P5.098 Clinical Prediction of Fluoroquinolone Susceptibility, Directly from Residual Routine NAAT Gonococcal-Positive Samples Using agyrASNP Detection Assay

V F Miari, M J Pond, K Laing, H Jagatia, I Monahan, T Planche, P D Butcher, S T Sadiq
2013 Sexually Transmitted Infections  
Conclusion Culture and antibiotic susceptibility testing remains essential in gonorrhoea management in regard of recent surveillance data suggesting that cephalosporins are becoming less effective in the treatment of gonorrhoea. Our data suggest that treatment failures with oral cefixime may occur even in infections with cefixime susceptible N. gonorrhoeae strains. Background Antimicrobial resistance to treatment can hinder gonorrhoea prevention and control efforts, thereby leading to increases
more » ... in gonorrhoea incidence. We estimated the economic burden of potential increases in gonorrhoea incidence in the US as a result of emerging cephalosporin resistance. Methods The potential increase in gonorrhoea due to resistance was based on an analysis of historical gonorrhoea incidence and ciprofloxacin resistance data. We used clinic-level resistance data from the Gonococcal Isolates Surveillance Project (GISP) and city-level gonorrhoea incidence rates from surveillance data for 17 GISP cities from 1991 to 2006. We performed a regression analysis in which the gonorrhoea rate (log) was the dependent variable and the independent variable of interest was the percentage of GISP isolates (from the clinic in the respective city) resistant to ciprofloxacin. To estimate the cost of potential increases in gonorrhoea, we used STIC- Figure, a spreadsheet programme that applies published equations of the economic impact of STDs. Results The regression analysis found a significant, positive association (p < 0.01) between ciprofloxacin resistance and gonorrhoea incidence at the city level. The results suggested that an increase in resistance from 0% to 10% of isolates could result in a net increase in gonorrhoea of about 7% (range: 3% -12%) in the first year and 17% (range: 6% -28%) after ten years. Over ten years, the estimated impact would be substantial: 48,000 additional cases of PID, 5,000 additional cases of epididymitis, and 560 additional HIV infections, with direct medical costs totaling $405 million (range: $152 million -$689 million). Conclusions Ciprofloxacin resistance was associated with increased gonorrhoea rates, despite availability of alternative treatments at the time. Correspondingly, emerging cephalosporin resistance could have substantial health and economic consequences. Efforts to control the spread and reduce the consequences of resistant strains can mitigate this potential burden. on 24 July 2018 by guest. Protected by copyright. Conclusions Direct genotypic testing of routine gonococcal NAAT-positive genital samples allows for safe use of ciprofloxacin in gonorrhoea but may have limited impact, particularly for men until available at the point of care. mEtronidazolE antimicrobial drUg rEsistancE tEsting of TrichomoNas VaGiNalis collEctEd from womEn attEnding an anti-rEtroviral clinic, PrEtoria, soUth africa
doi:10.1136/sextrans-2013-051184.1142 fatcat:fe6yf5x4vnbyboxtmfgxmwzxeq