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Ong JJ, Lim A, Bradshaw C, Taylor-Robinson D, Unemo M, Horner PJ, Vickerman P, Zhang L. Cost-effectiveness of testing for Mycoplasma genitalium among men who have sex with men in Australia. Sex Transm Infect 2023; 99:398-403. [PMID: 36958826 DOI: 10.1136/sextrans-2022-055611] [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: 10/03/2022] [Accepted: 01/23/2023] [Indexed: 03/25/2023] Open
Abstract
OBJECTIVES Mycoplasma genitalium (MG) disproportionately affects men who have sex with men (MSM). We determined the cost-effectiveness of different testing strategies for MG in MSM, taking a healthcare provider perspective. METHODS We used inputs from a dynamic transmission model of MG among MSM living in Australia in a decision tree model to evaluate the impact of four testing scenarios on MG incidence: (1) no one tested; (2) symptomatic MSM; (3) symptomatic and high-risk asymptomatic MSM; (4) all MSM. We calculated the incremental cost-effectiveness ratios (ICERs) using a willingness-to-pay threshold of $A30 000 per quality-adjusted life year (QALY) gained. We explored the impact of adding an antimicrobial resistance (AMR) tax (ie, additional cost per antibiotic consumed) to identify the threshold, whereby any testing for MG is no longer cost-effective. RESULTS Testing only symptomatic MSM is the most cost-effective (ICER $3677 per QALY gained) approach. Offering testing to all MSM is dominated (ie, higher costs and lower QALYs gained compared with other strategies). When the AMR tax per antibiotic given was above $150, any testing for MG was no longer cost-effective. CONCLUSION Testing only symptomatic MSM is the most cost-effective option, even when the potential costs associated with AMR are accounted for (up to $150 additional cost per antibiotic given). For pathogens like MG, where there are anticipated future costs related to AMR, we recommend models that test the impact of incorporating an AMR tax as they can change the results and conclusions of cost-effectiveness studies.
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Affiliation(s)
- Jason J Ong
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- London School of Hygiene and Tropical Medicine, London, UK
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Aaron Lim
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Catriona Bradshaw
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | | | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, Örebro University, Orebro, Sweden
- Institute for Global Health, University College London, London, UK
| | - Paddy J Horner
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lei Zhang
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
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Sokoll PR, Migliavaca CB, Siebert U, Schmid D, Arvandi M. Prevalence of Mycoplasma genitalium infection among HIV PrEP users: a systematic review and meta-analysis. Sex Transm Infect 2023:sextrans-2022-055687. [PMID: 36759179 DOI: 10.1136/sextrans-2022-055687] [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: 11/07/2022] [Accepted: 01/28/2023] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVES To summarise the prevalence of Mycoplasma genitalium (MG) and antibiotic-resistant MG infection among HIV pre-exposure prophylaxis (PrEP) users. METHODS We searched MEDLINE, Embase, Web of Science and Global Index Medicus up to 30 September 2022. We included studies reporting the prevalence of MG and/or antibiotic-resistant MG infection among PrEP users. Two reviewers independently searched for studies and extracted data. A systematic review with random-effects meta-analysis was performed to quantitatively summarise the results of included studies. The critical appraisal of included studies was conducted with the Joanna Briggs Institute checklist for prevalence studies and the quality of evidence was assessed with Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS A total of 15 studies were included in the systematic review, with 2341 individuals taking PrEP. Studies were conducted in high-income level countries between 2014 and 2019. Median age of participants varied from 23.5 to 40 years. The majority were men (85%) and among them, 93% were men who have sex with men. To identify MG, urine samples were analysed in 14 studies, rectal or anal swabs in 12 studies, oral or pharyngeal swabs in 9 studies, and urethral or vaginal in 3 studies. The pooled point prevalence of MG among PrEP users was 16.7% (95% CI 13.6% to 20.3%; 95% prediction interval (95% PI) 8.2% to 31.1%). The pooled point prevalence of macrolide-resistant infections was 82.6% (95% CI 70.1% to 90.6%; 95% PI 4.7% to 99.8%) and the prevalence of fluoroquinolone-resistant infections was 14.3% (95% CI 1.8% to 42.8%). Individuals taking PrEP have a higher chance of being infected with MG compared with those not taking PrEP (OR 2.30; 95% CI 1.6 to 3.4). The quality of evidence was very low to moderate. CONCLUSION We observed a high prevalence of MG and its macrolide resistance among PrEP users, highlighting the need to reinforce prevention strategies against sexually transmitted infections in this population. PROSPERO REGISTRATION NUMBER CRD42022310597.
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Affiliation(s)
- Paulo Roberto Sokoll
- Institute of Public Health, Medical Decision Making and Heath Technology Assessment, Department for Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Celina Borges Migliavaca
- Health Technology Assessment Institute (IATS), Clinical Research Center, Hospital de Clínicas de Porto Alegre (HCPA). Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Heath Technology Assessment, Department for Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Daniela Schmid
- Division for Quantitative Methods in Public Health and Health Services Research, Department for Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Marjan Arvandi
- Institute of Public Health, Medical Decision Making and Heath Technology Assessment, Department for Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
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3
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Goodfellow JJ, Hughes S, Smith J, Jones R, Moore LSP, Rayment M. Novel use of oral chloramphenicol for treatment-resistant Mycoplasma genitalium. Sex Transm Infect 2023; 99:208-210. [PMID: 36717253 DOI: 10.1136/sextrans-2022-055621] [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: 09/09/2022] [Accepted: 10/02/2022] [Indexed: 02/01/2023] Open
Abstract
We describe the novel use of oral chloramphenicol for treatment-resistant Mycoplasma genitalium (M. genitalium) infection in a 20-year-old heterosexual cisgender male presenting with recurrent symptomatic non-gonococcal urethritis. M. genitalium urethritis is an increasingly common clinical conundrum in sexual health clinics and in cases of second-line treatment failure (such as moxifloxacin), UK and international guidelines struggle to make recommendations for third-line treatments. As shown in our case, the evidence base for third-line treatments is lacking, with poor success rates, and may be poorly tolerated. Here we demonstrate the novel use of a well-tolerated oral antimicrobial, chloramphenicol, resulting in rapid microbiological and clinical cure in treatment-resistant M. genitalium urethritis.
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Affiliation(s)
| | - Stephen Hughes
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Jo Smith
- Directorate of HIV and Sexual Health, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Rachael Jones
- Directorate of HIV and Sexual Health, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Luke S P Moore
- Clinical Infection Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.,North West London Pathology, Imperial College Healthcare NHS Trust, London, UK
| | - Michael Rayment
- Directorate of HIV and Sexual Health, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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4
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Van Dijck C, Kenyon C. No evidence of reduced cephalosporin susceptibility of circulating strains of Neisseria gonorrhoeae in the Netherlands despite nearly a decade of recommending ceftriaxone monotherapy. Sex Transm Infect 2022; 99:213-214. [PMID: 36601743 DOI: 10.1136/sextrans-2022-055603] [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: 08/20/2022] [Accepted: 11/12/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Christophe Van Dijck
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium .,Laboratory of Medical Microbiology, University of Antwerp, Antwerpen, Belgium
| | - Chris Kenyon
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium.,Department of Medicine, University of Cape Town, Cape Town, South Africa
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5
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de Vries HJC, Baral S. Assessing the health and well-being of gay, bisexual and other men who have sex with men around the world. Sex Transm Infect 2017; 93:303-304. [PMID: 28729515 DOI: 10.1136/sextrans-2016-052679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 06/03/2017] [Indexed: 11/03/2022] Open
Affiliation(s)
- Henry John Christiaan de Vries
- STI Outpatient Clinic, Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands.,Department of Dermatology, Academic Medical Centre University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Infection & Immunity Institute (AI&II), Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Stefan Baral
- Key Populations Program, Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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6
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Sadiq ST, Mazzaferri F, Unemo M. Rapid accurate point-of-care tests combining diagnostics and antimicrobial resistance prediction for Neisseria gonorrhoeae and Mycoplasma genitalium. Sex Transm Infect 2017; 93:S65-S68. [PMID: 28684610 DOI: 10.1136/sextrans-2016-053072] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [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: 12/31/2016] [Revised: 03/21/2017] [Accepted: 04/01/2017] [Indexed: 01/19/2023] Open
Abstract
In addition to inadequate access to early diagnosis and treatment with antimicrobial agents for patients and sexual contacts, management and control of STIs is significantly challenged by emergence and spread of antimicrobial resistance (AMR), particularly for STIs such as Neisseria gonorrhoeae and Mycoplasma genitalium This is further compounded by use of nucleic acid amplification techniques for diagnosis, resulting in reduced phenotypic AMR testing for N. gonorrhoeae and absence or suboptimal AMR surveillance for guiding treatment of both STIs in many settings. Rapid accurate point-of-care (POC) tests for diagnosis of all STIs would be valuable but to significantly impact treatment precision and management of N. gonorrhoeae and M. genitalium infections, combinations of rapid POC diagnostic and AMR testing (POC-AMR) will likely be required. This strategy would combat STI burden and AMR emergence and spread by enabling diagnosis and individualised treatment at the first healthcare visit, potentially reducing selection pressure on recommended antimicrobials, reducing transmission of resistant strains and providing means for AMR surveillance. Microfluidic and nanotechnology platforms under development for rapid detection of STIs provide a basis to also develop molecular rapid POC-AMR prediction. A number of prototypic devices are in the pipeline but none as yet approved for routine use. However, particularly for N. gonorrhoeae, more knowledge is required to assess which antimicrobials lend themselves to a genotypic POC-AMR approach, in relation to genotypic-phenotypic associations and potential impact clinically and epidemiologically. Key for successful deployment will include also understanding cost-effectiveness, cost-consequences and acceptability for key stakeholders.
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Affiliation(s)
- Syed Tariq Sadiq
- Applied Diagnostic Research and Evaluation Unit, St George's, University of London, London, UK
| | - Fulvia Mazzaferri
- Diagnostic and Public Health Department, Infectious Diseases and Tropical Medicine Section, University of Verona, Verona, Italy
| | - Magnus Unemo
- World Health Organization Collaborating Centre for Gonorrhoea and other STIs, Örebro University, Örebro, Sweden
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7
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Latif AS, Gwanzura L, Machiha A, Ndowa F, Tarupiwa A, Gudza-Mugabe M, Shukusho FD, Chakanyuka Musanhu C, Wi T, Unemo M. Antimicrobial susceptibility in Neisseria gonorrhoeae isolates from five sentinel surveillance sites in Zimbabwe, 2015-2016. Sex Transm Infect 2017; 94:62-66. [PMID: 28476914 DOI: 10.1136/sextrans-2016-053090] [Citation(s) in RCA: 14] [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: 01/05/2017] [Revised: 03/28/2017] [Accepted: 04/18/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Gonorrhoea and antimicrobial resistance (AMR) in Neisseria gonorrhoeae are major public health concerns worldwide. Enhanced AMR surveillance for gonococci is essential globally. In Zimbabwe, very limited gonococcal AMR data were reported. Our aims were to (i) implement quality-assured gonococcal AMR surveillance in Zimbabwe and (ii) investigate gonococcal AMR at five health centres in 2015-2016. METHODS Gonococcal isolates from 104 men with urethral discharge were tested for susceptibility to kanamycin, ceftriaxone, cefixime, ciprofloxacin and azithromycin using Etest. RESULTS All isolates (102 possible to test) were susceptible to ceftriaxone and cefixime. The level of resistance (intermediate resistance) to kanamycin and ciprofloxacin was 2.0% (2.0%) and 18.6% (27.5%), respectively. The two kanamycin-resistant isolates (R≥128 mg/L) had a kanamycin minimum inhibitory concentration (MIC) of >256 mg/L. The ciprofloxacin resistance ranged from 9.5% to 30.8% in the five sentinel sites. Only 10 (9.6%) of the isolates were tested for susceptibility to azithromycin and 1 (10.0%) was resistant (MIC=4 mg/L). CONCLUSIONS The emergence of multidrug-resistant gonorrhoea internationally is a major public health concern and gonococcal AMR surveillance is crucial globally. In Zimbabwe, gonococcal AMR surveillance has now been implemented and quality assured according to WHO standards. The results of this first surveillance will be used to directly inform revisions of the national treatment guidelines. It is imperative to further strengthen the surveillance of gonococcal AMR, and ideally also treatment failures, in Zimbabwe and most countries in the WHO African region, which requires continuous national and international support, including technical support, and political and financial commitment.
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Affiliation(s)
| | - Lovemore Gwanzura
- Department of Medical Laboratory Sciences, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Anna Machiha
- STI, HIV/AIDS and TB Programmes, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Francis Ndowa
- STI, HIV/AIDS and TB Programmes, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Andrew Tarupiwa
- National Microbiology Reference Laboratory, Southerton, Harare, Zimbabwe
| | | | - Fungai D Shukusho
- National Microbiology Reference Laboratory, Southerton, Harare, Zimbabwe
| | | | - Teodora Wi
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Magnus Unemo
- World Health Organization Collaborating Centre for Gonorrhoea and other STIs, Örebro University, Örebro, Sweden
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8
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Horner P, Saunders J. Should azithromycin 1 g be abandoned as a treatment for bacterial STIs? The case for and against. Sex Transm Infect 2016; 93:85-87. [PMID: 27418572 DOI: 10.1136/sextrans-2015-052414] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 06/02/2016] [Accepted: 06/18/2016] [Indexed: 12/22/2022] Open
Affiliation(s)
- Patrick Horner
- School of Social and Community Medicine, University of Bristol, Bristol, UK.,National Institute for Health Research Health Protection Research Unit (NIHR HPRU), Evaluation of Interventions in Partnership with Public Health England, University of Bristol, Bristol, UK
| | - John Saunders
- HIV & STI Department, National Infection Service, Public Health England, London, UK
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9
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Fitzgerald C, Stapleton P, Phelan E, Mulhare P, Carey B, Hickey M, Lynch B, Doyle M. Rapid identification and antimicrobial susceptibility testing of positive blood cultures using MALDI-TOF MS and a modification of the standardised disc diffusion test: a pilot study. J Clin Pathol 2016; 69:jclinpath-2015-203436. [PMID: 27122186 DOI: 10.1136/jclinpath-2015-203436] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 10/20/2015] [Accepted: 03/31/2016] [Indexed: 11/04/2022]
Abstract
AIMS In an era when clinical microbiology laboratories are under increasing financial pressure, there is a need for inexpensive, yet effective, rapid microbiology tests. The aim of this study was to evaluate a novel modification of standard methodology for the identification and antimicrobial susceptibility testing (AST) of pathogens in positive blood cultures, reducing the turnaround time of laboratory results by 24 h. METHODS 277 positive blood cultures had a Gram stain performed and were subcultured and incubated at 37°C in a CO2 atmosphere for 4-6 h. Identification of the visible growth was performed using matrix-assisted laser desorption time of flight mass spectrometry (MALDI-TOF MS). Taking a modified approach to the Clinical and Laboratory Standards Institute-standardised AST methodology, an inoculum density of 0.5 McFarland was prepared from the early growth for disc diffusion testing. The standard AST method was also performed on the 18-24 h culture. RESULTS 96% (n=73/76) of gram-negative organisms were correctly identified by MALDI-TOF MS. Comparative analysis of the rapid and standard AST results showed an overall interpretive category error rate of 7.7% (6.7% minor errors, 0.6% major errors and 0.4% very major errors). 100% of Staphylococcus aureus (n=41) and enterococcus isolates (n=9) were correctly identified after 4-6 h incubation. The overall AST categorical agreement was also 100% for these isolates. CONCLUSIONS An incubation of 4-6 h directly from positive blood cultures allowed for both a rapid species identification and an antimicrobial susceptibility result approximately 24 h earlier than is possible using standard methodology.
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Affiliation(s)
- C Fitzgerald
- Microbiology Laboratory, University Hospital Waterford, Waterford, Ireland
| | - P Stapleton
- Microbiology Laboratory, University Hospital Waterford, Waterford, Ireland
| | - E Phelan
- Microbiology Laboratory, University Hospital Waterford, Waterford, Ireland
| | - P Mulhare
- Microbiology Laboratory, University Hospital Waterford, Waterford, Ireland
| | - B Carey
- Microbiology Laboratory, University Hospital Waterford, Waterford, Ireland
| | - M Hickey
- Microbiology Laboratory, University Hospital Waterford, Waterford, Ireland
| | - B Lynch
- Microbiology Laboratory, University Hospital Waterford, Waterford, Ireland
| | - M Doyle
- Microbiology Laboratory, University Hospital Waterford, Waterford, Ireland
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10
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Graham RMA, Doyle CJ, Jennison AV. Epidemiological typing of Neisseria gonorrhoeae and detection of markers associated with antimicrobial resistance directly from urine samples using next generation sequencing. Sex Transm Infect 2016; 93:65-67. [PMID: 26968786 DOI: 10.1136/sextrans-2015-052422] [Citation(s) in RCA: 24] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 02/16/2016] [Accepted: 02/20/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To investigate the potential for next generation sequencing (NGS) to be used directly on clinical specimens that have tested positive for Neisseria gonorrhoeae by nucleic acid amplification testing (NAAT), to generate information on epidemiological genotyping and antimicrobial resistance (AMR) markers. METHODS DNA was extracted from 13 N. gonorrhoeae NAAT-positive urine specimens, enriched for microbial DNA and sequenced using the Ion Torrent PGM workflow. Sequences that aligned to the human genome were filtered out and the remaining sequences were de novo assembled. The resulting contigs were searched for regions of interest using Ridom SeqSphere. MLST and NG-MAST alleles were assigned according to the schemes at PubMLST.org and NG-MAST.net, respectively. RESULTS In total, 11 of the 13 samples tested generated a sufficient number of N. gonorrhoeae sequence reads to provide full coverage of the genome at a depth of 6-130×. Complete MLST and NG-MAST sequence types could be generated for each of these samples. The presence of 10 different AMR markers was investigated, and both previously reported and novel mutations were identified in genes associated with reduced susceptibility to several antimicrobials. CONCLUSIONS We found that sequencing the entire genome of N. gonorrhoeae directly from clinical samples is possible using NGS, and that multiple levels of N. gonorrhoeae typing information can be generated. As NAAT only testing becomes more common, this method could be used to detect both known and novel mutations associated with AMR and to generate genotyping information, supporting AMR and epidemiological surveillance in the absence of culturing.
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Affiliation(s)
- R M A Graham
- Public Health Microbiology, Public and Environmental Health, Forensic and Scientific Services, Queensland Department of Health, Brisbane, Queensland, Australia
| | - C J Doyle
- Public Health Microbiology, Public and Environmental Health, Forensic and Scientific Services, Queensland Department of Health, Brisbane, Queensland, Australia
| | - A V Jennison
- Public Health Microbiology, Public and Environmental Health, Forensic and Scientific Services, Queensland Department of Health, Brisbane, Queensland, Australia
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11
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Chisholm SA, Wilson J, Alexander S, Tripodo F, Al-Shahib A, Schaefer U, Lythgow K, Fifer H. An outbreak of high-level azithromycin resistant Neisseria gonorrhoeae in England. Sex Transm Infect 2015; 92:365-7. [PMID: 26601852 DOI: 10.1136/sextrans-2015-052312] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [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: 07/31/2015] [Accepted: 10/28/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To investigate a potential outbreak of high-level azithromycin resistant (HL-AziR) gonococcal infections diagnosed in eight patients attending a sexual health clinic in Leeds, North England, between November 2014 and March 2015. METHODS Eight cases of infection with gonococci exhibiting azithromycin minimum inhibitory concentrations (MICs) ≥256 mg/L were identified from patients in Leeds as part of the routine service provided by the Sexually Transmitted Bacteria Reference Unit. All patient records were reviewed to collate epidemiological and clinical information including evaluation of patient management. Whole-genome sequencing (WGS) was performed on seven gonococcal isolates to determine Neisseria gonorrhoeae multiantigen sequence type (NG-MAST), WGS comparison and mutations in the 23S rRNA genes. RESULTS All patients were heterosexual (five male, three female) from a range of ethnic backgrounds and from the Leeds area. Three patients were linked by partner notification. All patients were infected at genital sites and two women had pharyngeal infection also. Six patients received the recommended first-line therapy for uncomplicated gonorrhoea, one was treated for pelvic inflammatory disease and one received spectinomycin followed later by ciprofloxacin. Test of cure was achieved in seven patients and confirmed successful eradication. All seven isolates sequenced were identical by NG-MAST and WGS comparison, and contained an A2143G mutation in all four 23S rRNA alleles. CONCLUSIONS Epidemiological and microbiological investigations confirm that an outbreak of a gonococcal strain showing HL-AziR is ongoing in the North of England. Every effort should be made to identify and curtail dissemination of this strain as it presents a significant threat to the current recommended front-line dual therapy.
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Affiliation(s)
- Stephanie A Chisholm
- Sexually Transmitted Bacteria Reference Unit, Microbiology Services, Public Health England, London, UK
| | - Janet Wilson
- Leeds Sexual Health, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust
| | - Sarah Alexander
- Sexually Transmitted Bacteria Reference Unit, Microbiology Services, Public Health England, London, UK
| | - Francesco Tripodo
- Sexually Transmitted Bacteria Reference Unit, Microbiology Services, Public Health England, London, UK
| | - Ali Al-Shahib
- Infectious Disease Informatics, Microbiology Services, Public Health England, London, UK
| | - Ulf Schaefer
- Infectious Disease Informatics, Microbiology Services, Public Health England, London, UK
| | - Kieren Lythgow
- Infectious Disease Informatics, Microbiology Services, Public Health England, London, UK
| | - Helen Fifer
- Sexually Transmitted Bacteria Reference Unit, Microbiology Services, Public Health England, London, UK
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12
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Saha SB, Uttam V, Verma V. u-CARE: user-friendly Comprehensive Antibiotic resistance Repository of Escherichia coli. J Clin Pathol 2015; 68:648-51. [PMID: 25935546 DOI: 10.1136/jclinpath-2015-202927] [Citation(s) in RCA: 9] [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: 02/04/2015] [Accepted: 04/14/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND AIMS Despite medical advancements, Escherichia coli-associated infections remain a major public health concern and although an abundant information about E. coli and its antibiotic resistance mechanisms is available, no effective tool exists that integrates gene and genomic data in context to drug resistance, thus raising a need to develop a repository that facilitates integration and assimilation of factors governing drug resistance in E. coli. DESCRIPTIONS User-friendly Comprehensive Antibiotic resistance Repository of Escherichia coli (u-CARE) is a manually curated catalogue of 52 antibiotics with reported resistance, 107 genes, transcription factors and single nucleotide polymorphism (SNPs) involved in multiple drug resistance of this pathogen. Each gene page provides detailed information about its resistance mechanisms, while antibiotic page consists of summary, chemical description and structural descriptors with links to external public databases like GO, CDD, DEG, Ecocyc, KEGG, Drug Bank, PubChem and UniProt. Moreover, the database integrates this reductive information to holistic data such as strain-specific and segment-specific pathogenic islands and operons. In addition, the database offers rich user interface for the visualisation and retrieval of information using various search criteria such as sequence, keyword, image and class search. CONCLUSIONS u-CARE is aimed to cater to the needs of researchers working in the field of antimicrobial drug resistance with minimal knowledge of bioinformatics. This database is also intended as a guide book to medical practitioners to avoid use of antibiotics against which resistance has already been reported in E. coli. The database is available from: http://www.e-bioinformatics.net/ucare.
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Affiliation(s)
- Saurav B Saha
- Department of Computational Biology and Bioinformatics, JSBB, SHIATS Allahabad, Uttar Pradesh, India
| | - Vishwas Uttam
- Department of Computational Biology and Bioinformatics, JSBB, SHIATS Allahabad, Uttar Pradesh, India
| | - Vivek Verma
- Clinical Vaccine R&D Center, Chonnam National University Hwasun Hospital, Jeonnam, South Korea
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Abstract
OBJECTIVE We aimed to outline why core groups should be targeted in Neisseria gonorrhoeae control and suggest several important and timely interventions to target core groups while highly resistant strains are spreading. METHODS Core group definition, feasibility and impact of gonorrhoea core group interventions as well as gonorrhoea resistance development have been reviewed in the paper. RESULTS Core group interventions have proven effective in gonorrhoea control in the past but are compromised by the spread of highly resistant strains. CONCLUSIONS Worldwide functional Gonorrhoea Antimicrobial Surveillance Program, better screening and better treatment programmes are needed. Prevention through condom promotion aimed at core groups remains essential. More specific treatment guidance for low-income and middle-income countries without resistance data is required in the meantime to achieve a better use of antibiotics.
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Affiliation(s)
- Katia Giguère
- Centre de recherche du CHU de Québec, Québec, Canada Département de médecine sociale et préventive, Université Laval, Québec, Canada
| | - Michel Alary
- Centre de recherche du CHU de Québec, Québec, Canada Département de médecine sociale et préventive, Université Laval, Québec, Canada Institut national de santé publique du Québec, Québec, Canada
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Trecker MA, Hogan DJ, Waldner CL, Dillon JAR, Osgood ND. Revised simulation model does not predict rebound in gonorrhoea prevalence where core groups are treated in the presence of antimicrobial resistance. Sex Transm Infect 2014; 91:300-2. [PMID: 25512669 DOI: 10.1136/sextrans-2014-051792] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 07/25/2014] [Accepted: 11/22/2014] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To determine the effects of using discrete versus continuous quantities of people in a compartmental model examining the contribution of antimicrobial resistance (AMR) to rebound in the prevalence of gonorrhoea. METHODS A previously published transmission model was reconfigured to represent the occurrence of gonorrhoea in discrete persons, rather than allowing fractions of infected individuals during simulations. RESULTS In the revised model, prevalence only rebounded under scenarios reproduced from the original paper when AMR occurrence was increased by 10(5) times. In such situations, treatment of high-risk individuals yielded outcomes very similar to those resulting from treatment of low-risk and intermediate-risk individuals. Otherwise, in contrast with the original model, prevalence was the lowest when the high-risk group was treated, supporting the current policy of targeting treatment to high-risk groups. CONCLUSIONS Simulation models can be highly sensitive to structural features. Small differences in structure and parameters can substantially influence predicted outcomes and policy prescriptions, and must be carefully considered.
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Affiliation(s)
- Molly A Trecker
- Vaccine and Infectious Disease Organization-International Vaccine Centre, Saskatoon, Saskatchewan, Canada School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Daniel J Hogan
- Department of Computer Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Cheryl L Waldner
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jo-Anne R Dillon
- Vaccine and Infectious Disease Organization-International Vaccine Centre, Saskatoon, Saskatchewan, Canada Department of Microbiology and Immunology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Nathaniel D Osgood
- Department of Computer Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Ndowa FJ, Francis JM, Machiha A, Faye-Kette H, Fonkoua MC. Gonococcal antimicrobial resistance: perspectives from the African region. Sex Transm Infect 2014; 89 Suppl 4:iv11-5. [PMID: 24243873 DOI: 10.1136/sextrans-2012-050907] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [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: 11/04/2022] Open
Abstract
Many countries in Africa have weak surveillance systems for data collection of sexually transmitted infections, and hardly any programmes for gonococcal antimicrobial susceptibility assessment. The widespread adoption of the syndromic approach to the diagnosis and management of sexually transmitted infections has also meant that the collection of a genital specimen for laboratory analysis is no longer routinely done when patients present with genital complaints, and clinical staff and laboratory technicians have lost the skill to collect genital specimens and processing them for culture and antimicrobial susceptibility testing. Following reports of gonococcal antimicrobial resistance to quinolones, WHO urged countries to monitor gonococcal antimicrobial resistance in a more systematic and regular manner. Although the response in Africa has been slow to take off, a number of studies have been conducted in a few countries and plans for implementation are in place in others. However, the number of isolates studied has been small in nearly all the countries except one, and the barriers to scaling up gonococcal antimicrobial resistance surveys seem overwhelming. In spite of the studies being few and of small sample sizes, enough information can be discerned to indicate that quinolones can no longer be a medicine of choice for the treatment of gonorrhoea in Africa and the threat of antimicrobial resistance developing in Neisseria gonorrhoeae to third-generation cephalosporins is real and imminent.
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Affiliation(s)
- Francis J Ndowa
- Former Lead Specialist, STI Team, Department of Reproductive Health and Research, World Health Organization, Geneva
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Abstract
Although the key focus of this supplement is related to antimicrobial resistance (AMR) in a sexually transmitted infection, Neisseria gonorrhoeae, the purpose of this article is to highlight the wider public health impact of AMR and the need for different disciplines of health to coordinate and collaborate in their selection and use of antimicrobial agents. AMR is being detected in health areas ranging from simple drugs used to treat common bacterial infections to the complex formulations used to treat tuberculosis, malaria and HIV infection, and on all continents. Tackling and containing AMR present an ordeal to international and national health authorities on many fronts. In June 2012, WHO launched the WHO Global Action Plan to Control the Spread and Impact of Antimicrobial Resistance in Neisseria gonorrhoeae with a vision to enhance the global response to the prevention, diagnosis and control of N gonorrhoeae infection and mitigate the health impact of AMR through enhanced, sustained, evidence-based and collaborative multisectoral action. This global action plan is positioned within a long-standing commitment of WHO to the issue of AMR with the launch of the Global Strategy on AMR in 2001 and World Health Day on AMR in 2011.
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Affiliation(s)
- Manjula Lusti-Narasimhan
- Department of Reproductive Health and Research, World Health Organization, , Geneva, Switzerland
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Hançali A, Ndowa F, Bellaji B, Bennani A, Kettani A, Charof R, El Aouad R. Antimicrobial resistance monitoring in Neisseria gonorrhoeae and strategic use of funds from the Global Fund to set up a systematic Moroccan gonococcal antimicrobial surveillance programme. Sex Transm Infect 2013; 89 Suppl 4:iv24-7. [PMID: 24037141 DOI: 10.1136/sextrans-2013-051166] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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: 11/04/2022] Open
Abstract
OBJECTIVES The aims of this study were to assess antimicrobial resistance in Neisseria gonorrhoeae infections and update the treatment in the national guidelines for the syndromic management of sexually transmitted infections in Morocco. METHODS 171 men complaining of urethral discharge were recruited from basic health services during 2009. Urethral swab samples were collected and N gonorrhoeae identification was performed by culture. Antimicrobial susceptibility testing was performed using the Etest method and the antimicrobial agents tested were ciprofloxacin, penicillin, spectinomycin, tetracycline, ceftriaxone and cefixime. RESULTS A total of 72 isolates were examined. Significant resistance to tetracycline (92.8%) and ciprofloxacin (86.8%), which was used as first-line treatment in gonococcal infections, was noted. No resistance to spectinomycin, ceftriaxone or cefixime was detected in all the isolates. CONCLUSIONS Following these results the Ministry of Health of Morocco replaced ciprofloxacin and introduced ceftriaxone 250 mg as a single dose in the treatment of gonococcal infections. Using funds from the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund), a surveillance programme was set up for antimicrobial resistance testing in N gonorrhoeae.
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Affiliation(s)
- Amina Hançali
- STIs Laboratory, National Institute of Hygiene, , Ministry of Health, Morocco
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