Impact of Rapid Susceptibility Testing and Antibiotic Selection Strategy on the Emergence and Spread of Antibiotic Resistance in Gonorrhea

Tuite, Ashleigh R.; Gift, Thomas L.; Chesson, Harrell W.; Hsu, Katherine; Salomon, Joshua A.; Grad, Yonatan H.

doi:10.1093/infdis/jix450

Cited by 67 publications

(70 citation statements)

References 37 publications

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“…About 42% of gonorrhea cases in 2017 were among MSM, and the emergence of resistance among this population is of particular concern [1,5]. The model is adapted from Tuite and colleagues [15], with additional details necessary to evaluate the strategies described in Table 1. [15], with additional details necessary to evaluate the strategies in Table 1.…”

Section: A Gonorrhea Transmission Dynamic Modelmentioning

confidence: 99%

“…The model is adapted from Tuite and colleagues [15], with additional details necessary to evaluate the strategies described in Table 1. [15], with additional details necessary to evaluate the strategies in Table 1.…”

Section: A Gonorrhea Transmission Dynamic Modelmentioning

confidence: 99%

“…Resistance may arise while an individual receives antibiotic treatment ( Fig 1B). To account for the fitness cost associated with resistance, we assumed that compared to susceptible strains, resistant strains are less transmissible [15], at least initially. Data from GISP indicate that despite the decrease in the use of tetracycline, penicillin, ciprofloxacin, cefixime, ceftriaxone, and azithromycin in recent years, the prevalence of resistance to these antibiotics has been fairly stable [1].…”

Section: Plos Medicinementioning

confidence: 99%

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Adaptive guidelines for the treatment of gonorrhea to increase the effective life span of antibiotics among men who have sex with men in the United States: A mathematical modeling study

et al. 2020

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Background The rise of gonococcal antimicrobial resistance highlights the need for strategies that extend the clinically useful life span of antibiotics. Because there is limited evidence to support the current practice of switching empiric first-line antibiotic when resistance exceeds 5% in the population, our objective was to compare the impact of alternative strategies on the effective life spans of antibiotics and the overall burden of gonorrhea.

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Section: A Gonorrhea Transmission Dynamic Modelmentioning

confidence: 99%

Section: A Gonorrhea Transmission Dynamic Modelmentioning

confidence: 99%

Section: Plos Medicinementioning

confidence: 99%

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Adaptive guidelines for the treatment of gonorrhea to increase the effective life span of antibiotics among men who have sex with men in the United States: A mathematical modeling study

et al. 2020

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“…Nucleic acid-based diagnostics that enable rapid pathogen identification and prediction of drug susceptibility profiles can improve clinical decision-making, reduce inappropriate antibiotic use, and help address the challenge of antibiotic resistance 1–3 . However, the sensitivity of such diagnostics may be undermined by undetected genetic variants 4–12 .…”

Section: Introductionmentioning

confidence: 99%

Targeted surveillance strategies for efficient detection of novel antibiotic resistance variants

Hicks

Kissler

Mortimer

et al. 2020

Preprint

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20Genotype-based diagnostics for antibiotic resistance represent a promising alternative to 21 empiric therapy, reducing inappropriate and ineffective antibiotic use. However, because 22 103 Results: 104Composition of the datasets. 105The datasets (Table 1) were biased across patient demographics and/or geographic 106 regions (Tables S1 and S2). Isolates from men and men who have sex with men (MSM) 107 were overrepresented in datasets 1 and 2 compared to overall gonorrhea incidence in 108 men and MSM in the US and Australia, respectively, during the study periods (Table S2, 109 P < 0.001 for both datasets by chi-squared test of men vs. women and MSM vs. non-110 MSM in dataset vs. reported incidence). Dataset 4 was comprised exclusively of isolates 111 from men 31 . While it is difficult to estimate the prevalence of pharyngeal gonococcal 112 infections, as they tend to be asymptomatic 32 , pharyngeal isolates represented 4% and 113

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“…Among a number of innovative approaches to improve antibiotic use (9–15), one of the most promising leverages point-of-care resistance diagnostics (POC-RD) that provide prescribers with a rapid readout of the sensitivity/resistance profile of an infecting organism. POC-RD allows prescribers to choose older, cheaper, and/or narrower-spectrum antibiotics when such drugs are most appropriate for patients, thereby saving newer, more expensive, and/or broader-spectrum antibiotics for situations where they are really needed, and perhaps reducing the intensity of selection for resistance to these drugs (16–18).…”

Section: Introductionmentioning

confidence: 99%

Resistance diagnostics as a public health tool to combat antibiotic resistance: A model-based evaluation

McAdams

Waldetoft

Tedijanto

et al. 2018

Preprint

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16Rapid point-of-care resistance diagnostics (POC-RD) are a key tool in the fight against 17 antibiotic resistance. By tailoring drug choice to infection genotype, doctors can improve 18 treatment efficacy while limiting costs of inappropriate antibiotic prescription. Here we 19 combine epidemiological theory and data to assess the potential of RD innovations in a 20 public health context, as a means to limit or even reverse selection for antibiotic 21 resistance. POC-RD can be used to impose a non-biological fitness cost on resistant 22 strains, by enabling diagnostic-informed treatment and targeted interventions that 23 reduce resistant strains' opportunities for transmission. We assess this diagnostic-24 imposed fitness cost in the context of a spectrum of bacterial population biologies, and 25 find that the expected impact varies from selection against resistance for obligate 26 pathogens to marginal public health improvements for opportunistic pathogens with high 27 'bystander' antibiotic exposure during asymptomatic carriage (e.g. the pneumococcus). 28We close by generalizing the notion of RD-informed strategies to incorporate carriage 29 surveillance information, and illustrate that coupling transmission-control interventions to 30 the discovery of resistant strains in carriage can potentially select against resistance in 31 a broad range of opportunistic pathogens. 32 33 34 "Because antibiotic resistance occurs as part of a natural evolution 35 process, it can be significantly slowed but not stopped. Therefore, new 36 antibiotics will always be needed to keep up with resistant bacteria." 37 (CDC, "Antibiotic Resistance Threats in the United States, 2013") (1) 38 The antimicrobial resistance crisis threatens to undermine key features of modern 39 medicine, at great costs in terms of patient morbidity, mortality and treatment expense 40 (2-6). Current mainstream antibiotic-treatment strategies sow the seeds of their own 41 downfall by strongly selecting for resistant strains, leading some to argue that continual 42 new-antibiotic discovery is the only way to stay ahead of a "post-antibiotic future" (1, 7, 43 8). If this bleak vision is correct, there is an urgent need to buy time by extending the 44 lifespan of existing antibiotics while research and development for new ones takes its 45 course. More optimistically, it may be possible to improve how we use existing 46 antibiotics and to implement other control measures so that an endless supply of new 47 antibiotics is not required. 48 Among a number of innovative approaches to improve antibiotic use (9-15), one of the 49 most promising leverages point-of-care resistance diagnostics (POC-RD) that provide 50 prescribers with a rapid readout of the sensitivity/resistance profile of an infecting 51 organism. POC-RD allows prescribers to choose older, cheaper, and/or narrower-52 spectrum antibiotics when such drugs are most appropriate for patients, thereby saving 53 newer, more expensive, and/or broader-spectrum antibiotics for situations where they 54 are rea...

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Impact of Rapid Susceptibility Testing and Antibiotic Selection Strategy on the Emergence and Spread of Antibiotic Resistance in Gonorrhea

Abstract: Mathematical modeling suggests that rapid diagnostics that report antibiotic susceptibility have the potential to extend the usefulness of existing antibiotics for treatment of gonorrhea compared with the current guidelines for empiric 2-drug treatment.

Cited by 67 publications

References 37 publications

Adaptive guidelines for the treatment of gonorrhea to increase the effective life span of antibiotics among men who have sex with men in the United States: A mathematical modeling study

Adaptive guidelines for the treatment of gonorrhea to increase the effective life span of antibiotics among men who have sex with men in the United States: A mathematical modeling study

Targeted surveillance strategies for efficient detection of novel antibiotic resistance variants

Resistance diagnostics as a public health tool to combat antibiotic resistance: A model-based evaluation

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