Antimicrobial Susceptibility of Urogenital and Extragenital Neisseria gonorrhoeae Isolates Among Men Who Have Sex With Men: Strengthening the US Response to Resistant Gonorrhea and Enhanced Gonococcal Isolate Surveillance Project, 2018 to 2019

Quilter, Laura; Cyr, Sancta B St; Hong, Jaeyoung; Asbel, Lenore; Bautista, Ilene; Carter, Bonnie; Casimir, Yanick; Denny, Michael; Ervin, Melissa; Gomez, Raquel; Harvey, Alesia; Holderman, Justin L; Johnson, Kimberly; Kohn, Robert; Learner, Emily R; Mauk, Kerry; Menza, Timothy W.; Mettenbrink, Christie; Nettleton, William D; Nicosia, Karen R; Pham, Cau D.; Ried, Christopher; Schlanger, Karen; Schneider, Annah; Soge, Olusegun O.; Tabidze, Irina; Taylor, Stephanie N.; Tilghman, Winston; Toler, Cindy; Weinstock, Hillard; Torrone, Elizabeth

doi:10.1097/olq.0000000000001548

Cited by 9 publications

(12 citation statements)

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“…And, among the 10,814 specimens positive for N. gonorrhoeae, most were urethral (62.5%), nearly 30% were pharyngeal or rectal, and only 8% were cervical or vaginal. Among specimens collected for culture, 60.1% (35,128) were from self-identified males or transgender males and 39.6% (23,166) were from self-identified females or transgender females, whereas among positive cultures, 88.8% (9600) were from males and 10.7% (1160) from females (data not shown). Culture success by anatomic site among NAATpositive patients in SURRG is reported elsewhere.…”

Section: Resultsmentioning

confidence: 94%

“…Despite these challenges, SURRG demonstrated feasibility of collecting and isolating N. gonorrhoeae from such specimens, as over 4000 nonurethral isolates were included. Inclusion of nonurethral isolates in SURRG expanded the reach of surveillance for rapid detection and response and facilitated important explorations of possible differences in antimicrobial susceptibility trends by gender or anatomic site of infection 22,23 …”

Section: Discussionmentioning

confidence: 99%

“…Inclusion of nonurethral isolates in SURRG expanded the reach of surveillance for rapid detection and response and facilitated important explorations of possible differences in antimicrobial susceptibility trends by gender or anatomic site of infection. 22,23 Presently, detection of resistance requires culture-based AST. Whereas susceptibility data from existing surveillance of long-term susceptibility trends (ie, GISP) has often been available 1 to 3 months after specimen collection, SURRG grantees rapidly processed culture specimens and performed and reported AST by Etest locally within a median of 5 days from specimen collection.…”

Section: |mentioning

confidence: 99%

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Strengthening the US Response to Resistant Gonorrhea: An Overview of a Multisite Program to Enhance Local Response Capacity for Antibiotic-Resistant Neisseria gonorrhoeae

et al. 2021

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Background: In 2016, Centers for Disease Control and Prevention initiated Strengthening the US Response to Resistant Gonorrhea (SURRG) in multiple jurisdictions to enhance antibiotic resistant gonorrhea rapid detection and response infrastructure and evaluate the impact of key strategies.Methods: Eight jurisdictions were funded to establish or enhance local gonococcal culture specimen collection in sexually transmitted disease and community clinics, conduct rapid antimicrobial susceptibility testing (AST) in local laboratories, modify systems for enhanced data collection and rapid communication of results, and initiate enhanced partner services among patients with gonorrhea demonstrating elevated minimum inhibitory concentrations (MICs) to ceftriaxone, cefixime or azithromycin.Results: Grantees incorporated genital, pharyngeal, and rectal gonococcal culture collection from all genders at participating clinics. During 2018 to 2019, grantees collected 58,441 culture specimens from 46,822 patients and performed AST on 10,814 isolates (representing 6.8% [3412] and 8.9% [4883] of local reported cases in 2018 and 2019, respectively). Of isolates that underwent AST, 11% demonstrated elevated azithromycin MICs; fewer than 0.5% demonstrated elevated ceftriaxone or cefixime MICs. Among patients whose infections demonstrated elevated MICs, 81.7% were interviewed for partner elicitation; however, limited new cases were identified among partners and contacts.

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Section: Resultsmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: |mentioning

confidence: 99%

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Strengthening the US Response to Resistant Gonorrhea: An Overview of a Multisite Program to Enhance Local Response Capacity for Antibiotic-Resistant Neisseria gonorrhoeae

et al. 2021

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“…Although a small demonstration project conducted in 2011 to 2013 did not show differences in AMR GC by anatomic sites, 9 Quilter et al 10 combined SURRG data with eGISP data (eGISP, or enhanced GISP, is a supplemental GISP project in which some sites also collect extragenital specimens) to amass data from 5456 isolates and found differences in cefixime minimal inhibitory concentrations (MIC) and the proportion of isolates with elevated ceftriaxone MIC at the pharynx compared with anogenital sites among men who have sex with men (MSM). This may be some of the first population-level evidence to support the theory that the pharynx is the site of the development of antimicrobial resistance, at least for the cephalosporins, and reinforces the need to continue to monitor GC isolates from various anatomic sites.…”

Section: Epidemiology and Surveillance Lessonsmentioning

confidence: 95%

New Evidence for Antimicrobial-Resistant Gonorrhea Control Programs: Lessons Learned from the SURRG Project

Barbee¹

2021

Sexual Trans Dis

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“…Although cefixime minimal inhibitory concentrations rose steadily over the past 30 years, this trend has recently reversed in the United States, Canada, and England. 10,11 In addition, the effectiveness of cefixime at various anatomical sites of infection is poorly understood 12,13 We performed a systematic review and meta-analysis to compare the effectiveness of 400-and 800-mg single-dose cefixime at treating urogenital, rectal, and pharyngeal gonococcal infections.…”

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Effectiveness of Cefixime for the Treatment of Neisseria gonorrhoeae Infection at 3 Anatomic Sites: A Systematic Review and Meta-Analysis

et al. 2022

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Background: To treat Neisseria gonorrhoeae infection, the Centers for Disease Control and Prevention recommends a single oral dose of cefixime as an alternative to injectable ceftriaxone. Methods:We conducted a systematic review and meta-analysis to describe the effectiveness of cefixime in treating N. gonorrhoeae infection at 3 different anatomic sites.We searched PubMed and Embase database to abstract treatment success rates and cefixime dosage/frequency for studies that reported the anatomical site of infection. We included reports published between January 1, 1980, and December 7, 2021. Twenty studies published between 1989 and 2015 were included in our meta-analysis. We calculated pooled treatment success percentages and 95% confidence intervals (CIs) using random-effects models.Results: Of patients who received a 400-mg single dose of cefixime, 824 of 846 (97%; 95% CI, 96%-98%) patients with urogenital infection, 107 of 112 (97%; 95% CI, 84%-100%) patients with rectal infection, and 202 of 242 (89%; 95% CI, 76%-96%) patients with pharyngeal infection were cured. Of patients who received an 800-mg single dose of cefixime, 295 of 301 (98%; 95% CI, 96%-99%) patients with urogenital infection and 21 of 26 (81%; 95% CI, 61%-92%) patients with pharyngeal infection were cured. Conclusions:Our meta-analysis found that cefixime is highly effective at treating urogenital infections and less effective at treating pharyngeal infections.We recommend more investigation into the effectiveness of cefixime in treating rectal infections and studying multidose therapy for the cefixime treatment of pharyngeal infection.N eisseria gonorrhoeae infection is a public health concern worldwide, due in large part to the fact that N. gonorrhoeae has demonstrated unprecedented capacity to develop antibiotic resistance. 1 There is evidence of N. gonorrhoeae antimicrobial resistance to all recommended antimicrobial agents. 2,3 The Centers for Disease Control and Prevention (CDC) identified antimicrobial-resistant N. gonorrhoeae as 1 of the top 3 ongoing public health threats. 4 For those reasons, identifying effective therapies is critical for clinicians, public health professionals, and patients.Current recommendations for the treatment of gonorrhea rely on ceftriaxone as first-line therapy. In their 2020 European guidelines on the treatment of gonorrhea, the International Union against Sexually Transmitted Infections put forward 2 recommendations. The first International Union against Sexually Transmitted Infections recommendation was dual therapy of ceftriaxone 1 g intramuscularly as a single dose with azithromycin 2 g as a single oral dose. Their second recommendation was monotherapy of ceftriaxone 1 g intramuscularly alone. 5 The British Association for Sexual Health and HIV, in their 2018 guidelines on the treatment of infection with N. gonorrhoeae, also recommended ceftriaxone 1 g intramuscularly. 6 The CDC's 2020 update on treatment guidelines for gonococcal infection recommended a single intramuscular dose of ceftriaxone 500 mg ...

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Antimicrobial Susceptibility of Urogenital and Extragenital Neisseria gonorrhoeae Isolates Among Men Who Have Sex With Men: Strengthening the US Response to Resistant Gonorrhea and Enhanced Gonococcal Isolate Surveillance Project, 2018 to 2019

Cited by 9 publications

References 25 publications

Strengthening the US Response to Resistant Gonorrhea: An Overview of a Multisite Program to Enhance Local Response Capacity for Antibiotic-Resistant Neisseria gonorrhoeae

Strengthening the US Response to Resistant Gonorrhea: An Overview of a Multisite Program to Enhance Local Response Capacity for Antibiotic-Resistant Neisseria gonorrhoeae

New Evidence for Antimicrobial-Resistant Gonorrhea Control Programs: Lessons Learned from the SURRG Project

Effectiveness of Cefixime for the Treatment of Neisseria gonorrhoeae Infection at 3 Anatomic Sites: A Systematic Review and Meta-Analysis

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