Exploring the Benefits of Molecular Testing for Gonorrhoea Antibiotic Resistance Surveillance in Remote Settings

Hui, Ben B; Ryder, Nathan; Su, Jiunn-Yih; Ward, James; Chen, Marcus Y; Donovan, Basil; Fairley, Christopher K.; Guy, Rebecca; Lahra, Monica M; Law, Matthew; Whiley, David M.; Regan, David G.

doi:10.1371/journal.pone.0133202

Cited by 10 publications

(15 citation statements)

References 30 publications

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“…decision support. Only seven articles in this series develop individual-based representations of the system of interest [47,55,56,69,72,87,96], suggesting that ABMs have been infrequently used to examine the AMU/AMR relationship at the population level. While experts decidedly agree that AMR is a 'One Health' problem requiring multi-sectoral action [7], there are few examples of inter-host models outside of strictly human contexts.…”

Section: Model Type and Contextmentioning

confidence: 99%

Application of dynamic modelling techniques to the problem of antibacterial use and resistance: a scoping review

et al. 2018

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Selective pressure exerted by the widespread use of antibacterial drugs is accelerating the development of resistant bacterial populations. The purpose of this scoping review was to summarise the range of studies that use dynamic models to analyse the problem of bacterial resistance in relation to antibacterial use in human and animal populations. A comprehensive search of the peer-reviewed literature was performed and non-duplicate articles (n = 1486) were screened in several stages. Charting questions were used to extract information from the articles included in the final subset (n = 81). Most studies (86%) represent the system of interest with an aggregate model; individual-based models are constructed in only seven articles. There are few examples of inter-host models outside of human healthcare (41%) and community settings (38%). Resistance is modelled for a non-specific bacterial organism and/or antibiotic in 40% and 74% of the included articles, respectively. Interventions with implications for antibacterial use were investigated in 67 articles and included changes to total antibiotic consumption, strategies for drug management and shifts in category/class use. The quality of documentation related to model assumptions and uncertainty varies considerably across this subset of articles. There is substantial room to improve the transparency of reporting in the antibacterial resistance modelling literature as is recommended by best practice guidelines.

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Section: Model Type and Contextmentioning

confidence: 99%

Application of dynamic modelling techniques to the problem of antibacterial use and resistance: a scoping review

et al. 2018

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“…They found that increased treatment rates could increase the spread of resistance, whereas re-treatment could slow it down. Hui et al [ 14 ] used an individual-based N. gonorrhoeae transmission model in a heterosexual host population to investigate the effect of a molecular resistance test on the time until 5% resistance are reported. None of these studies has investigated or explained the differences in the spread of antibiotic-resistant N. gonorrhoeae in MSM and heterosexual host populations.…”

Section: Introductionmentioning

confidence: 99%

Antibiotic-Resistant Neisseria gonorrhoeae Spread Faster with More Treatment, Not More Sexual Partners

et al. 2016

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The sexually transmitted bacterium Neisseria gonorrhoeae has developed resistance to all antibiotic classes that have been used for treatment and strains resistant to multiple antibiotic classes have evolved. In many countries, there is only one antibiotic remaining for empirical N. gonorrhoeae treatment, and antibiotic management to counteract resistance spread is urgently needed. Understanding dynamics and drivers of resistance spread can provide an improved rationale for antibiotic management. In our study, we first used antibiotic resistance surveillance data to estimate the rates at which antibiotic-resistant N. gonorrhoeae spread in two host populations, heterosexual men (HetM) and men who have sex with men (MSM). We found higher rates of spread for MSM (0.86 to 2.38 y−1, mean doubling time: 6 months) compared to HetM (0.24 to 0.86 y−1, mean doubling time: 16 months). We then developed a dynamic transmission model to reproduce the observed dynamics of N. gonorrhoeae transmission in populations of heterosexual men and women (HMW) and MSM. We parameterized the model using sexual behavior data and calibrated it to N. gonorrhoeae prevalence and incidence data. In the model, antibiotic-resistant N. gonorrhoeae spread with a median rate of 0.88 y−1 in HMW and 3.12 y−1 in MSM. These rates correspond to median doubling times of 9 (HMW) and 3 (MSM) months. Assuming no fitness costs, the model shows the difference in the host population’s treatment rate rather than the difference in the number of sexual partners explains the differential spread of resistance. As higher treatment rates result in faster spread of antibiotic resistance, treatment recommendations for N. gonorrhoeae should carefully balance prevention of infection and avoidance of resistance spread.

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“…Using an individual-based dynamic transmission model that incorporated partner treatment and which was applied to a London MSM population, Zienkiewicz et al [ 38 ] also demonstrated that AMR POCTs for NG ciprofloxacin sensitivity reduced ceftriaxone use, by 70% compared with the reference scenario. An individual-based model of molecular NG AMR test use compared with culture within an NG surveillance system in remote settings found that they substantially improved the timeliness of NG AMR detection, facilitating a faster change in recommended treatment, with potential for decreasing NG AMR impact on the wider population [ 39 ]. Fingerhuth et al [ 36 ] developed a compartmental transmission model of antibiotic-sensitive and antibiotic-resistant NG to look at proportion of resistant infections and cases averted.…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial resistance point-of-care testing for gonorrhoea treatment regimens: cost-effectiveness and impact on ceftriaxone use of five hypothetical strategies compared with standard care in England sexual health clinics

et al. 2020

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Background Widespread ceftriaxone antimicrobial resistance (AMR) threatens Neisseria gonorrhoeae (NG) treatment, with few alternatives available. AMR point-of-care tests (AMR POCT) may enable alternative treatments, including abandoned regimens, sparing ceftriaxone use. We assessed cost-effectiveness of five hypothetical AMR POCT strategies: A-C included a second antibiotic alongside ceftriaxone; and D and E consisted of a single antibiotic alternative, compared with standard care (SC: ceftriaxone and azithromycin). Aim Assess costs and effectiveness of AMR POCT strategies that optimise NG treatment and reduce ceftriaxone use. Methods The five AMR POCT treatment strategies were compared using a decision tree model simulating 38,870 NG-diagnosed England sexual health clinic (SHC) attendees; A micro-costing approach, representing cost to the SHC (for 2015/16), was employed. Primary outcomes were: total costs; percentage of patients given optimal treatment (regimens curing NG, without AMR); percentage of patients given non-ceftriaxone optimal treatment; cost-effectiveness (cost per optimal treatment gained). Results All strategies cost more than SC. Strategy B (azithromycin and ciprofloxacin (azithromycin preferred); dual therapy) avoided most suboptimal treatments (n = 48) but cost most to implement (GBP 4,093,844 (EUR 5,474,656)). Strategy D (azithromycin AMR POCT; monotherapy) was most cost-effective for both cost per optimal treatments gained (GBP 414.67 (EUR 554.53)) and per ceftriaxone-sparing treatment (GBP 11.29 (EUR 15.09)) but with treatment failures (n = 34) and suboptimal treatments (n = 706). Conclusions AMR POCT may enable improved antibiotic stewardship, but require net health system investment. A small reduction in test cost would enable monotherapy AMR POCT strategies to be cost-saving.

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Exploring the Benefits of Molecular Testing for Gonorrhoea Antibiotic Resistance Surveillance in Remote Settings

Cited by 10 publications

References 30 publications

Application of dynamic modelling techniques to the problem of antibacterial use and resistance: a scoping review

Application of dynamic modelling techniques to the problem of antibacterial use and resistance: a scoping review

Antibiotic-Resistant Neisseria gonorrhoeae Spread Faster with More Treatment, Not More Sexual Partners

Antimicrobial resistance point-of-care testing for gonorrhoea treatment regimens: cost-effectiveness and impact on ceftriaxone use of five hypothetical strategies compared with standard care in England sexual health clinics

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