Impact of rapid susceptibility testing and antibiotic selection strategy on the emergence and spread of antibiotic resistance in gonorrhea
| Autor: | Joshua A. Salomon, Ashleigh R. Tuite, Yonatan H. Grad, Thomas L. Gift, Katherine K. Hsu, Harrell W. Chesson |
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| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
0301 basic medicine
medicine.medical_specialty antibiotic resistance medicine.drug_class Point-of-care testing Point-of-Care Systems Population 030106 microbiology Gonorrhea Antibiotics Microbial Sensitivity Tests Azithromycin medicine.disease_cause 03 medical and health sciences Major Articles and Brief Reports 0302 clinical medicine Antibiotic resistance Ciprofloxacin Internal medicine medicine Disease Transmission Infectious Immunology and Allergy Humans 030212 general & internal medicine Intensive care medicine education education.field_of_study Bacteria gonorrhea Transmission (medicine) business.industry Ceftriaxone Drug Resistance Microbial Models Theoretical medicine.disease Neisseria gonorrhoeae Anti-Bacterial Agents Infectious Diseases point-of-care test business mathematical model medicine.drug |
| Zdroj: | The Journal of Infectious Diseases |
| DOI: | 10.1101/122200 |
| Popis: | 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. Background Increasing antibiotic resistance limits treatment options for gonorrhea. We examined the impact of a hypothetical point-of-care (POC) test reporting antibiotic susceptibility profiles on slowing resistance spread. Methods A mathematical model describing gonorrhea transmission incorporated resistance emergence probabilities and fitness costs associated with resistance based on characteristics of ciprofloxacin (A), azithromycin (B), and ceftriaxone (C). We evaluated time to 1% and 5% prevalence of resistant strains among all isolates with the following: (1) empiric treatment (B and C), and treatment guided by POC tests determining susceptibility to (2) A only and (3) all 3 antibiotics. Results Continued empiric treatment without POC testing was projected to result in >5% of isolates being resistant to both B and C within 15 years. Use of either POC test in 10% of identified cases delayed this by 5 years. The 3 antibiotic POC test delayed the time to reach 1% prevalence of triply-resistant strains by 6 years, whereas the A-only test resulted in no delay. Results were less sensitive to assumptions about fitness costs and test characteristics with increasing test uptake. Conclusions Rapid diagnostics reporting antibiotic susceptibility may extend the usefulness of existing antibiotics for gonorrhea treatment, but ongoing monitoring of resistance patterns will be critical. |
| Databáze: | OpenAIRE |
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