated as operation start time minus time sent for patient. Average time during the pandemic for emergency LC KTS was 56 minutes and 35 minutes for elective LC. Comparison of these times to HD revealed no statistical difference (Emergency LC 56 mins vs 58 mins p > 0.05, Elective LC 35 mins vs 35 mins p > 0.05). The anaesthetic time for emergency LC during the pandemic vs HD was 10 mins vs 14 mins (p < 0.05), no statistical difference was found in the elective group, 16mins vs 14mins (p > 0.05)
Conclusions
The Covid-19 pandemic has had no detectable effect on Knife to skin time as compared to our previous historical data. It seems the extra Covid 19 precautions involving PPE, pathways etc. have not affected theatre efficiency or utilisation. In fact, there was very little variance in KTS time over the six years studied (2015-2021) with very consistent levels for both elective and emergency procedures. The shorter anaesthetic time for emergency LC during the pandemic needs to be further investigated but one hypothesis is the unconscious or conscious decision to decrease the amount of preoxygenation to minimise aerosolisation.
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Affiliation(s)
- Martin Michel
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | - Helen Fifer
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | - Emily Moran
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | - Clare Bonner
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | - Felix Hammett
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | | | | | - Ala Saab
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | | | - Arin Saha
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
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22
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Fifer H, Schaefer U, Pitt R, Allen H, Day M, Woodford N, Cole MJ. Use of genomics to investigate Neisseria gonorrhoeae antimicrobial susceptibility testing discrepancies. J Antimicrob Chemother 2021; 77:849-850. [PMID: 34878109 DOI: 10.1093/jac/dkab438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Helen Fifer
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London NW9 5HT, UK
| | - Ulf Schaefer
- Bioinformatics Unit - Data, Analytics, and Surveillance, UK Health Security Agency, London NW9 5HT, UK
| | - Rachel Pitt
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, UK Health Security Agency, London NW9 5HT, UK
| | - Hester Allen
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London NW9 5HT, UK
| | - Michaela Day
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, UK Health Security Agency, London NW9 5HT, UK
| | - Neil Woodford
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, UK Health Security Agency, London NW9 5HT, UK
| | - Michelle J Cole
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, UK Health Security Agency, London NW9 5HT, UK
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23
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Beale MA, Marks M, Cole MJ, Lee MK, Pitt R, Ruis C, Balla E, Crucitti T, Ewens M, Fernández-Naval C, Grankvist A, Guiver M, Kenyon CR, Khairullin R, Kularatne R, Arando M, Molini BJ, Obukhov A, Page EE, Petrovay F, Rietmeijer C, Rowley D, Shokoples S, Smit E, Sweeney EL, Taiaroa G, Vera JH, Wennerås C, Whiley DM, Williamson DA, Hughes G, Naidu P, Unemo M, Krajden M, Lukehart SA, Morshed MG, Fifer H, Thomson NR. Global phylogeny of Treponema pallidum lineages reveals recent expansion and spread of contemporary syphilis. Nat Microbiol 2021; 6:1549-1560. [PMID: 34819643 PMCID: PMC8612932 DOI: 10.1038/s41564-021-01000-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 10/20/2021] [Indexed: 12/26/2022]
Abstract
Syphilis, which is caused by the sexually transmitted bacterium Treponema pallidum subsp. pallidum, has an estimated 6.3 million cases worldwide per annum. In the past ten years, the incidence of syphilis has increased by more than 150% in some high-income countries, but the evolution and epidemiology of the epidemic are poorly understood. To characterize the global population structure of T. pallidum, we assembled a geographically and temporally diverse collection of 726 genomes from 626 clinical and 100 laboratory samples collected in 23 countries. We applied phylogenetic analyses and clustering, and found that the global syphilis population comprises just two deeply branching lineages, Nichols and SS14. Both lineages are currently circulating in 12 of the 23 countries sampled. We subdivided T. p. pallidum into 17 distinct sublineages to provide further phylodynamic resolution. Importantly, two Nichols sublineages have expanded clonally across 9 countries contemporaneously with SS14. Moreover, pairwise genome analyses revealed examples of isolates collected within the last 20 years from 14 different countries that had genetically identical core genomes, which might indicate frequent exchange through international transmission. It is striking that most samples collected before 1983 are phylogenetically distinct from more recently isolated sublineages. Using Bayesian temporal analysis, we detected a population bottleneck occurring during the late 1990s, followed by rapid population expansion in the 2000s that was driven by the dominant T. pallidum sublineages circulating today. This expansion may be linked to changing epidemiology, immune evasion or fitness under antimicrobial selection pressure, since many of the contemporary syphilis lineages we have characterized are resistant to macrolides.
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Affiliation(s)
- Mathew A Beale
- Parasites and Microbes Programme, Wellcome Sanger Institute, Hinxton, UK.
| | - Michael Marks
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK
| | - Michelle J Cole
- HCAI, Fungal, AMR, AMU and Sepsis Division, UK Health Security Agency, London, UK
| | - Min-Kuang Lee
- British Columbia Centre for Disease Control, Public Health Laboratory, Vancouver, British Columbia, Canada
| | - Rachel Pitt
- HCAI, Fungal, AMR, AMU and Sepsis Division, UK Health Security Agency, London, UK
| | - Christopher Ruis
- Molecular Immunity Unit, MRC-Laboratory of Molecular Biology, Department of Medicine, University of Cambridge, Cambridge, UK
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Eszter Balla
- Bacterial STIs Reference Laboratory, Department of Bacteriology, National Public Health Centre, Budapest, Hungary
| | - Tania Crucitti
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Michael Ewens
- Brotherton Wing Clinic, Brotherton Wing, Leeds General Infirmary, Leeds, UK
| | - Candela Fernández-Naval
- Microbiology Department, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Grankvist
- National Reference Laboratory for STIs, Department of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Malcolm Guiver
- Laboratory Network, Manchester, UK Health Security Agency, Manchester Royal Infirmary, Manchester, UK
| | - Chris R Kenyon
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Rafil Khairullin
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Ranmini Kularatne
- Centre for HIV and STI, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Maider Arando
- STI Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - Barbara J Molini
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Andrey Obukhov
- Tuvan Republican Skin and Venereal Diseases Dispensary, Ministry of Health of Tuva Republic, Kyzyl, Russia
| | - Emma E Page
- Virology Department, Old Medical School, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Fruzsina Petrovay
- Bacterial STIs Reference Laboratory, Department of Bacteriology, National Public Health Centre, Budapest, Hungary
| | | | | | | | - Erasmus Smit
- Clinical Microbiology Department, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Environmental Science and Research, Wellington, New Zealand
| | - Emma L Sweeney
- The University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - George Taiaroa
- Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Jaime H Vera
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Christine Wennerås
- National Reference Laboratory for STIs, Department of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - David M Whiley
- The University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Pathology Queensland Central Laboratory, Brisbane, Queensland, Australia
| | - Deborah A Williamson
- Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Gwenda Hughes
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Prenilla Naidu
- Alberta Precision Laboratories, Edmonton, Alberta, Canada
- Department of Laboratory Medicine and Pathology, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections, National Reference Laboratory for STIs, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Mel Krajden
- British Columbia Centre for Disease Control, Public Health Laboratory, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sheila A Lukehart
- Departments of Medicine/Infectious Diseases and Global Health, University of Washington, Seattle, WA, USA
| | - Muhammad G Morshed
- British Columbia Centre for Disease Control, Public Health Laboratory, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Helen Fifer
- Blood Safety, Hepatitis, STI and HIV Division, UK Health Security Agency, London, UK
| | - Nicholas R Thomson
- Parasites and Microbes Programme, Wellcome Sanger Institute, Hinxton, UK.
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
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24
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Fifer H, Merrick R, Pitt R, Yung M, Allen H, Day M, Sinka K, Woodford N, Mohammed H, Brown CS, Hughes G, Cole M. Frequency and Correlates of Mycoplasma genitalium Antimicrobial Resistance Mutations and Their Association With Treatment Outcomes: Findings From a National Sentinel Surveillance Pilot in England. Sex Transm Dis 2021; 48:951-954. [PMID: 34108410 DOI: 10.1097/olq.0000000000001493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Mycoplasma genitalium infection is a public health concern due to extensive antimicrobial resistance. Using data from a pilot of M. genitalium antimicrobial resistance surveillance, we determined the prevalence and risk factors for resistance among specimens from sexual health clinic attendees and assessed treatment outcomes. METHODS Seventeen sexual health clinics in England sent consecutive M. genitalium-positive specimens to the national reference laboratory from January to March 2019. Regions of the 23S rRNA, parC, and gyrA genes associated with macrolide and fluoroquinolone resistance, respectively, were amplified and sequenced where appropriate. Fisher exact tests, and univariate and multivariable logistic regression models were used to determine associations between demographic, clinical, and behavioral factors and resistance-associated mutations. RESULTS More than two-thirds (173 of 249 [69%]) of M. genitalium specimens had mutations associated with macrolide resistance, whereas predicted fluoroquinolone (21 of 251 [8%]) and dual-drug (12 of 237 [5%]) resistance were less prevalent. No specimens had both gyrA and parC resistance-associated mutations. Macrolide resistance was more common in specimens from men who have sex with men compared with heterosexual men (adjusted odds ratio, 2.64; 95% confidence interval, 1.09-6.38; P = 0.03). There was an association between both macrolide and fluoroquinolone resistance and having a previous sexually transmitted infection (P = 0.06).Only 19% of individuals returned for a test of cure. Of those infected with a macrolide-resistant genotype who were given azithromycin, 57 of 78 (73%) were known or assumed to be clinically cured; however, 43 of these 57 (75%) also received doxycycline. Of the 21 with a macrolide-resistant genotype who failed treatment, 18 of 21 (86%) also received doxycycline. CONCLUSIONS Although macrolide resistance was widespread, particularly among specimens from men who have sex with men and those with a previous sexually transmitted infection diagnosis in the past year, resistance-associated mutations in M. genitalium did not seem to be unequivocally predictive of treatment failure.
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Affiliation(s)
- Helen Fifer
- From the National Infection Service, Public Health England, London, United Kingdom
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25
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Fifer H, Hussain MI, Grey T, Saha A, Peter M. SP2.2.12Safety and Quality using GIRFT parameters; the use of hospital coded data as a quality measure. Br J Surg 2021. [DOI: 10.1093/bjs/znab361.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
Several indicators measure performance of hospital departments. Despite keeping accurate personal logbooks, surgeons rarely interrogate hospital-level data though these are used nationally (such as on HES databases) to assess performance. This study assessed the accuracy of hospital-level data.
Methods
Patients who were recorded as having had a length of stay (LoS) of > 7 days, readmissions and patients who had a return to theatre were identified. A weekly ‘Safety and Quality (SnQ)’ governance meeting was established where consultant general surgeons assessed and analysed these data. Differences between hospital level data and outcomes after consultant review were compared.
Results
Over a six month study period, there were 306 patients (32 elective, 274 acute) who had a LoS of > 7 days. After review, just 33 patients (13%) had a prolonged LoS due to a complication whereas the majority were due to non-surgical reasons.
There were 789 coded readmissions. Most coded readmissions were actually planned with 318 patients (43%) having an unplanned readmission. There were 47 recorded cases of a ‘return to theatre’ but after review, one-third (15 cases) were for planned central venous access and 22 cases were planned returns.
Conclusions
This responsive and accurate clinical governance system can assess performance beyond standard morbidity and mortality review. Hospital-level data often miss nuance; in this study, most coded readmissions were planned rather than unplanned and these discrepancies may reflect poorly on the department if entered onto national databases. Engagement with these data can help units improve outcomes and accuracy of their performance metrics.
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26
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Fifer H, Hussain MI, Grey T, Saha A, Peter M. SP4.2.10 COVID-19 and General Surgery in a District General; Safety and Quality data. Br J Surg 2021. [PMCID: PMC8574442 DOI: 10.1093/bjs/znab361.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
The Covid-19 pandemic forced departments to change standard modes of delivery of care. Within our unit, reductions in junior workforce and changed operating protocols resulted in greater consultant presence on in-patient wards and the ambulatory unit. This study aimed to determine the effect on patient outcomes by interrogation of data collected from weekly Safety and Quality Clinical Governance meetings.
Methods
Patients admitted between December 2019 and February 2020 were compared to those admitted between April 2020 and June 2020. The weekly meeting mandates consultant discussion of all readmissions, all patients who had a length of stay (LoS) of > 7 days and all admissions to critical care. Outcomes between the two time periods were compared.
Results
There was a marked reduction in admissions during the second study period. However, the proportion of patients discharged from ambulatory care increased as did the proportion of readmissions; in the pre-Covid period, there were 429 readmissions of which 188 (44%) were unplanned but in the post-Covid period, there were 311 readmissions. There were no serious adverse events from discharged patients or readmissions.
There were markedly fewer patients who had a LoS > 7days (179 patients versus 87) and a greater number of unplanned admissions to critical care (44% versus 64%).
Conclusions
Increased consultant presence may explain the reduced LoS and increased readmissions due to the greater ‘risk’ that senior clinicians are prepared to take. Enhanced consultant presence should be a permanent change, even after the pandemic is over.
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27
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Fifer H, Hughes G, Ladhani S. Shining the light on congenital syphilis: from TORCH to SCORTCH. Arch Dis Child 2021; 106:937-938. [PMID: 33177053 DOI: 10.1136/archdischild-2019-318503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Helen Fifer
- Blood Safety, Hepatitis, Sexually Transmitted Infections & HIV Division, Public Health England, London, UK
| | - Gwenda Hughes
- Blood Safety, Hepatitis, Sexually Transmitted Infections & HIV Division, Public Health England, London, UK
| | - Shamez Ladhani
- Immunisation and Countermeasures Division, Public Health England, London, UK.,Paediatric Infectious Diseases Research Group, St. George's University of London, London, UK
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28
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Cole MJ, Davis GS, Fifer H, Saunders JM, Unemo M, Hadad R, Roberts DJ, Fazal M, Day MJ, Minshull J, Muir P, Horner PJ, Gill NO, Folkard K. No widespread dissemination of Chlamydia trachomatis diagnostic-escape variants and the impact of Neisseria gonorrhoeae positivity on the Aptima Combo 2 assay. Sex Transm Infect 2021; 98:366-370. [PMID: 34510008 DOI: 10.1136/sextrans-2021-054988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 09/04/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES A Finnish Chlamydia trachomatis (CT) new variant was detected in 2019 that escaped detection in the Hologic Aptima Combo 2 (AC2) assay due to a C1515T mutation in the CT 23S rRNA target region. Reflex testing of CT-negative/CT-equivocal specimens as well as those positive for Neisseria gonorrhoeae (NG) with the Hologic Aptima CT (ACT) assay was recommended to identify any CT variants. METHODS From June to October 2019, specimens with discrepant AC2/ACT CT results were submitted to Public Health England and screened for detectable CT DNA using an inhouse real-time (RT)-PCR. When enough DNA was present, partial CT 23S rRNA gene sequencing was performed. Analysis of available relative light units and interpretative data was performed. RESULTS A total of 317 discordant AC2/ACT specimens were collected from 315 patients. Three hundred were tested on the RT-PCR; 53.3% (n=160) were negative and 46.7% (n=140) were positive. Due to low DNA load in most specimens, sequencing was successful for only 36 specimens. The CT 23S rRNA wild-type sequence was present in 32 specimens, and two variants with C1514T or G1523A mutation were detected in four specimens from three patients. Of the discordant specimens with NG interpretation, 36.6% of NG-negative/CT-negative AC2 specimens had detectable CT DNA on the inhouse RT-PCR vs 53.3% of NG-positive/CT-negative specimens. CONCLUSIONS No widespread dissemination of AC2 diagnostic-escape CT variants has occurred in England. We however identified the impact of NG positivity on the discordant AC2/ACT specimens; a proportion appeared due to NG positivity and the associated NG signal, rather than any diagnostic-escape variants or low DNA load. Several patients with gonorrhoea may therefore receive false-negative AC2 CT results. Single diagnostic targets and multiplex diagnostic assays have their limitations such as providing selection pressure for escape mutants and potentially reduced sensitivity, respectively. These limitations must be considered when establishing diagnostic pathways.
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Affiliation(s)
| | - Grahame S Davis
- National Infection Service, Public Health England, London, UK
| | - Helen Fifer
- National Infection Service, Public Health England, London, UK
| | - John Michael Saunders
- National Infection Service, Public Health England, London, UK.,Research Department of Infection and Population Health, University College London, London, UK
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Orebro, Sweden
| | - Ronza Hadad
- WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Orebro, Sweden
| | - David J Roberts
- National Infection Service, Public Health England, London, UK
| | - Mohammed Fazal
- National Infection Service, Public Health England, London, UK
| | | | - Jack Minshull
- National Infection Service, Public Health England, London, UK
| | - Peter Muir
- Bristol Public Health Laboratory, Public Health England, Bristol, UK
| | - Paddy J Horner
- School of Social and Community Medicine, University of Bristol, Bristol, UK.,Bristol Sexual Health Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Noel O Gill
- National Infection Service, Public Health England, London, UK
| | - Kate Folkard
- National Infection Service, Public Health England, London, UK
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29
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Fifer H, Livermore DM, Uthayakumaran T, Woodford N, Cole MJ. What's left in the cupboard? Older antimicrobials for treating gonorrhoea. J Antimicrob Chemother 2021; 76:1215-1220. [PMID: 33471098 DOI: 10.1093/jac/dkaa559] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/17/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Neisseria gonorrhoeae has developed resistance to all antimicrobials used to treat gonorrhoea, with even ceftriaxone being undermined. It is therefore important to examine any potential to redeploy older antimicrobials routinely used for other infections to treat ceftriaxone-resistant gonococcal infections. OBJECTIVES We examined the susceptibility of N. gonorrhoeae to aztreonam, chloramphenicol, co-trimoxazole, fosfomycin, piperacillin/tazobactam and rifampicin. METHODS N. gonorrhoeae isolates (n = 94) were selected to include a range of antimicrobial susceptibilities: 58 were collected in the Gonococcal Resistance to Antimicrobials Surveillance Programme; 17 were clinical isolates referred to the PHE reference laboratory; and 19 were control strains. MICs were determined by agar dilution for the six study antimicrobials and for ceftriaxone and azithromycin as comparators. RESULTS There was correlation between piperacillin/tazobactam and ceftriaxone MICs, but all five isolates with high ceftriaxone MICs (>0.5 mg/L) were inhibited by piperacillin/tazobactam at 0.06-0.5 mg/L. Aztreonam MICs for ceftriaxone-resistant isolates exceeded those of ceftriaxone. Among non-β-lactams, fosfomycin and co-trimoxazole had low, tightly clustered MICs, suggesting widespread susceptibility, rifampicin split the collection into highly susceptible and highly resistant groups and chloramphenicol had a wide MIC distribution. CONCLUSIONS Although unsuitable for empirical use, piperacillin/tazobactam, fosfomycin, co-trimoxazole, rifampicin and, possibly, chloramphenicol could be considered for individual patients with ceftriaxone-resistant gonococcal infection once MICs are known. Wider surveillance of the susceptibility of N. gonorrhoeae to these agents is needed, along with clinical trials and the establishment of clinical breakpoints for N gonorrhoeae.
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Affiliation(s)
- Helen Fifer
- National Infection Service, Public Health England, London NW9 5EQ, UK
| | - David M Livermore
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | | | - Neil Woodford
- National Infection Service, Public Health England, London NW9 5EQ, UK
| | - Michelle J Cole
- National Infection Service, Public Health England, London NW9 5EQ, UK
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30
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Abstract
OBJECTIVE To develop a tool predicting individualised treatment for gonorrhoea, enabling treatment with previously recommended antibiotics, to reduce use of last-line treatment ceftriaxone. DESIGN A modelling study. SETTING England and Wales. PARTICIPANTS Individuals accessing sentinel health services. INTERVENTION Developing an Excel model which uses participants' demographic, behavioural and clinical characteristics to predict susceptibility to legacy antibiotics. Model parameters were calculated using data for 2015-2017 from the Gonococcal Resistance to Antimicrobials Surveillance Programme. MAIN OUTCOME MEASURES Estimated number of doses of ceftriaxone saved, and number of people delayed effective treatment, by model use in clinical practice. Model outputs are the predicted risk of resistance to ciprofloxacin, azithromycin, penicillin and cefixime, in groups of individuals with different combinations of characteristics (gender, sexual orientation, number of recent sexual partners, age, ethnicity), and a treatment recommendation. RESULTS Between 2015 and 2017, 8013 isolates were collected: 64% from men who have sex with men, 18% from heterosexual men and 18% from women. Across participant subgroups, stratified by all predictors, resistance prevalence was high for ciprofloxacin (range: 11%-51%) and penicillin (range: 6%-33%). Resistance prevalence for azithromycin and cefixime ranged from 0% to 13% and for ceftriaxone it was 0%. Simulating model use, 88% of individuals could be given cefixime and 10% azithromycin, saving 97% of ceftriaxone doses, with 1% of individuals delayed effective treatment. CONCLUSIONS Using demographic and behavioural characteristics, we could not reliably identify a participant subset in which ciprofloxacin or penicillin would be effective. Cefixime resistance was almost universally low; however, substituting ceftriaxone for near-uniform treatment with cefixime risks re-emergence of resistance to cefixime and ceftriaxone. Several subgroups had low azithromycin resistance, but widespread azithromycin monotherapy risks resistance at population level. However, this dataset had limitations; further exploration of individual characteristics to predict resistance to a wider range of legacy antibiotics may still be appropriate.
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Affiliation(s)
- Lucy Findlater
- National Infection Service, Public Health England, Bristol, UK
| | | | - Maya Gobin
- National Infection Service, Public Health England, Bristol, UK
| | - Helen Fifer
- Reference Microbiology, Public Health England, London, UK
| | - Jonathan Ross
- Institute of Microbiology and Infection, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Katy M E Turner
- Bristol Veterinary School, University of Bristol, Bristol, UK
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31
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Cole MJ, Tan W, Fifer H, Brittain C, Duley L, Hepburn T, Lawrence T, Montgomery AA, Sprange K, Thandi S, Churchward C, Tripodo F, Woodford N, Ross JDC. Gentamicin, azithromycin and ceftriaxone in the treatment of gonorrhoea: the relationship between antibiotic MIC and clinical outcome. J Antimicrob Chemother 2021; 75:449-457. [PMID: 31670808 DOI: 10.1093/jac/dkz436] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 09/05/2019] [Accepted: 09/23/2019] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES To investigate the relationship between MIC and clinical outcome in a randomized controlled trial that compared gentamicin 240 mg plus azithromycin 1 g with ceftriaxone 500 mg plus azithromycin 1 g. MIC analysis was performed on Neisseria gonorrhoeae isolates from all participants who were culture positive before they received treatment. METHODS Viable gonococcal cultures were available from 279 participants, of whom 145 received ceftriaxone/azithromycin and 134 received gentamicin/azithromycin. Four participants (6 isolates) and 14 participants (17 isolates) did not clear infection in the ceftriaxone/azithromycin and gentamicin/azithromycin arms, respectively. MICs were determined by Etest on GC agar base with 1% Vitox. The geometric mean MICs of azithromycin, ceftriaxone and gentamicin were compared using logistic and linear regression according to treatment received and N. gonorrhoeae clearance. RESULTS As the azithromycin MIC increased, gentamicin/azithromycin treatment was less effective than ceftriaxone/azithromycin at clearing N. gonorrhoeae. There was a higher geometric mean MIC of azithromycin for isolates from participants who had received gentamicin/azithromycin and did not clear infection compared with those who did clear infection [ratio 1.95 (95% CI 1.28-2.97)], but the use of categorical MIC breakpoints did not accurately predict the treatment response. The geometric mean MIC of azithromycin was higher in isolates from the pharynx compared with genital isolates. CONCLUSIONS We found that categorical resistance to azithromycin or ceftriaxone in vitro, and higher gentamicin MICs in the absence of breakpoints, were poorly predictive of treatment failure.
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Affiliation(s)
| | - Wei Tan
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | | | - Clare Brittain
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Lelia Duley
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Trish Hepburn
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Tessa Lawrence
- University Hospitals Birmingham NHS Foundation Trust, Whittall Street Clinic, Birmingham, UK
| | - Alan A Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Kirsty Sprange
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Sukhwinder Thandi
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | | | | | | | - Jonathan D C Ross
- University Hospitals Birmingham NHS Foundation Trust, Whittall Street Clinic, Birmingham, UK
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Day MJ, Cole MJ, Fifer H, Woodford N, Pitt R. Detection of markers predictive of macrolide and fluoroquinolone resistance in Mycoplasma genitalium from patients attending sexual health services. Sex Transm Infect 2021; 98:215-218. [PMID: 34088790 DOI: 10.1136/sextrans-2020-054897] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/09/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study sought to provide data on the prevalence of macrolide (23S rRNA) and fluoroquinolone (parC) resistance-associated mutations seen in Mycoplasma genitalium-positive specimens received in the UK national reference laboratory. METHODS In total, 2580 clinical specimens from patients with suspected or confirmed M. genitalium infection were received at the national reference laboratory between September 2017 and November 2018. M. genitalium-positive clinical specimens were identified using a reverse transcription-PCR targeting two M. genitalium genes: MgPa and gap. Resistance-associated single nucleotide poylmorphisms were sought in all positive specimens by sequence analysis of the 23S rRNA and parC genes. RESULTS Eighteen per cent (458 of 2580) of clinical specimens were positive for M. genitalium and 389 had sequence data for both macrolide and fluoroquinolone resistance markers. Of these, 71% (275 of 389) had macrolide resistance-associated mutations, 8% (31 of 389) had fluoroquinolone resistance-associated mutations (S83I/R and D87Y/N) and 7% (26 of 389) had mutations associated with resistance to both antimicrobials. Only 28% (108 of 389) had no mutations associated with resistance to either class of antibiotic. Five specimens had mutations of unknown clinical significance in the parC gene (eg, G81C and S83N). CONCLUSIONS Mutations associated with resistance to macrolides were very frequent. By contrast, susceptibility to the second-line treatment, moxifloxacin (a fluoroquinolone), was estimated at 92% based on the absence of resistance-associated mutations. The few specimens with mutations of unknown clinical significance in the parC gene were excluded from the analysis and so the actual level of fluoroquinolone susceptibility may be slightly lower than that reported here. Surveillance of antimicrobial resistance in M. genitalium is imperative for this to remain a treatable infection.
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Affiliation(s)
- Michaela Joanne Day
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI), National Infection Service, Public Health England, London, UK
| | - Michelle Jayne Cole
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI), National Infection Service, Public Health England, London, UK
| | - Helen Fifer
- Blood Safety, Hepatitis, Sexually-Transmitted Infections and HIV Division, National Infection Service, Public Health England, London, UK
| | - Neil Woodford
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI), National Infection Service, Public Health England, London, UK
| | - Rachel Pitt
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI), National Infection Service, Public Health England, London, UK
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Fifer H, Coe P, Geogloman I, Qaiser R, Saleh A, Adair R, Peter M, Dobbins B, Saha A. 941 Post-Operative Outcomes of Patients Undergoing Surgery During the Acceleration Period of COVID-19 Infection. Br J Surg 2021. [PMCID: PMC8135829 DOI: 10.1093/bjs/znab134.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Introduction There are concerns around the safety of performing surgery during COVID-19 outbreaks with few sources of robust evidence. Method We analysed 5020 consecutive patients who underwent surgery during the acceleration phase of COVID-19 at our hospital from 31st January to 13th April 2020. Data were also analysed for all patients who had a COVID-19 positive test result during the same study period. Results 156 patients (3%) developed COVID-19 symptoms after surgery; 28 patients (<1%) subsequently had a positive swab result. All-cause mortality was 44 patients (0.9%); 33 deaths (75%) were due to non COVID-19 diagnoses. There were no adverse COVID-19 related outcomes in any of the 648 patients who had cancer operations. Of 28 COVID-19 positive patients, 11 died (8 orthopaedic, 2 urology, 1 vascular surgery) of which 10 had an emergency admission; all were over 70 years of age. Recent surgery was not an independent prognostic factor for survival after COVID-19 infection. 12% of positive COVID-19 swabs were from long-stay patients. Conclusions Of 5020 operative patients, 0.2% died from COVID-19 and most complications were not related to the infection. With careful consideration, surgery can be provided safely during times of COVID-19 outbreaks with particular emphasis on avoiding in-hospital transmission.
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Affiliation(s)
- H Fifer
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | - P Coe
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | - I Geogloman
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | - R Qaiser
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | - A Saleh
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | - R Adair
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | - M Peter
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | - B Dobbins
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | - A Saha
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
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Fifer H, Lewis A, Perin G, Balasubramanian SP. Letter to the Editor: Outcomes of Laparoscopic Splenectomy for Treatment of Splenomegaly: A Systematic Review and Meta-analysis. World J Surg 2021; 45:2306-2307. [PMID: 33782731 DOI: 10.1007/s00268-021-06090-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 11/29/2022]
Affiliation(s)
- H Fifer
- General surgery, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, England.
| | - A Lewis
- The University of Sheffield, Sheffield, England
| | - G Perin
- General surgery, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, England
| | - S P Balasubramanian
- General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
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Town K, Harris S, Sánchez-Busó L, Cole MJ, Pitt R, Fifer H, Mohammed H, Field N, Hughes G. Genomic and Phenotypic Variability in Neisseria gonorrhoeae Antimicrobial Susceptibility, England. Emerg Infect Dis 2021; 26:505-515. [PMID: 32091356 PMCID: PMC7045833 DOI: 10.3201/eid2603.190732] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a global concern. Phylogenetic analyses resolve uncertainties regarding genetic relatedness of isolates with identical phenotypes and inform whether AMR is due to new mutations and clonal expansion or separate introductions by importation. We sequenced 1,277 isolates with associated epidemiologic and antimicrobial susceptibility data collected during 2013–2016 to investigate N. gonorrhoeae genomic variability in England. Comparing genetic markers and phenotypes for AMR, we identified 2 N. gonorrhoeae lineages with different antimicrobial susceptibility profiles and 3 clusters with elevated MICs for ceftriaxone, varying mutations in the penA allele, and different epidemiologic characteristics. Our results indicate N. gonorrhoeae with reduced antimicrobial susceptibility emerged independently and multiple times in different sexual networks in England, through new mutation or recombination events and by importation. Monitoring and control for AMR in N. gonorrhoeae should cover the entire population affected, rather than focusing on specific risk groups or locations.
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Fifer H, Hughes G. Oropharyngeal Neisseria gonorrhoeae infections: should women be routinely tested? Lancet Infect Dis 2021; 21:754-756. [PMID: 33444557 DOI: 10.1016/s1473-3099(20)30777-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/23/2020] [Indexed: 11/17/2022]
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Brooks A, Lucidarme J, Campbell H, Campbell L, Fifer H, Gray S, Hughes G, Lekshmi A, Schembri G, Rayment M, Ladhani SN, Ramsay ME, Borrow R. Detection of the United States Neisseria meningitidis urethritis clade in the United Kingdom, August and December 2019 - emergence of multiple antibiotic resistance calls for vigilance. ACTA ACUST UNITED AC 2020; 25. [PMID: 32317054 PMCID: PMC7175650 DOI: 10.2807/1560-7917.es.2020.25.15.2000375] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Since 2015 in the United States (US), the US Neisseria meningitidis urethritis clade (US_NmUC) has caused a large multistate outbreak of urethritis among heterosexual males. Its ‘parent’ strain caused numerous outbreaks of invasive meningococcal disease among men who have sex with men in Europe and North America. We highlight the arrival and dissemination of US_NmUC in the United Kingdom and the emergence of multiple antibiotic resistance. Surveillance systems should be developed that include anogenital meningococci.
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Affiliation(s)
- Avril Brooks
- Manchester Medical Microbiology Partnership, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Jay Lucidarme
- Meningococcal Reference Unit, Manchester Royal Infirmary, Public Health England, Manchester, United Kingdom
| | - Helen Campbell
- Immunisation and Countermeasures Division, Public Health England, London, United Kingdom
| | - Laura Campbell
- Manchester Medical Microbiology Partnership, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Helen Fifer
- Blood Safety, Hepatitis, Sexually Transmitted Infections & HIV Division, Public Health England, London, United Kingdom
| | - Steve Gray
- Meningococcal Reference Unit, Manchester Royal Infirmary, Public Health England, Manchester, United Kingdom
| | - Gwenda Hughes
- Blood Safety, Hepatitis, Sexually Transmitted Infections & HIV Division, Public Health England, London, United Kingdom
| | - Aiswarya Lekshmi
- Meningococcal Reference Unit, Manchester Royal Infirmary, Public Health England, Manchester, United Kingdom
| | - Gabriel Schembri
- The Northern Integrated Contraception, Sexual Health & HIV Service, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Michael Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Shamez N Ladhani
- Paediatric Infectious Diseases Research Group, St George's University of London, London, United Kingdom.,Immunisation and Countermeasures Division, Public Health England, London, United Kingdom
| | - Mary E Ramsay
- Immunisation and Countermeasures Division, Public Health England, London, United Kingdom
| | - Ray Borrow
- Meningococcal Reference Unit, Manchester Royal Infirmary, Public Health England, Manchester, United Kingdom
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Abstract
Mycoplasma genitalium is a fastidious organism of the class Mollicutes, the smallest prokaryote capable of independent replication. First isolated in 1981, much is still unknown regarding its natural history in untreated infection. It is recognized as a sexually transmitted pathogen causing acute and chronic non-gonococcal urethritis (NGU) in men, with a growing body of evidence to suggest it also causes cervicitis and pelvic inflammatory disease in women. Its role in several other clinical syndromes is uncertain. The majority of people infected remain asymptomatic and clear infection without developing disease; asymptomatic screening is therefore not recommended. Prevalence rates are higher in patients attending sexual health clinics and in men with NGU. Limited availability of diagnostics has encouraged syndromic management, resulting in widespread antimicrobial resistance and given that few antimicrobial classes have activity against M. genitalium, there is significant concern regarding the emergence of untreatable strains. There is a need for wider availability of testing, which should include detection of macrolide resistance mediating mutations. Expertise in interpretation of microbiological results with clinical correlation ensures targeted treatment avoiding unnecessary antibiotic exposure. Public health surveillance nationally and internationally is vital in monitoring and responding to changing epidemiology trends. In this review, we summarize current knowledge of M. genitalium, including epidemiology, clinical and microbiological data, and discuss treatment challenges in the era of rising multidrug resistance.
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Affiliation(s)
- Roshina Gnanadurai
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Helen Fifer
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
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Pitt R, Fifer H, Woodford N, Hopkins S, Cole MJ. Prevalence of Chlamydia trachomatis and Mycoplasma genitalium coinfections and M. genitalium antimicrobial resistance in rectal specimens. Sex Transm Infect 2020; 97:469-470. [PMID: 33106438 DOI: 10.1136/sextrans-2020-054803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 09/30/2020] [Accepted: 10/11/2020] [Indexed: 11/03/2022] Open
Affiliation(s)
- Rachel Pitt
- National Infection Service, Public Health England, London, UK
| | - Helen Fifer
- National Infection Service, Public Health England, London, UK
| | - Neil Woodford
- National Infection Service, Public Health England, London, UK
| | - Susan Hopkins
- National Infection Service, Public Health England, London, UK
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O'Halloran C, Croxford S, Mohammed H, Gill ON, Hughes G, Fifer H, Allen H, Owen G, Nutland W, Delpech V, Saunders JM. Factors associated with reporting antibiotic use as STI prophylaxis among HIV PrEP users: findings from a cross-sectional online community survey, May–July 2019, UK. Sex Transm Infect 2020; 97:429-433. [DOI: 10.1136/sextrans-2020-054592] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/08/2020] [Accepted: 09/27/2020] [Indexed: 01/31/2023] Open
Abstract
ObjectivesThe use of antibiotics as pre-exposure or postexposure prophylaxis for sexually transmitted infection (STI) prevention (STI prophylaxis) is not currently recommended in the UK, but there is evidence that self-prescribing occurs among those at greatest risk. We present the prevalence and factors associated with STI prophylaxis among a community sample of HIV pre-exposure prophylaxis (PrEP) users.MethodsThe 2019 online PrEP User Survey ran between 17 May and 1 July. Eligible participants included UK residents reporting HIV PrEP use or having tried to obtain HIV PrEP since January 2017. STI prophylaxis use was defined as reporting buying antibiotics to prevent STIs, either privately or through the internet; this question was only asked to HIV PrEP users. Factors associated with STI prophylaxis use were assessed using univariable and multivariable logistic regression.ResultsOverall, 9% (167/1856) of HIV PrEP users reported STI prophylaxis use; 97% were gay or bisexual men, 84% reported white ethnicity, 55% resided in London and 69% were aged ≥35 years. Factors associated with STI prophylaxis included: reporting ≥5 compared with 1–4 condomless sex partners in the past 6 months (12% vs 5.6%, adjusted odds ratio (aOR)=1.80; 95% CI 1.22 to 2.64), reporting chemsex drug use compared with no sexualised drug use in the past 12 months (13% vs 6.0%, aOR=1.88; 95% CI 1.20 to 2.93) and reporting an STI diagnosis in the past 12 months (12% vs 6.6%, aOR=1.54; 95% CI 1.08 to 2.18). Variables not significant in multivariable analyses included: ethnicity, age, residence and HIV PrEP sourcing.ConclusionsApproximately 1 in 10 HIV PrEP users from this community sample reported self-prescribed STI prophylaxis. STI prophylaxis was associated with sexual behaviour known to facilitate STI transmission and with a history of recent STIs acquisition. Given the potential risk of antimicrobial resistance, sexual health clinicians should consider asking attendees, especially HIV PrEP users, about the use of antibiotics as STI prophylaxis, to inform appropriate counselling, testing and management.
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Roberts DJ, Davis GS, Cole MJ, Naik D, Maru H, Woodford N, Muir P, Horner P, Simms I, Thickett G, Crook P, Foster K, Andrews N, Saunders J, Fifer H, Folkard K, Gill ON, On Behalf Of The Incident Management Team. Prevalence of new variants of Chlamydia trachomatis escaping detection by the Aptima Combo 2 assay, England, June to August 2019. ACTA ACUST UNITED AC 2020; 24. [PMID: 31552817 PMCID: PMC6761577 DOI: 10.2807/1560-7917.es.2019.24.38.1900557] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We identified two new Chlamydia trachomatis (CT) variants escaping Aptima Combo 2 (AC2) assay detection, in clinical specimens of two patients. One had a C1514T mutation the other a G1523A mutation, both within the AC2 23S rRNA target region. The prevalence of such variants among persons tested for CT in England was estimated to be fewer than 0.003%.
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Affiliation(s)
- David J Roberts
- National Infection Service, Public Health England, London, United Kingdom
| | - Grahame S Davis
- National Infection Service, Public Health England, London, United Kingdom
| | - Michelle J Cole
- National Infection Service, Public Health England, London, United Kingdom
| | - Dixita Naik
- National Infection Service, Public Health England, London, United Kingdom
| | - Hitiksha Maru
- National Infection Service, Public Health England, London, United Kingdom
| | - Neil Woodford
- National Infection Service, Public Health England, London, United Kingdom
| | - Peter Muir
- South West Regional Public Health Laboratory, Public Health England, Bristol, United Kingdom
| | - Paddy Horner
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Ian Simms
- National Infection Service, Public Health England, London, United Kingdom
| | - George Thickett
- National Infection Service, Public Health England, London, United Kingdom
| | - Paul Crook
- Field Service South East and London, Public Health England, London, United Kingdom
| | - Kirsty Foster
- Public Health England North East Centre, Newcastle-upon-Tyne, United Kingdom
| | - Nick Andrews
- Statistics, Modelling and Economics Department, Public Health England, London, United Kingdom
| | - John Saunders
- National Infection Service, Public Health England, London, United Kingdom
| | - Helen Fifer
- National Infection Service, Public Health England, London, United Kingdom
| | - Kate Folkard
- National Infection Service, Public Health England, London, United Kingdom
| | - O Noel Gill
- National Infection Service, Public Health England, London, United Kingdom
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Pitt R, Sadouki Z, Town K, Fifer H, Mohammed H, Hughes G, Woodford N, Cole MJ. Detection of tet(M) in high-level tetracycline-resistant Neisseria gonorrhoeae. J Antimicrob Chemother 2020; 74:2115-2116. [PMID: 31225605 DOI: 10.1093/jac/dkz130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Rachel Pitt
- Public Health England, National Infection Service, 61 Colindale Avenue, Colindale, London, UK
| | - Zahra Sadouki
- Public Health England, National Infection Service, 61 Colindale Avenue, Colindale, London, UK
| | - Katy Town
- Public Health England, National Infection Service, 61 Colindale Avenue, Colindale, London, UK
| | - Helen Fifer
- Public Health England, National Infection Service, 61 Colindale Avenue, Colindale, London, UK
| | - Hamish Mohammed
- Public Health England, National Infection Service, 61 Colindale Avenue, Colindale, London, UK
| | - Gwenda Hughes
- Public Health England, National Infection Service, 61 Colindale Avenue, Colindale, London, UK
| | - Neil Woodford
- Public Health England, National Infection Service, 61 Colindale Avenue, Colindale, London, UK
| | - Michelle J Cole
- Public Health England, National Infection Service, 61 Colindale Avenue, Colindale, London, UK
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Allen H, Pitt R, Bardsley M, Smolarchuk C, Sullivan A, Mohammed H, Cole M, Fifer H, Wallace L, Thomas D, Irvine N, Templeton K, Hughes G, Simms I. Investigating the decline in Lymphogranuloma venereum diagnoses in men who have sex with men in the United Kingdom since 2016: an analysis of surveillance data. Sex Health 2020; 17:344-351. [PMID: 32762828 DOI: 10.1071/sh20001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 05/26/2020] [Indexed: 01/18/2023]
Abstract
Background Following an upward trajectory in Lymphogranuloma venereum (LGV) diagnoses in the UK from 2004 to 2016, with annual diagnoses increasing from 28 to 904, diagnoses fell to 641 in 2017; this was inconsistent with the upward trend in other bacterial sexually transmissible infections (STIs) between 2016 and 2017. An analysis of surveillance data from multiple sources to investigate the possible factors contributing to this decline in LGV was performed. METHODS LGV tests and diagnoses in the UK from 2004 to 2018 were captured through laboratory data from the LGV Reference Laboratories and laboratories conducting in-house LGV testing. These data and clinical diagnoses data from England were analysed alongside the national management guidelines issued over the course of the epidemic. RESULTS LGV diagnoses increased between 2004 and 2015 and then decreased between 2016 and 2018. LGV testing increased from 2010 to 2018 (2690-10850). Test positivity halved between 2015 (14.8%, 929-6272) and 2018 (7.3%, 791-10850). Peaks in LGV testing and diagnoses appeared to coincide with the publication of national LGV management guidelines and changes to clinical practice. The proportion of LGV diagnoses among HIV-positive men who have sex with men (MSM) fell between 2013 and 2018 (74-48%). CONCLUSIONS The fall in diagnoses and positivity were likely due to increasing earlier clinical diagnosis and treatment. Changes to the national management guidelines, the clinical policy and practice of some larger clinics and potentially changes to the guidelines for the treatment of chlamydia broadened the scope of testing and increased testing in asymptomatic patients which, in combination, likely had a positive effect on the control of LGV infection.
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Affiliation(s)
- Hester Allen
- National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK; and Corresponding author.
| | - Rachel Pitt
- National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Megan Bardsley
- National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Christa Smolarchuk
- National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Ann Sullivan
- National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Hamish Mohammed
- National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Michelle Cole
- National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Helen Fifer
- National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Lesley Wallace
- Health Protection Scotland, 5 Cadogan Street, Glasgow, G2 6QE, UK
| | - Daniel Thomas
- Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4B, UK
| | - Neil Irvine
- Public Health Agency, Health and Social Care Northern Ireland, 12-22 Linenhall Street, Belfast, BT2 8BS, UK
| | - Kate Templeton
- Scottish Bacterial Sexually Transmitted Infections Reference Laboratory, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Gwenda Hughes
- National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Ian Simms
- National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
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Jennison AV, Whiley D, Lahra MM, Graham RM, Cole MJ, Hughes G, Fifer H, Andersson M, Edwards A, Eyre D. Genetic relatedness of ceftriaxone-resistant and high-level azithromycin resistant Neisseria gonorrhoeae cases, United Kingdom and Australia, February to April 2018. ACTA ACUST UNITED AC 2020; 24. [PMID: 30808445 PMCID: PMC6446956 DOI: 10.2807/1560-7917.es.2019.24.8.1900118] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Between February and April 2018, three ceftriaxone-resistant and high-level azithromycin-resistant Neisseria gonorrhoeae cases were identified; one in the United Kingdom and two in Australia. Whole genome sequencing was used to show that the isolates from these cases belong to a single gonococcal clone, which we name the A2543 clone.
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Affiliation(s)
- Amy V Jennison
- Forensic and Scientific Services, Queensland Department of Health, Brisbane, Queensland, Australia
| | - David Whiley
- Pathology Queensland Central Laboratory, Brisbane, Australia.,The University of Queensland, Brisbane, Queensland, Australia
| | - Monica M Lahra
- The University of New South Wales, Sydney, Australia.,New South Wales Health Pathology, Microbiology Randwick, The Prince of Wales Hospital, New South Wales, Australia
| | - Rikki M Graham
- Forensic and Scientific Services, Queensland Department of Health, Brisbane, Queensland, Australia
| | - Michelle J Cole
- National Infection Service, Public Health England, London, United Kingdom
| | - Gwenda Hughes
- Institute of Tropical Medicine, University of São Paulo, Brazil.,National Infection Service, Public Health England, London, United Kingdom
| | - Helen Fifer
- National Infection Service, Public Health England, London, United Kingdom
| | - Monique Andersson
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Anne Edwards
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - David Eyre
- Big Data Institute, University of Oxford, Oxford, United Kingdom.,Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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Eyre DW, Town K, Street T, Barker L, Sanderson N, Cole MJ, Mohammed H, Pitt R, Gobin M, Irish C, Gardiner D, Sedgwick J, Beck C, Saunders J, Turbitt D, Cook C, Phin N, Nathan B, Horner P, Fifer H. Detection in the United Kingdom of the Neisseria gonorrhoeae FC428 clone, with ceftriaxone resistance and intermediate resistance to azithromycin, October to December 2018. ACTA ACUST UNITED AC 2020; 24. [PMID: 30862336 PMCID: PMC6415501 DOI: 10.2807/1560-7917.es.2019.24.10.1900147] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
We describe detection in the United Kingdom (UK) of the drug-resistant Neisseria gonorrhoeae FC428 clone, with ceftriaxone resistance and intermediate azithromycin resistance. Two female patients developed infection following contact with UK-resident men from the same sexual network linked to travel to Ibiza, Spain. One case failed treatment with ceftriaxone, and azithromycin and gentamicin, before successful treatment with ertapenem. Both isolates had indistinguishable whole-genome sequences. Urgent action is essential to contain this drug-resistant strain.
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Affiliation(s)
- David W Eyre
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,Big Data Institute, University of Oxford, Oxford, United Kingdom
| | - Katy Town
- National Incident Management Team, Public Health England, London, United Kingdom
| | - Teresa Street
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Leanne Barker
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Nicholas Sanderson
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Michelle J Cole
- National Incident Management Team, Public Health England, London, United Kingdom
| | - Hamish Mohammed
- National Incident Management Team, Public Health England, London, United Kingdom
| | - Rachel Pitt
- National Incident Management Team, Public Health England, London, United Kingdom
| | - Maya Gobin
- National Incident Management Team, Public Health England, London, United Kingdom
| | - Charles Irish
- National Incident Management Team, Public Health England, London, United Kingdom
| | - Daniel Gardiner
- National Incident Management Team, Public Health England, London, United Kingdom
| | - James Sedgwick
- National Incident Management Team, Public Health England, London, United Kingdom
| | - Charles Beck
- National Incident Management Team, Public Health England, London, United Kingdom
| | - John Saunders
- National Incident Management Team, Public Health England, London, United Kingdom
| | - Deborah Turbitt
- National Incident Management Team, Public Health England, London, United Kingdom
| | - Clare Cook
- National Incident Management Team, Public Health England, London, United Kingdom
| | - Nick Phin
- National Incident Management Team, Public Health England, London, United Kingdom
| | - Bavithra Nathan
- These authors contributed equally to this work.,National Incident Management Team, Public Health England, London, United Kingdom
| | - Paddy Horner
- These authors contributed equally to this work.,Population Health Sciences, University of Bristol, Bristol, United Kingdom.,National Incident Management Team, Public Health England, London, United Kingdom
| | - Helen Fifer
- These authors contributed equally to this work.,National Incident Management Team, Public Health England, London, United Kingdom
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46
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Fifer H, Hughes G, Whiley D, Lahra MM. Lessons learnt from ceftriaxone-resistant gonorrhoea in the UK and Australia. Lancet Infect Dis 2020; 20:276-278. [PMID: 32112753 DOI: 10.1016/s1473-3099(20)30055-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 01/16/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Helen Fifer
- National Infection Service, Public Health England, London NW9 5EQ, UK.
| | - Gwenda Hughes
- National Infection Service, Public Health England, London NW9 5EQ, UK
| | - David Whiley
- Pathology Queensland, Microbiology Department, Herston, QLD, Australia; Faculty of Medicine, Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia
| | - Monica M Lahra
- WHO Collaborating Centre for Sexually Transmitted Infections and Antimicrobial Resistance, New South Wales Health Pathology, Department of Microbiology, The Prince of Wales Hospital, Randwick, NSW, Australia; Faculty of Medicine, School of Medical Sciences, University of New South Wales, NSW, Australia
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47
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Town K, Field N, Harris SR, Sánchez-Busó L, Cole MJ, Pitt R, Fifer H, Mohammed H, Hughes G. Phylogenomic analysis of Neisseria gonorrhoeae transmission to assess sexual mixing and HIV transmission risk in England: a cross-sectional, observational, whole-genome sequencing study. Lancet Infect Dis 2020; 20:478-486. [PMID: 31978353 PMCID: PMC7099395 DOI: 10.1016/s1473-3099(19)30610-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/21/2019] [Accepted: 10/10/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Characterising sexual networks with transmission of sexually transmitted infections might allow identification of individuals at increased risk of infection. We aimed to investigate sexual mixing in Neisseria gonorrhoeae transmission networks between women, heterosexual men, and men who report sex with men (MSM), and between people with and without HIV. METHODS In this cross-sectional observational study, we whole-genome sequenced N gonorrhoeae isolates from the archive of the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP).w Isolates that varied by five single nucleotide polymorphisms or fewer were grouped into clusters that represented sexual networks with N gonorrhoeae transmission. Clusters were described by gender, sexual risk group, and HIV status. FINDINGS We sequenced 1277 N gonorrhoeae isolates with linked clinical and sociodemographic data that were collected in five clinics in England during 2013-16 (July 1 to Sept 30 in 2013-15; July 1 to Sept 9 in 2016). The isolates grouped into 213 clusters. 30 (14%) clusters contained isolates from heterosexual men and MSM but no women and three (1%) clusters contained isolates from only women and MSM. 146 (69%) clusters comprised solely people with negative or unknown HIV status and seven (3%) comprised only HIV-positive people. 60 (28%) clusters comprised MSM with positive and negative or unknown HIV status. INTERPRETATION N gonorrhoeae molecular data can provide information indicating risk of HIV or other sexually transmitted infections for some individuals for whom such risk might not be known from clinical history. These findings have implications for sexual health care, including offering testing, prevention advice, and preventive treatment, such as HIV pre-exposure prophylaxis. FUNDING National Institute for Health Research Health Protection Research Unit; Wellcome; Public Health England.
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Affiliation(s)
- Katy Town
- National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, University College London, London, UK; Centre for Molecular Epidemiology and Translational Research, Institute for Global Health, University College London, London, UK; National Infection Service, Public Health England, London, UK.
| | - Nigel Field
- Centre for Molecular Epidemiology and Translational Research, Institute for Global Health, University College London, London, UK
| | | | - Leonor Sánchez-Busó
- Centre for Genomic Pathogen Surveillance, Wellcome Sanger Institute, Hinxton, UK; Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Michelle J Cole
- National Infection Service, Public Health England, London, UK
| | - Rachel Pitt
- National Infection Service, Public Health England, London, UK
| | - Helen Fifer
- National Infection Service, Public Health England, London, UK
| | - Hamish Mohammed
- National Infection Service, Public Health England, London, UK
| | - Gwenda Hughes
- National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, University College London, London, UK; National Infection Service, Public Health England, London, UK
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Affiliation(s)
- Helen Fifer
- Consultant Microbiologist, National Infection Service, Public Health England
| | - John Saunders
- Consultant in Sexual Health, National Infection Service, Public Health England and Central and North West London NHS Foundation Trust
| | - Suneeta Soni
- Consultant in Sexual Health, Brighton & Sussex University Hospitals NHS Trust
| | - S Tariq Sadiq
- Professor of Molecular Medicine, Institute for Infection and Immunity, St George's, University of London
| | - Mark FitzGerald
- Consultant in Sexual Health, Clinical Effectiveness Group, BASHH
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Kingston M, Fifer H, French P, Wilson J, Tipple C. Amendment to the UK guidelines on the management of syphilis 2015: Management of syphilis in pregnant women. Int J STD AIDS 2019; 30:1344-1345. [PMID: 31775588 DOI: 10.1177/0956462419862723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Margaret Kingston
- The Northern Contraception, Sexual Health & HIV Service, The Hathersage Centre, Manchester, UK
| | - Helen Fifer
- Blood Safety, Hepatitis, HIV and STI Service, National Infection Service, Public Health England, London, UK
| | | | - Janet Wilson
- Genitourinary Medicine and HIV, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - Craig Tipple
- GU/HIV, Clinical Development, Imperial College Healthcare NHS Trust, Jefferiss Wing, St Mary's Hospital, London, UK.,GSK R&D Infectious Disease, Uxbridge, UK
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50
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Smolarchuk C, Wensley A, Padfield S, Fifer H, Lee A, Hughes G. Persistence of an outbreak of gonorrhoea with high-level resistance to azithromycin in England, November 2014‒May 2018. ACTA ACUST UNITED AC 2019; 23. [PMID: 29897041 PMCID: PMC6152168 DOI: 10.2807/1560-7917.es.2018.23.23.1800287] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Between November 2014 and May 2018, 118 laboratory-confirmed cases of high-level azithromycin resistant Neisseria gonorrhoeae were identified in England. Cases emerged among heterosexuals in Leeds but spread across England and into sexual networks of men who have sex with men as the outbreak progressed. The few epidemiological links identified indicate substantial under-diagnosis of cases and this, along with the upturn in cases in 2017, highlights the difficulties in controlling the outbreak.
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Affiliation(s)
- Christa Smolarchuk
- These authors contributed equally to this work and share first authorship.,HIV & STI Department, Public Health England, Colindale, London, United Kingdom
| | - Adrian Wensley
- These authors contributed equally to this work and share first authorship.,Field Epidemiology Service, Public Health England, Leeds, United Kingdom
| | - Simon Padfield
- Field Epidemiology Service, Public Health England, Leeds, United Kingdom
| | - Helen Fifer
- Bacteriology Reference Department, National Infection Service, Public Health England, Colindale, London, United Kingdom
| | - Andrew Lee
- Public Health England, Yorkshire and Humber, Leeds
| | - Gwenda Hughes
- HIV & STI Department, Public Health England, Colindale, London, United Kingdom
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