Macrolide and Nonmacrolide Resistance with Mass Azithromycin Distribution

Doan, Thuy; Worden, Lee; Hinterwirth, Armin; Arzika, Ahmed M.; Maliki, Ramatou; Amza, Abdou; Zhong, Lina; Chen, Cindi; Cook, Catherine; Lebas, Elodie; O’Brien, Kieran; Oldenburg, Catherine E.; Chow, Eric D.; Porco, Travis C.; Lipsitch, Marc; Keenan, Jeremy D.; Lietman, Thomas M.

doi:10.1056/nejmoa2002606

Cited by 110 publications

(127 citation statements)

References 32 publications

(40 reference statements)

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“…Psychological stress and viral infections are both risk factors for miscarriage [ 40 ]. The psychological pressure brought by COVID-19 has driven several patients to terminate their pregnancies [ 24 ]. More information about pregnant women with COVID-19 is urgently needed to relieve their anxiety and guide them to make beneficial decisions.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and outcomes of pregnant women with COVID-19 and the risk of vertical transmission: a systematic review

Chi

Gong

Gao

2020

Arch Gynecol Obstet

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Purpose This systematic review summarizes the clinical features and maternal–infant outcomes of 230 pregnant women (154 patients gave birth) infected with COVID-19 and their 156 infants, including the possibility and evidence of vertical transmission. Methods An electronic search of PubMed, Embase, Medline, MedRxiv, CNKI, and the Chinese Medical Journal Full Text Database following PRISMA guidelines was performed through April 18, 2020. Search terms included COVID-19, SARS-CoV-2, pregnant women, infants, and vertical transmission. Results A total of 230 women with COVID-19 (154 deliveries, 66 ongoing pregnancies, and 10 abortions) and 156 newborns from 20 eligible studies were included in this systematic review. A total of 34.62% of the pregnant patients had obstetric complications, and 59.05% of patients displayed fever. Lymphopenia was observed in 40.71% of patients. A total of 5.19% of women received mechanical ventilation. Seven women were critically ill. One mother and two newborns died. A total of 24.74% of newborns were premature. Five newborns’ throat swab tests of SARS-CoV-2 were positive, all of which were delivered by cesarean section. For eight newborns with negative throat swab tests, three had both elevated IgM and IgG against SARS-CoV-2. Nucleic acid tests of vaginal secretions, breast milk, amniotic fluid, placental blood, and placental tissues were negative. Conclusion Most pregnant patients were mildly ill. The mortality of pregnant women with COVID-19 was lower than that of overall COVID-19 patients. Cesarean section was more common than vaginal delivery for pregnant women with COVID-19. Premature delivery was the main adverse event for newborns. The vertical transmission rate calculated by SARS-CoV-2 nucleic acid tests was 3.91%. Serum antibodies against SARS-CoV-2 should be tested more frequently, and multiple samples should be included in pathogenic testing.

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Section: Discussionmentioning

confidence: 99%

Clinical characteristics and outcomes of pregnant women with COVID-19 and the risk of vertical transmission: a systematic review

Chi

Gong

Gao

2020

Arch Gynecol Obstet

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“…Data continue to document the impact of antimicrobials on the microbiome and on pathogenic organisms. A recent investigation comparing children who received twice-yearly azithromycin with children who received placebo found that the gut’s resistome, a reservoir of antimicrobial resistance genes in the body, had increased determinants of macrolide and nonmacrolide resistance, including beta-lactam antibiotics, among children receiving azithromycin ( 10 ). A higher proportion of macrolide resistance in nasopharyngeal Streptococcus pneumoniae was demonstrated in communities receiving mass administration of oral azithromycin ( 11 ).…”

Section: Evidence and Rationalementioning

confidence: 99%

Update to CDC's Treatment Guidelines for Gonococcal Infection, 2020

Cyr¹,

Barbee²,

Workowski³

et al. 2020

MMWR Morb. Mortal. Wkly. Rep.

285

257

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“…With the widespread prophylactic deployment of azithromycin through clinical studies and public health programs in West Africa and South Asia [ 30 , 34 ] it will be critical to monitor global AMR patterns to mitigate a public health catastrophe. Recently published data from the MORDOR (Macrolides Oraux pour Réduire les Décès avec un Oeil sur la Résistance) cluster-randomized trial in Niger showed that a random sample of children (ages 1–59 months) living in villages randomized to receive a single dose of azithromycin twice annually through mass drug administration were 7.5 times more likely (95% confidence interval, 3.8–23.1) to have macrolide-resistance determinants in their gut microbiomes after 48 months than their peers residing in villages that were randomized to receive a placebo [ 35 ]. These data further underscore the need for continued and intensified AMR surveillance in these and other areas where community azithromycin use is high.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Emergence of Azithromycin Resistance in Independent Lineages of Salmonella Typhi in Northern India

Carey

Jain²,

Yousuf

et al. 2021

Clinical Infectious Diseases

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Background The emergence and spread of antimicrobial resistance (AMR) pose a major threat to the effective treatment and control of typhoid fever. The ongoing outbreak of extensively drug-resistant Salmonella Typhi (S. Typhi) in Pakistan has left azithromycin as the only remaining broadly efficacious oral antimicrobial for typhoid in South Asia. Ominously, azithromycin-resistant S. Typhi organisms have been subsequently reported in Bangladesh, Pakistan, and Nepal. Methods Here, we aimed to understand the molecular basis of AMR in 66 S. Typhi organisms isolated in a cross-sectional study performed in a suburb of Chandigarh in Northern India using whole-genome sequencing and phylogenetic analysis. Results We identified 7 S. Typhi organisms with the R717Q mutation in the acrB gene that was recently found to confer resistance to azithromycin in Bangladesh. Six out of the seven azithromycin-resistant S. Typhi isolates also exhibited triple mutations in gyrA (S83F and D87N) and parC (S80I) genes and were resistant to ciprofloxacin. These contemporary ciprofloxacin/azithromycin-resistant isolates were phylogenetically distinct from each other and from those reported from Bangladesh, Pakistan, and Nepal. Conclusions The independent emergence of azithromycin-resistant typhoid in Northern India reflects an emerging broader problem across South Asia and illustrates the urgent need for the introduction of typhoid conjugate vaccines in the region.

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Macrolide and Nonmacrolide Resistance with Mass Azithromycin Distribution

Cited by 110 publications

References 32 publications

Clinical characteristics and outcomes of pregnant women with COVID-19 and the risk of vertical transmission: a systematic review

Clinical characteristics and outcomes of pregnant women with COVID-19 and the risk of vertical transmission: a systematic review

Update to CDC's Treatment Guidelines for Gonococcal Infection, 2020

Spontaneous Emergence of Azithromycin Resistance in Independent Lineages of Salmonella Typhi in Northern India

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