Stewardship/Resistance Analysis June 17, 2022

Ultra-resistant gonorrhea strain identified in Austria

Austrian researchers report the identification of a second strain of extensively drug-resistant gonorrhea (XDR).

In a case report published yesterday in Eurosurveillance, the researchers described the strain, which was detected in a heterosexual man from Austria who had unprotected sex with a sex worker in Cambodia. The patient was treated with the standard treatment regimen for gonorrhea (one intramuscular dose of ceftriaxone plus one oral dose of azithromycin), and symptoms were resolved at the 2-week follow-up visit, but a reaction test polymerase chain (PCR) assay found the patient was still positive for Neisseria gonorrhoeae.

The case was considered a treatment failure and additional antibiotic treatment was prescribed.

Subsequent antimicrobial susceptibility testing of N gonorrhea the patient’s isolates showed high-level resistance to azithromycin and resistance to ceftriaxone, cefixime, cefotaxime, ciprofloxacin, and tetracycline. A molecular investigation revealed genetic mutations similar to those detected in a strain of XDR N gonorrhea identified in three patients in the UK and Australia in 2018. The researchers say the strains belong to the same subline, which they believe could make gonorrhea incurable if it establishes sustained transmission.

“XDR N. gonorrhoeae Strains, including those resistant to all available treatment options, are a major global public health problem,” the researchers wrote. “They pose a risk of treatment failure and serious complications/sequelae at the individual level, but also compromise gonorrhea management and control at the public health level.

They add that surveillance of antimicrobial susceptibility, both nationally and internationally, but particularly in Asia, where many strains of ceftriaxone-resistant gonorrhea have emerged, is needed, and that new antibiotics for effective treatment of gonorrhea are needed.
June 16 Eurosurveillance fast communication

Study notes overuse of antibiotics for respiratory infections in primary care

A study in a large Upper Midwest health system found that unnecessary prescribing of antibiotics for upper respiratory tract infections (URIs) was common among all primary care providers, but worse among older rural clinicians and those in high-volume specialties, researchers reported today. in Open Forum on Infectious Diseases.

In the analysis of electronic medical records from Sanford Health, which serves patients in South Dakota, North Dakota and Minnesota, researchers looked at all patients 18 and older who were seen by a healthcare provider. primary care for URI (acute bronchitis, pharyngitis, nonspecific acute respiratory tract infection, and uncomplicated acute rhinosinusitis) from June 2017 to May 2018. They then compared individual rates of unnecessary antibiotic prescribing by practicing primary care providers. in internal medicine, family medicine, and urgent care departments, and identified patient and provider characteristics associated with unnecessary prescribing.

Of the 49,463 patient consultations included in the study, antibiotics were prescribed unnecessarily for 42.2%. Acute bronchitis had the highest rate of unnecessary prescriptions, with antibiotics being prescribed in 74.2% of consultations. Men and elderly patients were more likely to be prescribed unnecessary antibiotics.

Provider characteristics associated with higher rates of unnecessary prescribing included being in a rural practice (odds ratio [OR], 1.49; 95% confidence interval [CI]1.20 to 1.84), having more years of practice (OR, 1.09; 95% CI, 1.01 to 1.06 every 5 years) and being in a high-volume specialty such as emergency care (OR, 1.43; 95% CI, 1.08 to 1.89).

“Despite multiple public health initiatives and guidelines from professional societies aimed at producing more judicious use of antibiotics for URI in outpatient settings, overuse remains quite common,” the study authors conclude. “Targeting higher volume clinicians can be particularly impactful.”

They add, “Health systems should be encouraged to engage them and new strategies to promote the necessary and appropriate use of antibiotics as an urgent priority for their quality improvement initiatives.
June 17 Infect Dis Open Forum abstract

Certified Antibiotic Resistance Application for Low Resource Settings

The global humanitarian organization Médecins Sans Frontières/Médecins Sans Frontières (MSF) announced this week that a mobile application it helped develop to facilitate the diagnosis of antibiotic-resistant infections in low- and middle-income countries (LMICs) ) has been certified in Europe and is a step closer to wide distribution.

Antibiogo, which is available as a free, open-source, and offline app for Android devices, allows non-LMICS lab technicians to measure and interpret antibiograms—the lab tests that determine whether cultured bacteria from patients are sensitive to antibiotics – with a phone call. Using image processing and artificial intelligence technology, the app processes an uploaded photo of the cultured bacteria and selected antibiotics in a Petri dish, summarizes and interprets the results according to the rules of the societies of European and American microbiology and recommends an antibiotic.

MSF says the test was specifically developed for low-resource settings, which often lack the equipment to perform antibiograms, don’t have enough microbiologists to interpret them, or aren’t well suited to automated diagnostic tests. that require reliable sources of electricity. Field testing showed a high level of agreement with the interpretation made by qualified microbiologists.

“Thanks to Antibiogo, any microbiology laboratory technician, wherever they are, will be able to read and interpret an antibiogram directly on their phone, online or offline, and know the resistance profile of the bacteria responsible for infection of a patient,” said Nada Malou, PhD, head of the Antibiogo program, MSF said in a press release.

“Used well, it is a fantastic new diagnostic tool that will help ensure wider access to high-quality bacteriological testing even in the absence of microbiologists. This will not only allow patients to be treated with the most appropriate antibiotics , but also to reduce antibiotic resistance.”

The app will first be used in MSF laboratories in Mali, Central African Republic, Yemen and Jordan this summer, allowing MSF to collect user feedback and performance data under real-world conditions.
June 15 MSF Press release

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