Is previous azithromycin treatment associated with azithromycin resistance in Neisseria gonorrhoeae? A cross-sectional study using national surveillance data in England
| Autor: | Hamish Mohammed, Katy Town, Sarah C Woodhall, Martina Furegato, Michelle J Cole, Helen Fifer, Gwenda Hughes, J Kevin Dunbar, Soazig Clifton |
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| Rok vydání: | 2018 |
| Předmět: |
0301 basic medicine
medicine.medical_specialty medicine.drug_class business.industry 030106 microbiology Non-gonococcal urethritis Dermatology Drug resistance urologic and male genital diseases medicine.disease_cause medicine.disease Azithromycin Macrolide Antibiotics 03 medical and health sciences 0302 clinical medicine Infectious Diseases Antibiotic resistance Internal medicine medicine Neisseria gonorrhoeae Urethritis 030212 general & internal medicine Chlamydia trachomatis business medicine.drug |
| Zdroj: | Sexually Transmitted Infections. 94:421-426 |
| ISSN: | 1472-3263 1368-4973 |
| DOI: | 10.1136/sextrans-2017-053461 |
| Popis: | ObjectivesIt has been suggested that treatment of STIs with azithromycin may facilitate development of azithromycin resistance in Neisseria gonorrhoeae (NG) by exposing the organism to suboptimal doses. We investigated whether treatment history for non-rectal Chlamydia trachomatis (CT), non-gonococcal urethritis (NGU) or NG (proxies for azithromycin exposure) in sexual health (GUM) services was associated with susceptibility of NG to azithromycin.MethodsAzithromycin susceptibility data from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP 2013–2015, n=4606) and additional high-level azithromycin-resistant isolates (HL-AziR) identified by the Public Health England reference laboratory (2013–2016, n=54) were matched to electronic patient records in the national GUMCAD STI surveillance dataset (2012–2016). Descriptive and regression analyses were conducted to examine associations between history of previous CT/NGU/NG and subsequent susceptibility of NG to azithromycin.ResultsModal azithromycin minimum inhibitory concentration (MIC) was 0.25 mg/L (one dilution below the resistance breakpoint) in those with and without history of previous CT/NGU/NG (previous 1 month/6 months). There were no differences in MIC distribution by history of CT/NGU (P=0.98) or NG (P=0.85) in the previous 1 month/6 months or in the odds of having an elevated azithromycin MIC (>0.25 mg/L) (Adjusted OR for CT/NGU 0.97 (95% CI 0.76 to 1.25); adjusted OR for NG 0.82 (95% CI: 0.65 to 1.04)) compared with those with no CT/NGU/NG in the previous 6 months. Among patients with HL-AziR NG, 3 (4%) were treated for CT/NGU and 2 (3%) for NG in the previous 6 months, compared with 6% and 8%, respectively for all GRASP patients.ConclusionsWe found no evidence of an association between previous treatment for CT/NGU or NG in GUM services and subsequent presentation with an azithromycin-resistant strain. As many CT diagnoses occur in non-GUM settings, further research is needed to determine whether azithromycin-resistant NG is associated with azithromycin exposure in other settings and for other conditions. |
| Databáze: | OpenAIRE |
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