Antimicrobial resistance in sexually transmitted infections in the developed world

Ison, Catherine

doi:10.1097/qco.0b013e32834e9a6a

Cited by 33 publications

(29 citation statements)

References 49 publications

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“…Hence, efficiency savings may be gained if the prevalence in partners is low, but it would be more costly to use a POC NAAT on partners first before treatment if a high proportion of partners are positive. However, both scenarios would reduce overtreatment and therefore improve antimicrobial stewardship in genitourinary medicine 14 15 18. Caution may be warranted however, to ensure that potential positive partners are not missed if they fall outside of the window period for detecting infection.…”

Section: Discussionmentioning

confidence: 99%

Mapping patient pathways and estimating resource use for point of care versus standard testing and treatment of chlamydia and gonorrhoea in genitourinary medicine clinics in the UK

et al. 2014

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ObjectivesWe aimed to explore patient pathways using a chlamydia/gonorrhoea point-of-care (POC) nucleic acid amplification test (NAAT), and estimate and compare the costs of the proposed POC pathways with the current pathways using standard laboratory-based NAAT testing.Design/participantsWorkshops were conducted with healthcare professionals at four sexual health clinics representing diverse models of care in the UK. They mapped out current pathways that used chlamydia/gonorrhoea tests, and constructed new pathways using a POC NAAT. Healthcare professionals' time was assessed in each pathway.Outcome measureThe proposed POC pathways were then priced using a model built in Microsoft Excel, and compared to previously published costs for pathways using standard NAAT-based testing in an off-site laboratory.ResultsPathways using a POC NAAT for asymptomatic and symptomatic patients and chlamydia/gonorrhoea-only tests were shorter and less expensive than most of the current pathways. Notably, we estimate that POC testing as part of a sexual health screen for symptomatic patients, or as stand-alone chlamydia/gonorrhoea testing, could reduce costs per patient by as much as £16 or £6, respectively. In both cases, healthcare professionals' time would be reduced by approximately 10 min per patient.ConclusionsPOC testing for chlamydia/gonorrhoea in a clinical setting may reduce costs and clinician time, and may lead to more appropriate and quicker care for patients. Further study is warranted on how to best implement POC testing in clinics, and on the broader clinical and cost implications of this technology.

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Section: Discussionmentioning

confidence: 99%

Mapping patient pathways and estimating resource use for point of care versus standard testing and treatment of chlamydia and gonorrhoea in genitourinary medicine clinics in the UK

et al. 2014

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“…However, internationally, there is now a high prevalence of N. gonorrhoeae strains with resistance to most antimicrobials previously and currently widely available for treatment (e.g., sulfonamides, penicillins, earlier cephalosporins, tetracyclines, macrolides, and fluoroquinolones). The recent occurrence of failures to treat gonorrhea with the extended-spectrum cephalosporins (ESCs) cefixime and ceftriaxone and the emergence of gonococcal strains exhibiting high-level clinical resistance to all ESCs (2)(3)(4)(5), combined with resistance to nearly all other available therapeutic antimicrobials, have caused great concern, as evidenced by publications in the medical literature (5)(6)(7)(8)(9) and the lay press (10) and by development of global, regional, and national action/response plans (11)(12)(13)(14). In most settings worldwide, ceftriaxone is the last remaining option for empirical first-line antimicrobial monotherapy.…”

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confidence: 99%

Antimicrobial Resistance in Neisseria gonorrhoeae in the 21st Century: Past, Evolution, and Future

2014

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SUMMARY Neisseria gonorrhoeae is evolving into a superbug with resistance to previously and currently recommended antimicrobials for treatment of gonorrhea, which is a major public health concern globally. Given the global nature of gonorrhea, the high rate of usage of antimicrobials, suboptimal control and monitoring of antimicrobial resistance (AMR) and treatment failures, slow update of treatment guidelines in most geographical settings, and the extraordinary capacity of the gonococci to develop and retain AMR, it is likely that the global problem of gonococcal AMR will worsen in the foreseeable future and that the severe complications of gonorrhea will emerge as a silent epidemic. By understanding the evolution, emergence, and spread of AMR in N. gonorrhoeae , including its molecular and phenotypic mechanisms, resistance to antimicrobials used clinically can be anticipated, future methods for genetic testing for AMR might permit region-specific and tailor-made antimicrobial therapy, and the design of novel antimicrobials to circumvent the resistance problems can be undertaken more rationally. This review focuses on the history and evolution of gonorrhea treatment regimens and emerging resistance to them, on genetic and phenotypic determinants of gonococcal resistance to previously and currently recommended antimicrobials, including biological costs or benefits; and on crucial actions and future advances necessary to detect and treat resistant gonococcal strains and, ultimately, retain gonorrhea as a treatable infection.

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“…However, N. gonorrhoeae has developed resistance to all antimicrobials previously and currently used for first-line treatment. During the latest decade, in vitro resistance, including high-level resistance, to the last remaining option for first-line empirical antimicrobial monotherapy, i.e., the extended-spectrum cephalosporin ceftriaxone, has emerged (5)(6)(7)(8)(9)(10)(11)(12). This in vitro resistance has also translated into rare clinical failures to treat pharyngeal gonorrhea with ceftriaxone in several countries (6,7,(12)(13)(14)(15)(16)(17)(18).…”

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confidence: 99%

High In Vitro Susceptibility to the Novel Spiropyrimidinetrione ETX0914 (AZD0914) among 873 Contemporary Clinical Neisseria gonorrhoeae Isolates from 21 European Countries from 2012 to 2014

Unemo

Ringlander

Wiggins

et al. 2015

Antimicrob Agents Chemother

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Antimicrobial resistance in sexually transmitted infections in the developed world

Abstract: Emerging resistance in all bacterial STIs and the particular problem of resistant gonorrhoea will present a challenge to maintain antimicrobial therapy at the forefront of public health control.

Cited by 33 publications

References 49 publications

Mapping patient pathways and estimating resource use for point of care versus standard testing and treatment of chlamydia and gonorrhoea in genitourinary medicine clinics in the UK

Mapping patient pathways and estimating resource use for point of care versus standard testing and treatment of chlamydia and gonorrhoea in genitourinary medicine clinics in the UK

Antimicrobial Resistance in Neisseria gonorrhoeae in the 21st Century: Past, Evolution, and Future

High In Vitro Susceptibility to the Novel Spiropyrimidinetrione ETX0914 (AZD0914) among 873 Contemporary Clinical Neisseria gonorrhoeae Isolates from 21 European Countries from 2012 to 2014

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