Antimicrobial Resistance in Gonorrhea: The Influence of Epidemiologic and Laboratory Surveillance Data on Treatment Guidelines: Alberta, Canada 2001–2007

Antimicrobial resistance (AMR) is a global problem, and Nepal is no exception. Countries are expected to report annually to the World Health Organization on their AMR surveillance progress through a Global Antimicrobial Resistance Surveillance System, in which Nepal enrolled in 2017. We assessed the quality of AMR surveillance data during 2019–2020 at nine surveillance sites in Province 3 of Nepal for completeness, consistency, and timeliness and examined barriers for non-reporting sites. Here, we present the results of this cross-sectional descriptive study of secondary AMR data from five reporting sites and barriers identified through a structured questionnaire completed by representatives at the five reporting and four non-reporting sites. Among the 1584 records from the reporting sites assessed for consistency and completeness, 77–92% were consistent and 88–100% were complete, with inter-site variation. Data from two sites were received by the 15th day of the following month, whereas receipt was delayed by a mean of 175 days at three other sites. All four non-reporting sites lacked dedicated data personnel, and two lacked computers. The AMR surveillance data collection process needs improvement in completeness, consistency, and timeliness. Non-reporting sites need support to meet the specific requirements for data compilation and sharing.

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Mycoplasma genitalium: test positivity in syndromic presentations and clinicians’ adherence with treatment guidelines at Sydney Sexual Health Centre

International Journal of STD & AIDS ◽

10.1177/09564624211022583 ◽

2021 ◽

pp. 095646242110225

Author(s):

Calvin Cheung ◽

Christopher Bourne ◽

Rick Varma

Keyword(s):

Decision Making ◽

Antimicrobial Resistance ◽

Sexual Health ◽

Treatment Guidelines ◽

Health Centre ◽

Diagnostic Testing ◽

Mycoplasma Genitalium ◽

Macrolide Resistance ◽

Adherence To Treatment ◽

Real World Data

Mycoplasma genitalium ( M.genitalium) is associated with urethritis, cervicitis, pelvic inflammatory disease, proctitis and epididymitis. Its treatment is complicated by antimicrobial resistance. To assess clinicians’ adherence to M.genitalium diagnostic testing recommendations for syndromic presentations, as well as resistance-guided management of M.genitalium at Sydney Sexual Health Centre, we reviewed patients presenting between August and December 2018. 349/372 (94%) syndromic presentations were tested for M.genitalium with 16% M.genitalium test positivity and 81% macrolide resistance. 16/27 (59%) macrolide-sensitive infections and 65/77 (84%) macrolide-resistant infections received resistance-guided treatment. Tests of cure (TOCs) were unnecessarily ordered for 82% macrolide-sensitive cases, while 88% macrolide-resistant cases were correctly ordered TOCs. Co-existing STIs at the time of macrolide-sensitive ( p = 0.30) or macrolide-resistant M.genitalium ( p = 0.94) diagnosis did not significantly affect adherence to treatment guidelines. This study confirms the expected prevalence of M.genitalium and macrolide resistance in syndromic presentations while our real-world data highlight the decision-making challenges involved with managing M.genitalium, offering insights for further research.

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Antimicrobial resistance in Neisseria gonorrhoeae isolates and gonorrhoea treatment in the Republic of Belarus, Eastern Europe, 2009–2019

BMC Infectious Diseases ◽

10.1186/s12879-021-06184-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Aliaksandra Aniskevich ◽

Iryna Shimanskaya ◽

Iryna Boiko ◽

Tatyana Golubovskaya ◽

Daniel Golparian ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Neisseria Gonorrhoeae ◽

Eastern Europe ◽

Treatment Guidelines ◽

Statistical Significance ◽

Antimicrobial Treatment ◽

National Guidelines ◽

First Line ◽

Exact Test ◽

The Republic

Abstract Background Limited antimicrobial resistance (AMR) data for Neisseria gonorrhoeae are available in Eastern Europe. We investigated AMR in N. gonorrhoeae isolates in the Republic of Belarus from 2009 to 2019, antimicrobial treatment recommended nationally, and treatment given to patients with gonorrhoea. Methods N. gonorrhoeae isolates (n = 522) cultured in three regions of Belarus in 2009–2019 were examined. Determination of minimum inhibitory concentrations (MICs) of eight antimicrobials was performed using Etest. Resistance breakpoints from the European Committee on Antimicrobial Susceptibility Testing were applied where available. A Nitrocefin test identified β-lactamase production. Gonorrhoea treatment for 1652 patients was also analysed. Statistical significance was determined by the Z-test, Fisher’s exact test, or Mann-Whitney U test with p-values of < 0.05 indicating significance. Results In total, 27.8% of the N. gonorrhoeae isolates were resistant to tetracycline, 24.7% to ciprofloxacin, 7.0% to benzylpenicillin, 2.7% to cefixime, and 0.8% to azithromycin. No isolates were resistant to ceftriaxone, spectinomycin, or gentamicin. However, 14 (2.7%) isolates had a ceftriaxone MIC of 0.125 mg/L, exactly at the resistance breakpoint (MIC > 0.125 mg/L). Only one (0.2%) isolate, from 2013, produced β-lactamase. From 2009 to 2019, the levels of resistance to ciprofloxacin and tetracycline were relatively high and stable. Resistance to cefixime was not identified before 2013 but peaked at 22.2% in 2017. Only sporadic isolates with resistance to azithromycin were found in 2009 (n = 1), 2012 (n = 1), and 2018–2019 (n = 2). Overall, 862 (52.2%) patients received first-line treatment according to national guidelines (ceftriaxone 1 g). However, 154 (9.3%) patients received a nationally recommended alternative treatment (cefixime 400 mg or ofloxacin 400 mg), and 636 (38.5%) were given non-recommended treatment. Conclusions The gonococcal resistance to ciprofloxacin and tetracycline was high, however, the resistance to azithromycin was low and no resistance to ceftriaxone was identified. Ceftriaxone 1 g can continuously be recommended as empiric first-line gonorrhoea therapy in Belarus. Fluoroquinolones should not be prescribed for treatment if susceptibility has not been confirmed by testing. Timely updating and high compliance with national evidence-based gonorrhoea treatment guidelines based on quality-assured AMR data are imperative. The need for continued, improved and enhanced surveillance of gonococcal AMR in Belarus is evident.

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Use of the moving epidemic method (MEM) to assess national surveillance data for respiratory syncytial virus (RSV) in the Netherlands, 2005 to 2017

Eurosurveillance ◽

10.2807/1560-7917.es.2019.24.20.1800469 ◽

2019 ◽

Vol 24 (20) ◽

Cited By ~ 4

Author(s):

Laura M Vos ◽

Anne C Teirlinck ◽

José E Lozano ◽

Tomás Vega ◽

Gé A Donker ◽

...

Keyword(s):

Respiratory Syncytial Virus ◽

The Netherlands ◽

Respiratory Infections ◽

Laboratory Data ◽

Age Distribution ◽

Age Groups ◽

Surveillance Data ◽

Cumulative Number ◽

Laboratory Surveillance ◽

Syncytial Virus

Background To control respiratory syncytial virus (RSV), which causes acute respiratory infections, data and methods to assess its epidemiology are important. Aim We sought to describe RSV seasonality, affected age groups and RSV-type distribution over 12 consecutive seasons in the Netherlands, as well as to validate the moving epidemic method (MEM) for monitoring RSV epidemics. Methods We used 2005−17 laboratory surveillance data and sentinel data. For RSV seasonality evaluation, epidemic thresholds (i) at 1.2% of the cumulative number of RSV-positive patients per season and (ii) at 20 detections per week (for laboratory data) were employed. We also assessed MEM thresholds. Results In laboratory data RSV was reported 25,491 times (no denominator). In sentinel data 5.6% (767/13,577) of specimens tested RSV positive. Over 12 seasons, sentinel data showed percentage increases of RSV positive samples. The average epidemic length was 18.0 weeks (95% confidence intervals (CI): 16.3–19.7) and 16.5 weeks (95% CI: 14.0–18.0) for laboratory and sentinel data, respectively. Epidemics started on average in week 46 (95% CI: 45–48) and 47 (95% CI: 46–49), respectively. The peak was on average in the first week of January in both datasets. MEM showed similar results to the other methods. RSV incidence was highest in youngest (0–1 and >1–2 years) and oldest (>65–75 and > 75 years) age groups, with age distribution remaining stable over time. RSV-type dominance alternated every one or two seasons. Conclusions Our findings provide baseline information for immunisation advisory groups. The possibility of employing MEM to monitor RSV epidemics allows prospective, nearly real-time use of surveillance data.

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Views of health care professionals and policy-makers on the use of surveillance data to combat antimicrobial resistance

10.21203/rs.2.17118/v4 ◽

2020 ◽

Author(s):

Mustafa Al-Haboubi ◽

Andrew Trathen ◽

Nick Black ◽

Elizabeth Eastmure ◽

Nicholas Mays

Keyword(s):

Health Care ◽

Antimicrobial Resistance ◽

Health Care Professionals ◽

Secondary Care ◽

Local Level ◽

Surveillance Data ◽

Data Availability ◽

Electronic Prescribing ◽

Data Systems ◽

Policy Makers

Abstract Background Providing healthcare professionals with health surveillance data aims to support professional and organisational behaviour change. The UK Five Year Antimicrobial Resistance (AMR) Strategy 2013 to 2018 identified better access to and use of surveillance data as a key component. Our aim was to determine the extent to which data on antimicrobial use and resistance met the perceived needs of health care professionals and policy-makers at national, regional and local levels, and how provision could be improved. Methods We conducted 41 semi-structured interviews with national policy makers in the four Devolved Administrations and 71 interviews with health care professionals in six locations across the United Kingdom selected to achieve maximum variation in terms of population and health system characteristics. Transcripts were analysed thematically using a mix of a priori reasoning guided by the main topics in the interview guide together with themes emerging inductively from the data. Views were considered at three levels - primary care, secondary care and national - and in terms of availability of data, current uses, benefits, gaps and potential improvements. Results Respondents described a range of uses for prescribing and resistance data. The principal gaps identified were prescribing in private practice, internet prescribing and secondary care (where some hospitals did not have electronic prescribing systems). Some respondents under-estimated the range of data available. There was a perception that the responsibility for collecting and analysing data often rests with a few individuals who may lack sufficient time and appropriate skills. Conclusions There is a need to raise awareness of data availability and the potential value of these data, and to ensure that data systems are more accessible. Any skills gap at local level in how to process and use data needs to be addressed. This requires an identification of the best methods to improve support and education relating to AMR data systems.

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Data handling as a basis for local antimicrobial resistance surveillance

Clinical Microbiology and Antimicrobial Chemotherapy ◽

10.36488/cmac.2020.2.137-141 ◽

2020 ◽

Vol 22 (2) ◽

pp. 137-141

Author(s):

Alina G. Vinogradova ◽

Alexey Yu. Kuzmenkov

Keyword(s):

Antimicrobial Resistance ◽

Surveillance Data ◽

Surveillance Systems ◽

Data Handling ◽

Basic Principles ◽

Antimicrobial Resistance Surveillance ◽

Local Levels

Continuing trends of antimicrobial resistance growth require a set of countermeasures, of which antimicrobial resistance surveillance at the global, national, and local levels plays one of the most important roles. Local surveillance systems are the most significant in controlling the changes in susceptibility of microorganisms in specific settings and contribute to the necessary activities, including prevention of epidemics. This paper presents basic principles and recommendations for handling antimicrobial resistance surveillance data, provides examples of table completion and metadata quick guide. A focus is made on specific issues and problems associated with surveillance data handling and the ways to resolve those problems are proposed.

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Epidemiology of chikungunya based on laboratory surveillance data—India, 2016–2018

Transactions of the Royal Society of Tropical Medicine and Hygiene ◽

10.1093/trstmh/try141 ◽

2019 ◽

Vol 113 (5) ◽

pp. 259-262 ◽

Cited By ~ 3

Author(s):

Manoj Murhekar ◽

K Kanagasabai ◽

Vishal Shete ◽

Vasna Joshua ◽

M Ravi ◽

...

Keyword(s):

Surveillance Data ◽

Laboratory Surveillance

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Antimicrobial resistance in Mycoplasma genitalium sampled from the British general population

Sexually Transmitted Infections ◽

10.1136/sextrans-2019-054129 ◽

2020 ◽

Vol 96 (6) ◽

pp. 464-468 ◽

Cited By ~ 3

Author(s):

Rachel Pitt ◽

Magnus Unemo ◽

Pam Sonnenberg ◽

Sarah Alexander ◽

Simon Beddows ◽

...

Keyword(s):

Antimicrobial Resistance ◽

General Population ◽

Sexual Health ◽

Treatment Guidelines ◽

Mycoplasma Genitalium ◽

Macrolide Resistance ◽

Sample Survey ◽

23S Rrna ◽

Health Clinic ◽

Rrna Gene

BackgroundMycoplasma genitalium is a common sexually transmitted infection. Treatment guidelines focus on those with symptoms and sexual contacts, generally with regimens including doxycycline and/or azithromycin as first-line and moxifloxacin as second-line treatment. We investigated the prevalence of antimicrobial resistance (AMR)-conferring mutations in M. genitalium among the sexually-active British general population.MethodsThe third national survey of sexual attitudes and lifestyles (Natsal-3) is a probability sample survey of 15 162 men and women aged 16–74 years in Britain conducted during 2010–12. Urine test results for M. genitalium were available for 4507 participants aged 16–44 years reporting >1 lifetime sexual partner. In this study, we sequenced regions of the 23S rRNA and parC genes to detect known genotypic determinants for resistance to macrolides and fluoroquinolones respectively.Results94% (66/70) of specimens were re-confirmed as M. genitalium positive, with successful sequencing in 85% (56/66) for 23S rRNA and 92% (61/66) for parC genes. Mutations in 23S rRNA gene (position A2058/A2059) were detected in 16.1% (95%CI: 8.6% to 27.8%) and in parC (encoding ParC D87N/D87Y) in 3.3% (0.9%–11.2%). Macrolide resistance was more likely in participants reporting STI diagnoses (past 5 years) (44.4% (18.9%–73.3%) vs 10.6% (4.6%–22.6%); p=0.029) or sexual health clinic attendance (past year) (43.8% (23.1%–66.8%) vs 5.0% (1.4%–16.5%); p=0.001). All 11 participants with AMR-conferring mutations had attended sexual health clinics (past 5 years), but none reported recent symptoms.ConclusionsThis study highlights challenges in M. genitalium management and control. Macrolide resistance was present in one in six specimens from the general population in 2010–2012, but no participants with AMR M. genitalium reported symptoms. Given anticipated increases in diagnostic testing, new strategies including novel antimicrobials, AMR-guided therapy, and surveillance of AMR and treatment failure are recommended.

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