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Martin SL, Mortimer TD, Grad YH. Machine learning models for Neisseria gonorrhoeae antimicrobial susceptibility tests. Ann N Y Acad Sci 2023; 1520:74-88. [PMID: 36573759 PMCID: PMC9974846 DOI: 10.1111/nyas.14549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Neisseria gonorrhoeae is an urgent public health threat due to the emergence of antibiotic resistance. As most isolates in the United States are susceptible to at least one antibiotic, rapid molecular antimicrobial susceptibility tests (ASTs) would offer the opportunity to tailor antibiotic therapy, thereby expanding treatment options. With genome sequence and antibiotic resistance phenotype data for nearly 20,000 clinical N. gonorrhoeae isolates now available, there is an opportunity to use statistical methods to develop sequence-based diagnostics that predict antibiotic susceptibility from genotype. N. gonorrhoeae, therefore, provides a useful example illustrating how to apply machine learning models to aid in the design of sequence-based ASTs. We present an overview of this framework, which begins with establishing the assay technology, the performance criteria, the population in which the diagnostic will be used, and the clinical goals, and extends to the choices that must be made to arrive at a set of features with the desired properties for predicting susceptibility phenotype from genotype. While we focus on the example of N. gonorrhoeae, the framework generalizes to other organisms for which large-scale genotype and antibiotic resistance data can be combined to aid in diagnostics development.
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Affiliation(s)
- Skylar L. Martin
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Tatum D. Mortimer
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Yonatan H. Grad
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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2
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Song S, Jiang M, Liu H, Yao J, Zhang X, Dai X. Base-catalyzed hydrolysis of spectinomycin in aqueous solutions: Kinetics and mechanisms. CHEMOSPHERE 2023; 312:137243. [PMID: 36395893 DOI: 10.1016/j.chemosphere.2022.137243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/11/2022] [Accepted: 11/12/2022] [Indexed: 06/16/2023]
Abstract
Hydrolysis plays an imperative role in the abiotic transformation process of antibiotics in aqueous solutions. However, little information is available on the hydrolysis process of spectinomycin (an aminocyclitol antibiotic). This study systematically investigated the spectinomycin hydrolysis kinetics and mechanisms under different pH via experiments and density functional theory (DFT) computation. Hydrolysis was first conducted in a pure water system under pH of 4.0-9.0 and temperature of 25 °C, 50 °C and 70 °C, respectively. Results showed that hydrolysis was highly dependent on pH and temperature. When pH > 6.0, spectinomycin hydrolysis was accelerated by the catalysis of OH-. Meanwhile, the hydrolysis rate increased with the elevation of temperature. Then, for the reference of the practical environment, the general base-catalyzed hydrolysis and mechanisms were studied under environmental pH 6.0-8.0 and 25 °C. DFT calculation demonstrated that base-catalyzed hydrolysis of spectinomycin could be more thermodynamically and kinetically favorable based on the lower Gibbs free energies of reaction and Gibbs free energies of activation. Further, instead of specific base catalysis (OH-), the general base catalysis (e.g., phosphate buffer) was also found to promote hydrolysis efficiency. The antibacterial activity and ecotoxicities of the hydrolysis product were analyzed to be lower than the precursor, thereby decreasing the environmental impact of spectinomycin.
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Affiliation(s)
- Siqi Song
- State Key Laboratory of Urban Water Resources and Environment, School of Environment, Harbin Institute of Technology, Harbin, 150090, China
| | - Mingye Jiang
- State Key Laboratory of Urban Water Resources and Environment, School of Environment, Harbin Institute of Technology, Harbin, 150090, China
| | - Huiling Liu
- College of Environmental Science and Engineering, Tongji University, Shanghai, 200092, China.
| | - Jie Yao
- State Key Laboratory of Urban Water Resources and Environment, School of Environment, Harbin Institute of Technology, Harbin, 150090, China.
| | - Xiaoyuan Zhang
- Advanced Environmental Biotechnology Centre, Nanyang Environment and Water Research Institute, Nanyang Technological University, 1 Cleantech Loop Singapore, 637141, Singapore
| | - Xiaohu Dai
- College of Environmental Science and Engineering, Tongji University, Shanghai, 200092, China
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3
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Dos Santos TF, Goveia MR, Moraes GM, Tavares MA, Davalos SR, Campos CB, de Oliveira FA, Benitez DF, Tavares MB, Colli EDH, Pinheiro ME, Rodrigues BDR, Neto CD, Ribeiro RS. Gonococci resistant to current antimicrobial management standards: a new threat to global public health. Future Microbiol 2022; 17:1241-1247. [PMID: 36006076 DOI: 10.2217/fmb-2022-0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
Gonorrhea is the second most common sexually transmitted bacterial infection on the planet and is caused by a Gram-negative cocco, Neisseria gonorrhoeae. Currently, the preferred regimen for the management of this disease in Brazil is a combination of antimicrobials, in this case, ceftriaxone and azithromycin. However, over time, the gonococcus developed a decrease in susceptibility to the regimen used, which resulted in frank resistance to antimicrobials, progressively reducing the therapeutic options available. Thus, the study presented here aims to analyze and discuss the current scenario of resistance of N. gonorrhoeae to the antimicrobials used to date, to encourage discussion on the subject in the academic environment. For this purpose, 47 articles indexed in the Bireme, PubMed, Scielo and UpToDate platforms were selected.
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Affiliation(s)
| | | | | | - Marco Asb Tavares
- Federal University of Mato Grosso do Sul, UFMS, Campo Grande, Brazil
| | - Silvio Ra Davalos
- Federal University of Mato Grosso do Sul, UFMS, Campo Grande, Brazil
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Medland NA, Zhang Y, Gunaratnam P, Lewis DA, Donovan B, Whiley DM, Guy RJ, Kaldor JM. Surveillance systems to monitor antimicrobial resistance in Neisseria gonorrhoeae: a global, systematic review, 1 January 2012 to 27 September 2020. EURO SURVEILLANCE : BULLETIN EUROPEEN SUR LES MALADIES TRANSMISSIBLES = EUROPEAN COMMUNICABLE DISEASE BULLETIN 2022; 27. [PMID: 35514308 PMCID: PMC9074396 DOI: 10.2807/1560-7917.es.2022.27.18.2100917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Effective surveillance of antimicrobial resistance (AMR) in Neisseria gonorrhoeae is required for the early detection of resistant strains and to ensure that treatment guidelines are appropriate for the setting in which they are implemented. AMR in N. gonorrhoeae has been identified as a global health threat. Aim We performed a systematic review to identify and describe surveillance systems targeting AMR in N. gonorrhoeae. Methods We searched Medline, PubMed, Global Health, EMBASE, CINAHL, Web of Science and ProQuest databases and grey literature between 1 January 2012 and 27 September 2020. Surveillance systems were defined as the continuous, systematic collection, analysis and interpretation of N. gonorrhoeae resistance data. The key components of surveillance systems were extracted, categorised, described and summarised. Results We found 40 publications reporting on N. gonorrhoeae AMR surveillance systems in 27 countries and 10 multi-country or global surveillance reports. The proportion of countries with surveillance systems in each of the WHO's six regions ranged from one of 22 countries in the Eastern Mediterranean and five of 54 in Africa, to three of 11 countries in South East Asia. Only four countries report systems which are both comprehensive and national. We found no evidence of a current surveillance system in at least 148 countries. Coverage, representativeness, volume, clinical specimen source, type and epidemiological information vary substantially and limit interpretability and comparability of surveillance data for public health action. Conclusion Globally, surveillance for N. gonorrhoeae AMR is inadequate and leaves large populations vulnerable to a major public health threat.
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Affiliation(s)
| | - Ye Zhang
- Kirby Institute, University of New South Wales, Sydney, Australia
| | | | - David A Lewis
- Westmead Clinical School and Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Australia.,Sydney Sexual Health Centre, Sydney, Australia
| | - Basil Donovan
- Kirby Institute, University of New South Wales, Sydney, Australia.,Sydney Sexual Health Centre, Sydney, Australia
| | - David M Whiley
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Rebecca J Guy
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - John M Kaldor
- Kirby Institute, University of New South Wales, Sydney, Australia
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Findlater L, Mohammed H, Gobin M, Fifer H, Ross J, Geffen Obregon O, Turner KME. Developing a model to predict individualised treatment for gonorrhoea: a modelling study. BMJ Open 2021; 11:e042893. [PMID: 34172543 PMCID: PMC8237724 DOI: 10.1136/bmjopen-2020-042893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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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Le W, Su X, Lou X, Li X, Gong X, Wang B, Genco CA, Mueller JP, Rice PA. Susceptibility Trends of Zoliflodacin against Multidrug-Resistant Neisseria gonorrhoeae Clinical Isolates in Nanjing, China, 2014 to 2018. Antimicrob Agents Chemother 2021; 65:e00863-20. [PMID: 33318010 PMCID: PMC8092536 DOI: 10.1128/aac.00863-20] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 11/16/2020] [Indexed: 11/20/2022] Open
Abstract
Previously, we reported the potent activity of a novel spiropyrimidinetrione, zoliflodacin, against Neisseria gonorrhoeae isolates collected in 2013 from symptomatic men in Nanjing, China. Here, we investigated trends of susceptibilities to zoliflodacin in 986 isolates collected from men between 2014 and 2018. N. gonorrhoeae isolates were tested for susceptibility to zoliflodacin and seven other antibiotics. Mutations in the gyrA, gyrB, parC, parE, and mtrR genes were determined by PCR and sequencing. The MICs of zoliflodacin ranged from ≤0.002 to 0.25 mg/liter; the overall MIC50 and MIC90 were 0.06 mg/liter and 0.125 mg/liter, respectively, in 2018, increasing 2-fold from 2014. However, the percentage of isolates with lower zoliflodacin MICs declined in each year sequentially, while the percentage with higher MICs increased yearly (P ≤ 0.00001). All isolates were susceptible to spectinomycin but resistant to ciprofloxacin (MIC ≥ 1 mg/liter); 21.2% (209/986) were resistant to azithromycin (≥1 mg/liter), 43.4% (428/986) were penicillinase-producing N. gonorrhoeae (PPNG), 26.9% (265/986) were tetracycline-resistant N. gonorrhoeae (TRNG), and 19.4% (191/986) were multidrug-resistant (MDR) isolates. 202 isolates with the lowest (≤0.002 to 0.015 mg/liter) and highest (0.125 to 0.25 mg/liter) zoliflodacin MICs were quinolone resistant with double or triple mutations in gyrA; 193/202 (95.5%) also had mutations in parC There were no D429N/A and/or K450T mutations in GyrB identified in the 143 isolates with higher zoliflodacin MICs; an S467N mutation in GyrB was identified in one isolate. We report that zoliflodacin continues to have excellent in vitro activity against clinical gonococcal isolates, including those with high-level resistance to ciprofloxacin, azithromycin, and extended-spectrum cephalosporins.
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Affiliation(s)
- Wenjing Le
- STD Clinic, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Xiaohong Su
- STD Clinic, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Xiangdi Lou
- STD Clinic, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Xuechun Li
- STD Clinic, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Xiangdong Gong
- STD Clinic, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Baoxi Wang
- STD Clinic, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
- Department of Dermatology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Caroline A Genco
- Department of Immunology, School of Medicine, Tufts University, Boston, Massachusetts, USA
| | | | - Peter A Rice
- Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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7
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Kenyon C, Buyze J, Spiteri G, Cole MJ, Unemo M. Population-Level Antimicrobial Consumption Is Associated With Decreased Antimicrobial Susceptibility in Neisseria gonorrhoeae in 24 European Countries: An Ecological Analysis. J Infect Dis 2021; 221:1107-1116. [PMID: 30957153 DOI: 10.1093/infdis/jiz153] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 04/01/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES There are substantial variations between different populations in the susceptibility of Neisseria gonorrhoeae to antimicrobials, and the reasons for this are largely unexplored. We aimed to assess whether the population-level consumption of antimicrobials is a contributory factor. METHODS Using antimicrobial susceptibility data from 24 countries in the European Gonococcal Antimicrobial Surveillance Programme and antimicrobial consumption data from the IQVIA MIDAS database, we built mixed-effects linear/logistic regression models with country-level cephalosporin, fluoroquinolone, and macrolide consumption (standard doses/1000 population/year) as the explanatory variables (from 2009 to 2015) and 1-year-lagged ceftriaxone, cefixime, azithromycin, and ciprofloxacin geometric mean minimum inhibitory concentrations (MICs) as the outcome variables (from 2010 to 2016). RESULTS Positive correlations were found between the consumption of cephalosporins and the geometric mean MICs of ceftriaxone and cefixime (P < .05 for both comparisons). Fluoroquinolone consumption was positively associated with the prevalence of resistance to ciprofloxacin (P < .05). CONCLUSIONS Differences in the population-level consumption of particular antimicrobials may contribute to variations in the level of antimicrobial resistance in N. gonorrhoeae in different settings. Further interventions to reduce misuse and overuse of antimicrobials in high-consumption populations and core groups are required.
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Affiliation(s)
- Chris Kenyon
- HIV/STI Unit.,Division of Infectious Diseases and HIV Medicine, University of Cape Town, South Africa
| | - Jozefien Buyze
- Clinical Trials Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - G Spiteri
- European Centre for Disease Prevention and Control, Stockholm
| | - M J Cole
- National Infection Service, Public Health England, London, United Kingdom
| | - M Unemo
- WHO Collaborating Centre for Gonorrhea and Other Sexually Transmitted Infections, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Kirkcaldy RD, Weston E, Segurado AC, Hughes G. Epidemiology of gonorrhoea: a global perspective. Sex Health 2020; 16:401-411. [PMID: 31505159 DOI: 10.1071/sh19061] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/19/2019] [Indexed: 12/14/2022]
Abstract
Although understanding the local epidemiology of gonorrhoea is critical for local efforts, understanding the multinational epidemiology may support development of national and international prevention and control policies and strategies. In this paper, current epidemiology of gonorrhoea is reviewed through an international lens and with a focus on selected populations. The World Health Organization (WHO) estimates that ~87 million new gonococcal infections occurred among people aged 15-49 years in 2016. Gonorrhoea rates are rising in many countries. Gay, bisexual and other men who have sex with men, racial or ethnic minorities, Indigenous populations and sex workers appear to bear disproportionate burdens of gonorrhoea. International travel can facilitate spread of gonorrhoea, including resistant strains, across international borders. Critical gaps in epidemiological knowledge are highlighted, including data on gonorrhoea among transgender persons and the burden of extragenital gonorrhoea. Even as further data are gathered, action - informed by currently available data - is needed now to confront this growing international threat.
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Affiliation(s)
- Robert D Kirkcaldy
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA; and Corresponding author.
| | - Emily Weston
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA
| | - Aluisio C Segurado
- Faculty of Medicine, University of São Paulo, Avenida Doutor Arnaldo, 455, 01246-903 São Paulo-SP, Brazil
| | - Gwenda Hughes
- Faculty of Medicine, University of São Paulo, Avenida Doutor Arnaldo, 455, 01246-903 São Paulo-SP, Brazil; and HIV & STI Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
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Derbie A, Mekonnen D, Woldeamanuel Y, Abebe T. Azithromycin resistant gonococci: a literature review. Antimicrob Resist Infect Control 2020; 9:138. [PMID: 32811545 PMCID: PMC7436955 DOI: 10.1186/s13756-020-00805-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/12/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Gonorrhea is the second most common sexually transmitted bacterial infection (STI) next to Chlamydia. Untreated cases could results in major complications like pelvic inflammatory disease (PID), ectopic pregnancy, infertility, miscarriage, fetal death and congenital infections. Gonorrhea has been treated with antibiotics for more than eight decades. However, the emergence and spread of antimicrobial resistance (AMR) in gonococcus seriously compromises the management of the disease. The aim of this review was to describe the current developments in the field of azithromycin resistant gonococci. METHODS Literatures published in English in the last 10 years were retrieved from PubMed, SCOPUS, Google scholar, Cochrane library and the Google databases using relevant searching terms. RESULTS Gonococcus is capable of using a number of strategies to confer resistance as the bacterium has an extraordinary capacity to alter its genome. So far the accumulated data on the field showed that the world is heading towards a pandemic of extensively drug-resistant (XDR) gonococcus which is now seems to be evolving into a true "superbug". Hence, in the near future gonorrhea may become untreatable on the international basis unless new drugs become available. An antibiotic resistance in gonococcus has been noted beginning in 1940s against sulfonamides. Since then, resistance has rapidly emerged to penicillins, tetracyclines, macrolides, fluoroquinolones, and cephalosporins. Currently, in most nations, the injectable extended-spectrum cephalosporin (ESC), i.e. ceftriaxone based therapy is the only remaining option for gonorrhea. Based on the WHO and the US-CDC recommendations, countries are increasingly using a combination of cephalosporin and azithromycin for the treatment of gonorrhoea. Azithromycin revolutionized gonoccocal therapy as it shortened treatment time by more than half from 7 to 14 days and improved patient compliance due to high tissue levels and long half-life. However, constantly emerging reports from different parts of the globe showed that N. gonorrhoeae is developing significant level of resistance against azithromycin, and so far more than 33% level of resistance was reported. Two strategies have been commonly implicated in gonococcal resistance against azithromycin: over expression of an efflux pump (due to mutations at mtrR coding region) and decreased antimicrobial affinity (due to mutations in genes encoding the 23S ribosomal subunit). CONCLUSIONS With no alternative antimicrobial treatment options for gonorrhoea and only a few new drugs in the development pipeline, it is necessary to monitor drug resistance and optimize treatment regimens regularly. Moreover, investigations for novel drugs should be wired.
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Affiliation(s)
- Awoke Derbie
- Department of Medical Microbiology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Bahir Dar, Ethiopia.
- Department of Health Biotechnology, Biotechnology Research Institute, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Daniel Mekonnen
- Department of Medical Microbiology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Department of Health Biotechnology, Biotechnology Research Institute, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yimtubezinash Woldeamanuel
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Bahir Dar, Ethiopia
- Department of Medical Microbiology, Immunology and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tamrat Abebe
- Department of Medical Microbiology, Immunology and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Sultan B, Benn P, Schembri G, Patel H, Brima N, Alexander S, Ison CA. Test of cure study: a feasibility study to estimate the time to test of cure (TOC) for Neisseria gonorrhoeae and Chlamydia trachomatis infections. Sex Transm Infect 2020; 96:402-407. [PMID: 32447324 DOI: 10.1136/sextrans-2019-054302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/21/2020] [Accepted: 03/17/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Test of cure (TOC) for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) infection is an important tool in the public health management of STIs. However, there are limited data about the optimal time to perform TOC using nucleic acid amplification tests (NAATs) for NG and CT infections. A study was performed to assess the feasibility of a larger study to determine the optimal time to TOC using NAATS. METHODS The Sexually Transmitted Bacteria Reference Unit at Public Health England undertook testing of gonococcal and chlamydial nucleic acids within neat urine stored in different conditions over 25 days to provide evidence of the stability of the nucleic acid prior to recruitment. Individuals diagnosed with uncomplicated NG or CT infection were recruited from three sexual health clinics. Individuals were asked to return nine self-taken samples from the site of infection over a course of 35 days. Survival analyses of time to first negative NAAT result for NG and CT infection and univariate regression analysis of factors that affect time to clearance were undertaken. RESULTS At room temperature, chlamydial DNA in urine is stable for up to 3 weeks and gonococcal DNA for up to 11 days. We analysed data for 147 infections (81 NG and 66 CT). The median time to clearance of infection was 4 days (IQR 2-10 days) for NG infection and 10 days (IQR 7-14 days) for CT infection. Vaginal CT infections took longer to clear (p=0.031). NG infection in men who have sex with men took longer to clear (p=0.052). CONCLUSION Chlamydial and gonococcal nucleic acids are stable in urine before addition of preservatives, longer than recommended by the manufacturer. The TOC results suggest that it may be possible to undertake TOC for NG and CT infections earlier than current guidelines suggest and that anatomical site of infection may affect time to clearance of infection.
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Affiliation(s)
- Binta Sultan
- Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK
| | - Paul Benn
- The Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK.,Department of Clinical Development, ViiV Healthcare, Brentford, London, UK
| | - Gabriel Schembri
- Manchester Centre for Sexual Health, Manchester Royal Infirmary, Manchester, UK
| | - Hemanti Patel
- Sexually Transmitted Bacteria Reference Unit, Public Health England Colindale, London, UK
| | - Nataliya Brima
- King's Global Health Partnership, King's College London, London, UK
| | - Sarah Alexander
- Sexually Transmitted Bacteria Reference Unit, Public Health England, London, UK
| | - Catherine A Ison
- Sexually Transmitted Bacteria Reference Unit, Public Health England, London, UK
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11
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Chen XS, Yin YP, Li XY. A ROADMAP Plan to Address Research Needs for Gonococcal Antimicrobial Resistance in China. Clin Infect Dis 2020; 68:505-510. [PMID: 29985996 DOI: 10.1093/cid/ciy566] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/08/2018] [Indexed: 12/30/2022] Open
Abstract
Gonococcal antimicrobial resistance (AMR) has become a global threat significantly hampering the control of gonorrhea. Many socioeconomic, biological, behavioral, and programmatic factors have played an important role in driving the emergence, transmission and spread of gonococcal AMR. However, research to address these scientific and programmatic questions is limited in China. Here we propose a ROADMAP (acronym for resistance surveillance, outcomes due to AMR, antibiotic stewardship and application, diagnostic tools, mechanisms of AMR, antimicrobial assessment, and population pharmacokinetics and pharmacodynamics) plan for expanding interdisciplinary collaborations to address the research needs in China.
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Affiliation(s)
- Xiang-Sheng Chen
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, China.,National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, China
| | - Yue-Ping Yin
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, China.,National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, China
| | - Xin-Yu Li
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, China
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Williamson DA, Fairley CK, Howden BP, Chen MY, Stevens K, De Petra V, Denham I, Chow EPF. Trends and Risk Factors for Antimicrobial-Resistant Neisseria gonorrhoeae, Melbourne, Australia, 2007 to 2018. Antimicrob Agents Chemother 2019; 63:e01221-19. [PMID: 31383663 PMCID: PMC6761556 DOI: 10.1128/aac.01221-19] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 07/30/2019] [Indexed: 01/19/2023] Open
Abstract
Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a major public health problem. Traditionally, AMR surveillance programs for N. gonorrhoeae have focused mainly on laboratory data to describe the prevalence and trends of resistance. However, integrating individual-level risk factors (e.g., sexual orientation or international travel) with laboratory data provides important insights into factors promoting the spread of resistant N. gonorrhoeae Here, over a 12-year period, we assessed the trends and risk factors for resistant N. gonorrhoeae in individuals attending a large publicly funded sexual health center in Melbourne, Australia. A total of 7,588 N. gonorrhoeae isolates were cultured from 5,593 individuals between 1 January 2007 and 31 December 2018. The proportion of isolates with penicillin resistance decreased from 49.5% in 2007 to 18.3% in 2018 (ptrend < 0.001) and from 63.5% in 2007 to 21.1% in 2018 for ciprofloxacin resistance (ptrend < 0.001). In contrast, the proportion of isolates displaying decreased susceptibility to ceftriaxone increased from 0.5% in 2007 to 2.9% in 2018 (ptrend < 0.001), with a significant increase in low-level azithromycin resistance, from 2.5% in 2012 to 8.2% in 2018 (ptrend < 0.001). Multivariate analysis identified risk factors for multidrug-resistant (MDR) N. gonorrhoeae, namely, female sex and country of birth, with MDR isolates more common in individuals born in northeast Asia, further highlighting the importance of this region and international travel as factors in the cross-border transmission of MDR N. gonorrhoeae Future surveillance work should incorporate additional epidemiological and genomic data to provide a comprehensive overview of the emergence and spread of resistant N. gonorrhoeae.
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Affiliation(s)
- Deborah A Williamson
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Benjamin P Howden
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Kerrie Stevens
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Vesna De Petra
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Ian Denham
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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de Laat MM, Wind CM, Bruisten SM, Dierdorp M, de Vries HJC, Schim van der Loeff MF, van Dam AP. Ceftriaxone Reduced Susceptible Neisseria gonorrhoeae in the Netherlands, 2009 to 2017: From PenA Mosaicism to A501T/V Nonmosaicism. Sex Transm Dis 2019; 46:594-601. [PMID: 31415041 DOI: 10.1097/olq.0000000000001031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To compare molecular and epidemiological differences between ceftriaxone-reduced susceptible (CRO-RS) and ceftriaxone-susceptible (CRO-S) N. gonorrhoeae (Ng) and to study the genetic relatedness of CRO-RS isolates. METHODS Demographic and clinical data and samples for cultures were routinely collected from gonorrhoea patients visiting the Amsterdam STI clinic in 2009 to 2017. Ng multiantigen sequence typing (NG-MAST) and penA types were compared between CRO-RS and CRO-S Ng (frequency matched on year of isolation and sexual risk group). Minimum spanning trees were produced based on multilocus variable number of tandem repeats analysis for Ng (NG-MLVA) genotypes. RESULTS We selected 174 CRO-RS isolates (minimum inhibitory concentration, ≥0.064 mg/L) and 174 CRO-S isolates (minimum inhibitory concentration, ≤0.016 mg/L). Demographic and clinical characteristics of patients were overall comparable between those infected with CRO-RS Ng and CRO-S Ng. However, CRO-RS isolates were more often collected from the pharyngeal site (odds ratios [OR], 3.64; P < 0.001), and patients with CRO-RS Ng were less often human immunodeficiency virus (HIV) and syphilis positive (OR, 0.63; P = 0.041 and OR, 0.58; P = 0.028, respectively). We identified 12 clusters based on NG-MLVA genotypes, including 3 large (>25 isolates) clusters predominantly containing CRO-RS isolates. Those from cluster 1 (n = 32) were mostly from 2009 to 2012 (n = 24; 75.0%), with a mosaic penA XXXIV pattern (n = 27; 84.4%) and belonging to NG-MAST genogroup G1407 (n = 24; 75.0%). Isolates from cluster 2 (n = 29) were mostly from 2013 to 2015 (n = 24; 82.7%), had a nonmosaic penA IX + A501T mutation (n = 22; 75.9%) and NG-MAST G2400 (n = 14; 48.3%). Most isolates from cluster 3 (n = 37) were from 2015 to 2017 (n = 26; 70.2%), had a nonmosaic penA IV + A501V mutation (n = 24; 64.9%) and NG-MAST G2318 (n = 22; 59.5%). CONCLUSIONS We observed a shift in the predominant penA (from mosaic toward nonmosaic plus A501T/V mutation), NG-MAST and NG-MLVA types among CRO-RS Ng over time. This indicates a successive spread of different CRO-RS Ng clones.
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Affiliation(s)
- Myrthe M de Laat
- From the Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
| | - Carolien M Wind
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Sylvia M Bruisten
- From the Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
- Amsterdam Infection & Immunity Institute (AI&II), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Mirjam Dierdorp
- From the Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
| | - Henry J C de Vries
- From the Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
- Amsterdam Infection & Immunity Institute (AI&II), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Maarten F Schim van der Loeff
- From the Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
- Amsterdam Infection & Immunity Institute (AI&II), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Alje P van Dam
- From the Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
- Amsterdam Infection & Immunity Institute (AI&II), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Kenyon C, Buyze J, Wi T. Antimicrobial Consumption and Susceptibility of Neisseria gonorrhoeae: A Global Ecological Analysis. Front Med (Lausanne) 2018; 5:329. [PMID: 30538989 PMCID: PMC6277557 DOI: 10.3389/fmed.2018.00329] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 11/09/2018] [Indexed: 12/22/2022] Open
Abstract
Aims: The reasons why antimicrobial resistance in Neisseria gonorrhoeae has emerged explosively in certain populations but not others are poorly understood. We hypothesized that population level consumption of antimicrobials plays a role. Methods: Using susceptibility data from the World Health Organizations Global Gonococcal Antimicrobial Surveillance Programme and antimicrobial consumption data from the IMS Health MIDAS database we built linear regression models with country-level cephalosporin, macrolide, and fluoroquinolone consumption (standard doses/1,000 population/year) as the explanatory variable and 1-year lagged ceftriaxone, azithromycin, and ciprofloxacin resistance as the outcome variables. These were performed at two time points 2008/2009 and 2013/2014. Results: The association between antimicrobial resistance and consumption at the level of individual countries was positive in all six assessments. In four instances the positive associations were statistically significant (cephalosporins 2008: coefficient 0.0005 [95% confidence interval (CI) 0.0002–0.0007] and 2013: coefficient 0.0003 [95% CI 0.0002–0.0004]; macrolides 2013: coefficient 0.0005 [95% CI 0.00002–0.001]; fluoroquinolones 2013: coefficient 0.02 [95% CI 0.006–0.031]). Conclusions: Differences in population level consumption of particular antimicrobials may play a role in explaining the variations in the emergence of antimicrobial resistance in N. gonorrhoeae.
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Affiliation(s)
- Chris Kenyon
- Sexually Transmitted Infections HIV/STI Unit, Institute of Tropical Medicine, Antwerp, Belgium.,Division of Infectious Diseases and HIV Medicine, University of Cape Town, Cape Town, South Africa
| | - Jozefien Buyze
- Clinical Trials Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - Teodora Wi
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Whittles LK, White PJ, Paul J, Didelot X. Epidemiological Trends of Antibiotic Resistant Gonorrhoea in the United Kingdom. Antibiotics (Basel) 2018; 7:antibiotics7030060. [PMID: 30011825 PMCID: PMC6165062 DOI: 10.3390/antibiotics7030060] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 07/06/2018] [Accepted: 07/11/2018] [Indexed: 11/16/2022] Open
Abstract
Gonorrhoea is one of the most common sexually-transmitted bacterial infections, globally and in the United Kingdom. The levels of antibiotic resistance in gonorrhoea reported in recent years represent a critical public health issue. From penicillins to cefixime, the gonococcus has become resistant to all antibiotics that have been previously used against it, in each case only a matter of years after introduction as a first-line therapy. After each instance of resistance emergence, the treatment recommendations have required revision, to the point that only a few antibiotics can reliably be prescribed to treat infected individuals. Most countries, including the UK, now recommend that gonorrhoea be treated with a dual therapy combining ceftriaxone and azithromycin. While this treatment is still currently effective for the vast majority of cases, there are concerning signs that this will not always remain the case, and there is no readily apparent alternative. Here, we review the use of antibiotics and epidemiological trends of antibiotic resistance in gonorrhoea from surveillance data over the past 15 years in the UK and describe how surveillance could be improved.
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Affiliation(s)
- Lilith K Whittles
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK.
| | - Peter J White
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK.
- MRC Centre for Outbreak Analysis and Modelling, School of Public Health, Imperial College London, London W2 1PG, UK.
- NIHR Health Protection Research Unit in Modelling Methodology, School of Public Health, Imperial College London, London W2 1PG, UK.
- Modelling and Economics Unit, National Infection Service, Public Health England, London NW9 5EQ, UK.
| | - John Paul
- Department of Microbiology, Public Health England Collaborative Centre, Royal Sussex County Hospital, Brighton BN2 5BE, UK.
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Falmer BN1 9PH, UK.
| | - Xavier Didelot
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK.
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Kenyon CR, De Baetselier I, Crucitti T. Does gonorrhoea screening intensity play a role in the early selection of antimicrobial resistance in men who have sex with men (MSM)? A comparative study of Belgium and the United Kingdom. F1000Res 2018; 7:569. [PMID: 30364212 PMCID: PMC6192441 DOI: 10.12688/f1000research.14869.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2018] [Indexed: 09/29/2023] Open
Abstract
Background: It is unclear why antimicrobial resistance in Neisseriagonorrhoeae in the United Kingdom (UK) and the United States has tended to first appear in men who have sex with men (MSM). We hypothesize that increased exposure to antimicrobials from intensive STI screening programmes plays a role. Methods: We assess if there is a difference in the distribution of azithromycin, cefixime and ceftriaxone minimum inhibitory concentrations (MICs) between MSM and women in the United Kingdom (UK) where 70% of MSM report STI screening in the past year vs. Belgium where 9% report STI screening in the past year. Our hypothesis is that MICs of the MSM should be higher than those of the women in the UK but not Belgium. Data for the MICs were taken from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) in the UK in 2010/2011 and 2014 and a similar national surveillance programme in Belgium in 2013/2014 (the first most complete available data). We used the Mann-Whitney test to compare the MIC distributions between MSM and women within each country Results: In the UK the MICs for all three antimicrobials were significantly higher in MSM than women at both time points (P all <0.0005). In Belgium only the MIC distribution for azithromycin was higher in MSM (P<0.0005). Conclusion: The findings for cefixime and ceftriaxone, but not azithromycin are compatible with our hypothesis that screening-intensity could contribute to the emergence of AMR. Numerous other interpretations of our results are discussed.
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Affiliation(s)
- Chris R. Kenyon
- HIV/STI Unit, Institute of Tropical Medicine, Antwerp, Belgium
- Division of Infectious Diseases and HIV Medicine, University of Cape Town, Cape Town, South Africa
| | - Irith De Baetselier
- HIV/STI Reference Laboratory, Institute of Tropical Medicine, Antwerp, Belgium
| | - Tania Crucitti
- HIV/STI Reference Laboratory, Institute of Tropical Medicine, Antwerp, Belgium
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Kenyon CR, De Baetselier I, Crucitti T. Does gonorrhoea screening intensity play a role in the early selection of antimicrobial resistance in men who have sex with men (MSM)? A comparative study of Belgium and the United Kingdom. F1000Res 2018; 7:569. [PMID: 30364212 PMCID: PMC6192441 DOI: 10.12688/f1000research.14869.2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2018] [Indexed: 01/06/2023] Open
Abstract
Background: It is unclear why antimicrobial resistance in Neisseriagonorrhoeae in the United Kingdom (UK) and the United States has tended to first appear in men who have sex with men (MSM). We hypothesize that increased exposure to antimicrobials from intensive STI screening programmes plays a role. Methods: We assess if there is a difference in the distribution of azithromycin, cefixime and ceftriaxone minimum inhibitory concentrations (MICs) between MSM and women in the United Kingdom (UK) where 70% of MSM report STI screening in the past year vs. Belgium where 9% report STI screening in the past year. Our hypothesis is that MICs of the MSM should be higher than those of the women in the UK but not Belgium. Data for the MICs were taken from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) in the UK in 2010/2011 and 2014 and a similar national surveillance programme in Belgium in 2013/2014 (the first most complete available data). We used the Mann-Whitney test to compare the MIC distributions between MSM and women within each country Results: In the UK the MICs for all three antimicrobials were significantly higher in MSM than women at both time points (P all <0.0005). In Belgium only the MIC distribution for azithromycin was higher in MSM (P<0.0005). Conclusion: The findings for cefixime and ceftriaxone, but not azithromycin are compatible with our hypothesis that screening-intensity could contribute to the emergence of AMR. Numerous other interpretations of our results are discussed.
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Affiliation(s)
- Chris R. Kenyon
- HIV/STI Unit, Institute of Tropical Medicine, Antwerp, Belgium
- Division of Infectious Diseases and HIV Medicine, University of Cape Town, Cape Town, South Africa
| | - Irith De Baetselier
- HIV/STI Reference Laboratory, Institute of Tropical Medicine, Antwerp, Belgium
| | - Tania Crucitti
- HIV/STI Reference Laboratory, Institute of Tropical Medicine, Antwerp, Belgium
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