Stewardship / Resistance Scan for June 17, 2022

Strain of extensively drug-resistant gonorrhea identified in Austria

Researchers in Austria report the identification of a second strain of extensively drug-resistant (XDR) gonorrhea.

In a case report published yesterday in Eurosurveillance, researchers described the strain, which was detected in a heterosexual man from Austria who had unprotected sex with a female commercial sex worker in Cambodia. The patient was treated with the standard treatment regimen for gonorrhea (an intramuscular dose of ceftriaxone plus an oral dose of azithromycin) and symptoms had resolved at the 2 week follow-up visit, but a polymerase chain reaction (PCR) test 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 Patient isolates found a high degree of resistance to azithromycin and resistance to ceftriaxone, cefixime, cefotaxime, ciprofloxacin, and tetracycline. Molecular research found 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 sublineage, which they warn could make gonorrhea untreatable if it triggers long-term transmission.

“XDR N. gonorrhea strains, including those with resistance 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/implications at the individual level, but also bring management and the control of gonorrhea at the public health level.”

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

Study notes overuse of antibiotics for primary care respiratory infections

A study conducted at a large healthcare system in the Upper Midwest found that unnecessary antibiotic prescribing for upper respiratory tract infections (URIs) was common among all primary care providers, but worse among elderly, rural clinicians and those in large-scale specialties, researchers reported today in Open Forum Infectious Diseases.

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

Of the 49,463 patients included in the study, 42.2% were prescribed unnecessary antibiotics. Acute bronchitis had the highest rate of unnecessary prescribing, with antibiotics prescribed in 74.2% of encounters. Men and older patients were more likely to be prescribed unnecessary antibiotics.

Characteristics of health care providers associated with higher rates of unnecessary prescribing include being in a national practice (odds ratio [OR], 1.49; 95% confidence interval [CI]1.20 to 1.84), have more years in practice (OR, 1.09; 95% CI, 1.01 to 1.06 for every 5 years), and have a high volume specialty such as emergency care care (OR, 1.43; 95% CI, 1.08 to 1.89).

“Despite multiple public health initiatives and professional society guidelines aimed at producing more judicious use of antibiotics for outpatient URIs, overuse remains common,” the study authors conclude. “Targeting higher volume clinicians in particular can have a big impact.”

They add, “Health systems should be encouraged to use these, as well as new strategies, to promote necessary and appropriate antibiotic use as an urgent priority for their quality improvement initiatives.”
June 17 Open Forum Infect Dis abstract

Antibiotic resistance app certified for resource-poor institutions

The global humanitarian organization Doctors Without Borders/Medecins Sans Frontieres (MSF) announced this week that a mobile application it helped develop to help diagnose antibiotic-resistant infections in low- and middle-income countries (LMICs) has been certified in Europe and is one step closer to wide availability.

Available as a free, open source, and offline application for Android devices, Antibiogo enables non-expert lab technicians in LMICS to measure and interpret antibiograms — the lab tests that determine whether bacteria grown from patients are susceptible to antibiotics — with a smart phone. Using image processing and artificial intelligence technology, the app processes an uploaded photo of the cultured bacteria and selected antibiotics in a petri dish, vats and interprets the results based on rules of European and American microbiological societies, and recommends an antibiotic.

Doctors Without Borders says the test was designed specifically for resource-poor institutions that often lack the equipment needed to run antibiograms, don’t have enough microbiologists to interpret them, or aren’t well-suited for automated diagnostic tests requiring reliable electricity sources. Field tests have shown a high degree of agreement with the interpretation of qualified microbiologists.

“Thanks to Antibiogo, any microbiology lab technician anywhere can read and interpret an antibiogram directly on their phone — online or offline — and know the resistance profile of the bacteria responsible for a patient’s infection,” Nada Malou, PhD, head of the Antibiogo program, according to a press release from Doctors Without Borders.

“When used properly, it is a fantastic new diagnostic tool that will contribute to wider access to high-quality bacteriological testing, even in the absence of microbiologists. Not only will this make it possible to treat patients with the most appropriate antibiotics, but also to reduce antibiotic resistance.”

The app will be used for the first time this summer in MSF labs in Mali, the Central African Republic, Yemen and Jordan, allowing MSF to collect user feedback and performance data under real-world conditions.
June 15 Doctors Without Borders press release

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