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[PMID]: 29304083 [Au] Autor: Adachi K; Xu J; Yeganeh N; Camarca M; Morgado MG; Watts DH; Mofenson LM; Veloso VG; Pilotto JH; Joao E; Gray G; Theron G; Santos B; Fonseca R; Kreitchmann R; Pinto J; Mussi-Pinhata MM; Ceriotto M; Machado DM; Bryson YJ; Grinsztejn B; Moye J; Klausner JD; Bristow CC; Dickover R; Mirochnick M; Nielsen-Saines K; NICHD HPTN 040 Study Team [Ad] Endereço: David Geffen UCLA School of Medicine, Los Angeles, CA, United States of America. [Ti] Título: Combined evaluation of sexually transmitted infections in HIV-infected pregnant women and infant HIV transmission. [So] Source: PLoS One;13(1):e0189851, 2018. [Is] ISSN: 1932-6203 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND: Sexually transmitted infections (STIs) including Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Treponema pallidum (TP), and cytomegalovirus (CMV) may lead to adverse pregnancy and infant outcomes. The role of combined maternal STIs in HIV mother-to-child transmission (MTCT) was evaluated in mother-infant pairs from NICHD HPTN 040. METHODOLOGY: Urine samples from HIV-infected pregnant women during labor were tested by polymerase chain reaction (PCR) for CT, NG, and CMV. Infant HIV infection was determined by serial HIV DNA PCR testing. Maternal syphilis was tested by VDRL and confirmatory treponemal antibodies. RESULTS: A total of 899 mother-infant pairs were evaluated. Over 30% had at least one of the following infections (TP, CT, NG, and/or CMV) detected at the time of delivery. High rates of TP (8.7%), CT (17.8%), NG (4%), and CMV (6.3%) were observed. HIV MTCT was 9.1% (n = 82 infants). HIV MTCT was 12.5%, 10.3%, 11.1%, and 26.3% among infants born to women with CT, TP, NG or CMV respectively. Forty-two percent of HIV-infected infants were born to women with at least one of these 4 infections. Women with these infections were nearly twice as likely to have an HIV-infected infant (aOR 1.9, 95% CI 1.1-3.0), particularly those with 2 STIs (aOR 3.4, 95% CI 1.5-7.7). Individually, maternal CMV (aOR 4.4 1.5-13.0) and infant congenital CMV (OR 4.1, 95% CI 2.2-7.8) but not other STIs (TP, CT, or NG) were associated with an increased risk of HIV MTCT. CONCLUSION: HIV-infected pregnant women identified during labor are at high risk for STIs. Co-infection with STIs including CMV nearly doubles HIV MTCT risk. CMV infection appears to confer the largest risk of HIV MTCT. TRIAL REGISTRATION: NCT00099359. [Mh] Termos MeSH primário: Infecções por HIV/complicações Infecções por HIV/transmissão Transmissão Vertical de Doença Infecciosa Complicações Infecciosas na Gravidez Doenças Sexualmente Transmissíveis/complicações [Mh] Termos MeSH secundário: Adolescente Adulto Infecções por Chlamydia/complicações Chlamydia trachomatis Estudos Transversais Feminino Gonorreia/complicações Seres Humanos Lactente Recém-Nascido Meia-Idade Gravidez Estudos Retrospectivos Fatores de Risco Sífilis/complicações Adulto Jovem [Pt] Tipo de publicação: CLINICAL TRIAL, PHASE III; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, NON-U.S. GOV'T [Em] Mês de entrada: 1801 [Cu] Atualização por classe: 180309 [Lr] Data última revisão: 180309 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 180106 [Cl] Clinical Trial: ClinicalTrial [St] Status: MEDLINE [do] DOI: 10.1371/journal.pone.0189851

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[PMID]: 28468648 [Au] Autor: Clark JL; Segura ER; Oldenburg CE; Rios J; Montano SM; Perez-Brumer A; Villaran M; Sanchez J; Coates TJ; Lama JR [Ad] Endereço: David Geffen School of Medicine, University of California, Los Angeles, CA, USA. jlclark@mednet.ucla.edu. [Ti] Título: Expedited Partner Therapy (EPT) increases the frequency of partner notification among MSM in Lima, Peru: a pilot randomized controlled trial. [So] Source: BMC Med;15(1):94, 2017 05 04. [Is] ISSN: 1741-7015 [Cp] País de publicação: England [La] Idioma: eng [Ab] Resumo: BACKGROUND: Expedited Partner Therapy (EPT) has been shown to improve treatment outcomes among heterosexual partners of individuals with curable sexually transmitted infections (STIs). Although the use of EPT with men who have sex with men (MSM) has been debated, due to the potential for missed opportunities to diagnose unidentified cases of HIV and syphilis infection in symptomatic partners, increases in partner notification (PN) resulting from use of EPT may promote testing and treatment of otherwise unidentified partners. We assessed the impact of EPT on self-reported PN among MSM in Peru with gonorrheal (GC) and/or chlamydial (CT) infection. METHODS: We enrolled 173 MSM in Lima, Peru with symptomatic or asymptomatic GC and/or CT infection between 2012 and 2014. We enrolled 44 MSM with symptomatic urethritis/proctitis and 129 MSM with asymptomatic GC/CT infection, diagnosed based on nucleic acid testing (Aptima Combo 2 Transcription-Mediated Amplification [TMA]) from urethral, pharyngeal, and rectal sites. Eligible participants were randomly assigned to receive either standard PN counseling (n = 84) or counseling plus EPT (cefixime 400 mg/azithromycin 1 g) for up to five recent partners (n = 89). Self-reported notification was assessed by computer-assisted self-administered survey among 155 participants who returned for 14-day follow-up. RESULTS: The median age of participants was 26 (interquartile range [IQR]: 23-31) with a median of 3 sexual partners (IQR: 2-4) in the previous 30-day period. Among all participants, 111/155 (71.6%) notified at least one partner at 14-day follow-up with a median of 1 partner notified per participant (IQR: 0-2). For participants randomized to receive EPT, 69/83 (83.1%) reported notifying at least one partner, compared with 42/72 (58.3%) of participants in the control arm (odds ratio = 3.52; 95% confidence interval [CI]: 1.68-7.39). The proportion of all recent partners notified was significantly greater in the EPT than in the control arm (53.5%, 95% CI: 45.0-62.0% versus 36.4%, 95% CI: 27.0-47.4%). CONCLUSIONS: Provision of EPT led to significant increases in notification among Peruvian MSM diagnosed with GC/CT infection. Additional research is needed to assess the impact of EPT on biological outcomes, including persistent or recurrent infection, antimicrobial resistance, and HIV/STI transmission, in MSM sexual networks. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01720654 . Registered on 10/29/2012. [Mh] Termos MeSH primário: Infecções por Chlamydia/terapia Busca de Comunicante Gonorreia/terapia Parceiros Sexuais [Mh] Termos MeSH secundário: Adulto Homossexualidade Masculina Seres Humanos Masculino Peru Projetos Piloto Adulto Jovem [Pt] Tipo de publicação: JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, NON-U.S. GOV'T [Em] Mês de entrada: 1710 [Cu] Atualização por classe: 180302 [Lr] Data última revisão: 180302 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170505 [Cl] Clinical Trial: ClinicalTrial [St] Status: MEDLINE [do] DOI: 10.1186/s12916-017-0858-9

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[PMID]: 28460033 [Au] Autor: Ram S; Shaughnessy J; de Oliveira RB; Lewis LA; Gulati S; Rice PA [Ad] Endereço: Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, MA 01605, USA. [Ti] Título: Gonococcal lipooligosaccharide sialylation: virulence factor and target for novel immunotherapeutics. [So] Source: Pathog Dis;75(4), 2017 Jun 01. [Is] ISSN: 2049-632X [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: Gonorrhea has become resistant to most conventional antimicrobials used in clinical practice. The global spread of multidrug-resistant isolates of Neisseria gonorrhoeae could lead to an era of untreatable gonorrhea. New therapeutic modalities with novel mechanisms of action that do not lend themselves to the development of resistance are urgently needed. Gonococcal lipooligosaccharide (LOS) sialylation is critical for complement resistance and for establishing infection in humans and experimental mouse models. Here we describe two immunotherapeutic approaches that target LOS sialic acid: (i) a fusion protein that comprises the region in the complement inhibitor factor H (FH) that binds to sialylated gonococci and IgG Fc (FH/Fc fusion protein) and (ii) analogs of sialic acid that are incorporated into LOS but fail to protect the bacterium against killing. Both molecules showed efficacy in the mouse vaginal colonization model of gonorrhea and may represent promising immunotherapeutic approaches to target multidrug-resistant isolates. Disabling key gonococcal virulence mechanisms is an effective therapeutic strategy because the reduction of virulence is likely to be accompanied by a loss of fitness, rapid elimination by host immunity and consequently, decreased transmission. [Mh] Termos MeSH primário: Gonorreia/prevenção & controle Lipopolissacarídeos/metabolismo Neisseria gonorrhoeae/fisiologia Ácidos Siálicos/metabolismo Fatores de Virulência/metabolismo [Mh] Termos MeSH secundário: Animais Fator H do Complemento/genética Fator H do Complemento/metabolismo Modelos Animais de Doenças Feminino Fragmentos Fc das Imunoglobulinas/genética Fragmentos Fc das Imunoglobulinas/metabolismo Camundongos Neisseria gonorrhoeae/efeitos dos fármacos Ligação Proteica Proteínas Recombinantes de Fusão/metabolismo Vagina/microbiologia [Pt] Tipo de publicação: JOURNAL ARTICLE [Nm] Nome de substância: 0 (Immunoglobulin Fc Fragments); 0 (Lipopolysaccharides); 0 (Recombinant Fusion Proteins); 0 (Sialic Acids); 0 (Virulence Factors); 0 (lipid-linked oligosaccharides); 80295-65-4 (Complement Factor H) [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180228 [Lr] Data última revisão: 180228 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170502 [St] Status: MEDLINE [do] DOI: 10.1093/femspd/ftx049

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[PMID]: 29360873 [Au] Autor: Xu SX; Leontyev D; Kaul R; Gray-Owen SD [Ad] Endereço: Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada. [Ti] Título: Neisseria gonorrhoeae co-infection exacerbates vaginal HIV shedding without affecting systemic viral loads in human CD34+ engrafted mice. [So] Source: PLoS One;13(1):e0191672, 2018. [Is] ISSN: 1932-6203 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: HIV synergy with sexually transmitted co-infections is well-documented in the clinic. Co-infection with Neisseria gonorrhoeae in particular, increases genital HIV shedding and mucosal transmission. However, no animal model of co-infection currently exists to directly explore this relationship or to bridge the gap in understanding between clinical and in vitro studies of this interaction. This study aims to test the feasibility of using a humanized mouse model to overcome this barrier. Combining recent in vivo modelling advancements in both HIV and gonococcal research, we developed a co-infection model by engrafting immunodeficient NSG mice with human CD34+ hematopoietic stem cells to generate humanized mice that permit both systemic HIV infection and genital N. gonorrhoeae infection. Systemic plasma and vaginal lavage titres of HIV were measured in order to assess the impact of gonococcal challenge on viral plasma titres and genital shedding. Engrafted mice showed human CD45+ leukocyte repopulation in blood and mucosal tissues. Systemic HIV challenge resulted in 104-105 copies/mL of viral RNA in blood by week 4 post-infection, as well as vaginal shedding of virus. Subsequent gonococcal challenge resulted in unchanged plasma HIV levels but higher viral shedding in the genital tract, which reflects published clinical observations. Thus, human CD34+ stem cell-transplanted NSG mice represent an experimentally tractable animal model in which to study HIV shedding during gonococcal co-infection, allowing dissection of molecular and immunological interactions between these pathogens, and providing a platform to assess future therapeutics aimed at reducing HIV transmission. [Mh] Termos MeSH primário: Antígenos CD34/imunologia Gonorreia/complicações Infecções por HIV/complicações HIV/fisiologia Neisseria gonorrhoeae/isolamento & purificação Vagina/virologia Carga Viral Eliminação de Partículas Virais [Mh] Termos MeSH secundário: Animais Feminino Infecções por HIV/virologia Seres Humanos Camundongos [Pt] Tipo de publicação: JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T [Nm] Nome de substância: 0 (Antigens, CD34) [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180226 [Lr] Data última revisão: 180226 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 180124 [St] Status: MEDLINE [do] DOI: 10.1371/journal.pone.0191672

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[PMID]: 29174733 [Au] Autor: Dize L; Silver B; Gaydos C [Ad] Endereço: International Sexually Transmitted Diseases Research Laboratory, Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA. Electronic address: Ladize@gmail.com. [Ti] Título: Comparison of the Cepheid GeneXpert CT/NG assay to the Hologic Aptima Combo2 assay for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae in self-collected rectal swabs. [So] Source: Diagn Microbiol Infect Dis;90(2):83-84, 2018 Feb. [Is] ISSN: 1879-0070 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: Self-collected rectal-swabs were tested for CT and NG on GeneXpert CT/NG as compared to APTIMA Combo2. Of 448 rectal-swabs, 22 were positive for CT; 7 for NG on both assays; two were discordant. Sensitivity and specificity of GeneXpert was 95.5% and 99.7% for chlamydia, respectively; for gonorrhea both were 100%. [Mh] Termos MeSH primário: Infecções por Chlamydia/diagnóstico Chlamydia trachomatis/genética Gonorreia/diagnóstico Tipagem Molecular/métodos Neisseria gonorrhoeae/genética Técnicas de Amplificação de Ácido Nucleico/métodos [Mh] Termos MeSH secundário: Infecções por Chlamydia/microbiologia Feminino Gonorreia/microbiologia Seres Humanos Masculino Reto/microbiologia Sensibilidade e Especificidade [Pt] Tipo de publicação: COMPARATIVE STUDY; JOURNAL ARTICLE [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180209 [Lr] Data última revisão: 180209 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 171128 [St] Status: MEDLINE

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[PMID]: 28745556 [Au] Autor: Berntsen S; Karlsen APH; Pedersen ML; Mulvad G [Ad] Endereço: a Queen Ingrid Health Care Center , Nuuk , Greenland. [Ti] Título: Gonorrhoea in Greenland, incidence and previous preventive measures: a review to improve future strategies. [So] Source: Int J Circumpolar Health;76(1):1350092, 2017. [Is] ISSN: 2242-3982 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: Gonorrhoea continues to be a significant health challenge in Greenland. The aim of this study was to describe the development of gonorrhoea in Greenland through time including incidence rates and previous measures taken to address the challenge. A systematic literature search in PubMed, Embase and The Cochrane Library was conducted. Furthermore, local archives were searched in the Health Clinic in Nuuk for relevant literature. From the 1940s the incidence of gonorrhoea increased steadily with a steep incline around 1970, possibly as a consequence of changes in living conditions and urbanisation. Significant declines in the incidence were seen the late 1970s and again in the late 1980s, most likely in the wake of an outbreak of ulcus molle/chancroid in the 1970s and as a result of focused education in venereology for Greenlandic nurses in the late 1980s combined with the stop-AIDS campaign. Since the early 1990s the incidence of gonorrhoea in Greenland has not risen to previously high levels. However, the incidence remains high and with a gradually increasing trend. Prevention intervention strategies such as peer-to-peer sexual education, storytelling and involvement of parent/guardian in sexual education of the youth could be appropriate approaches to improve sexual health in Greenland. [Mh] Termos MeSH primário: Serviços de Saúde Comunitária/organização & administração Gonorreia/epidemiologia Gonorreia/prevenção & controle Prevenção Primária/organização & administração Comportamento Sexual/estatística & dados numéricos [Mh] Termos MeSH secundário: Busca de Comunicante Feminino Gonorreia/diagnóstico Groenlândia Seres Humanos Masculino Neisseria gonorrhoeae/isolamento & purificação Prevalência Estudos Retrospectivos Fatores de Risco [Pt] Tipo de publicação: JOURNAL ARTICLE; REVIEW; RESEARCH SUPPORT, NON-U.S. GOV'T [Em] Mês de entrada: 1711 [Cu] Atualização por classe: 180202 [Lr] Data última revisão: 180202 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170727 [St] Status: MEDLINE [do] DOI: 10.1080/22423982.2017.1350092

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[PMID]: 28747205 [Au] Autor: Fingerhuth SM; Low N; Bonhoeffer S; Althaus CL [Ad] Endereço: Institute of Integrative Biology, ETH Zurich, Zurich, 8092, Switzerland. stephanie.fingerhuth@env.ethz.ch. [Ti] Título: Detection of antibiotic resistance is essential for gonorrhoea point-of-care testing: a mathematical modelling study. [So] Source: BMC Med;15(1):142, 2017 07 26. [Is] ISSN: 1741-7015 [Cp] País de publicação: England [La] Idioma: eng [Ab] Resumo: BACKGROUND: Antibiotic resistance is threatening to make gonorrhoea untreatable. Point-of-care (POC) tests that detect resistance promise individually tailored treatment, but might lead to more treatment and higher levels of resistance. We investigate the impact of POC tests on antibiotic-resistant gonorrhoea. METHODS: We used data about the prevalence and incidence of gonorrhoea in men who have sex with men (MSM) and heterosexual men and women (HMW) to calibrate a mathematical gonorrhoea transmission model. With this model, we simulated four clinical pathways for the diagnosis and treatment of gonorrhoea: POC test with (POC+R) and without (POC-R) resistance detection, culture and nucleic acid amplification tests (NAATs). We calculated the proportion of resistant infections and cases averted after 5 years, and compared how fast resistant infections spread in the populations. RESULTS: The proportion of resistant infections after 30 years is lowest for POC+R (median MSM: 0.18%, HMW: 0.12%), and increases for culture (MSM: 1.19%, HMW: 0.13%), NAAT (MSM: 100%, HMW: 99.27%), and POC-R (MSM: 100%, HMW: 99.73%). Per 100 000 persons, NAAT leads to 36 366 (median MSM) and 1228 (median HMW) observed cases after 5 years. Compared with NAAT, POC+R averts more cases after 5 years (median MSM: 3353, HMW: 118). POC tests that detect resistance with intermediate sensitivity slow down resistance spread more than NAAT. POC tests with very high sensitivity for the detection of resistance are needed to slow down resistance spread more than by using culture. CONCLUSIONS: POC with high sensitivity to detect antibiotic resistance can keep gonorrhoea treatable longer than culture or NAAT. POC tests without reliable resistance detection should not be introduced because they can accelerate the spread of antibiotic-resistant gonorrhoea. [Mh] Termos MeSH primário: Antibacterianos/uso terapêutico Resistência Microbiana a Medicamentos Gonorreia/tratamento farmacológico Gonorreia/transmissão Modelos Teóricos Neisseria gonorrhoeae/efeitos dos fármacos Testes Imediatos [Mh] Termos MeSH secundário: Adulto Feminino Gonorreia/microbiologia Seres Humanos Incidência Masculino Testes de Sensibilidade Microbiana/métodos Testes de Sensibilidade Microbiana/estatística & dados numéricos Técnicas de Amplificação de Ácido Nucleico/métodos Técnicas de Amplificação de Ácido Nucleico/estatística & dados numéricos Sistemas Automatizados de Assistência Junto ao Leito/normas Sistemas Automatizados de Assistência Junto ao Leito/estatística & dados numéricos Testes Imediatos/normas Testes Imediatos/estatística & dados numéricos Prevalência Adulto Jovem [Pt] Tipo de publicação: JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T [Nm] Nome de substância: 0 (Anti-Bacterial Agents) [Em] Mês de entrada: 1712 [Cu] Atualização por classe: 180127 [Lr] Data última revisão: 180127 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170728 [St] Status: MEDLINE [do] DOI: 10.1186/s12916-017-0881-x

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[PMID]: 29231153 [Au] Autor: Kulkarni SV; Bala M; Muqeeth SA; Sasikala G; Nirmalkar AP; Thorat R; Kambli H; Sawant J; Risbud A; Gangakhedkar RR; Godbole SV [Ad] Endereço: 1​ICMR-National AIDS Research Institute, Pune, Maharashtra, India. [Ti] Título: Antibiotic susceptibility pattern of Neisseria gonorrhoeae strains isolated from five cities in India during 2013-2016. [So] Source: J Med Microbiol;67(1):22-28, 2018 Jan. [Is] ISSN: 1473-5644 [Cp] País de publicação: England [La] Idioma: eng [Ab] Resumo: PURPOSE: Emergence of multidrug resistance in Neisseria gonorrhoeae, an STI of public health significance is the biggest challenge to gonorrhoea control. Monitoring for antimicrobial resistance is essential for the early detection of emergent drug resistance patterns. METHODOLOGY: One hundred and twenty four N. gonorrhoeae strains were isolated between September 2013-August 2016 [82-New Delhi, 3-Pune, 3-Mumbai, 20-Secunderabad and 16-Hyderabad] to determine antimicrobial susceptibility and to compare the CLSI disc diffusion method with Etest for these strains. The results of the two methods were compared by using kappa statistics. RESULTS: Ninety eight percent [CI: 96.2-100] of isolates were resistant to ciprofloxacin, 52 % [CI: 43.2-60.8] to penicillin, 56 % [CI: 47.2-64.7] to tetracycline and 5 % [CI: 1.2-8.8] to azithromycin. All the strains were susceptible to spectinomycin, ceftriaxone and cefixime except for two strains which showed decreased susceptibility to ceftriaxone and cefixime. Kappa scores for penicillin, azithromycin, ciprofloxacin, ceftriaxone and cefixime showed that the CLSI method had high agreement with Etest while tetracycline had substantial agreement. CONCLUSION: Our data suggest that the disc diffusion method which is both cost effective and more feasible, can effectively be used routinely for monitoring antibiotic susceptibility in N. gonorrhoeae, in limited resource countries like India. We demonstrate the emergence of decreased susceptibility to ceftriaxone and cefixime and threshold levels of resistance to azithromycin in India. This underscores the importance of maintaining continued surveillance for antibiotic resistance in N. gonorrhoeae and a potential requirement for strategic change in guidelines in the not so distant future. [Mh] Termos MeSH primário: Antibacterianos/uso terapêutico Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos Gonorreia/tratamento farmacológico Gonorreia/microbiologia Neisseria gonorrhoeae/efeitos dos fármacos Neisseria gonorrhoeae/isolamento & purificação [Mh] Termos MeSH secundário: Adulto Cidades Feminino Seres Humanos Índia Masculino [Pt] Tipo de publicação: JOURNAL ARTICLE [Nm] Nome de substância: 0 (Anti-Bacterial Agents) [Em] Mês de entrada: 1712 [Cu] Atualização por classe: 171227 [Lr] Data última revisão: 171227 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 171213 [St] Status: MEDLINE [do] DOI: 10.1099/jmm.0.000662

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[PMID]: 29219803 [Au] Autor: Papp JR; Rowlinson MC; O'Connor NP; Wholehan J; Razeq JH; Glennen A; Ware D; Iwen PC; Lee LV; Hagan C [Ad] Endereço: 1​Centers for Disease Control and Prevention, Atlanta, GA, USA. [Ti] Título: Accuracy and reproducibility of the Etest to detect drug-resistant Neisseria gonorrhoeae to contemporary treatment. [So] Source: J Med Microbiol;67(1):68-73, 2018 Jan. [Is] ISSN: 1473-5644 [Cp] País de publicação: England [La] Idioma: eng [Ab] Resumo: PURPOSE: Neisseria gonorrhoeae is a sexually transmitted bacterial pathogen that continues to evolve to become resistant to known antibiotics. In preparing for potential emergence, the Centers for Disease Control and Prevention recommends that clinical laboratories maintain or develop protocols to assess antibiotic susceptibly for this organism. This study examines the intra-laboratory variability of using the Etest method to provide consistent MIC values for N. gonorrhoeae and also compared the results of the Etest to known agar dilution MIC values. METHODOLOGY: Clinical N. gonorrhoeae isolates, 100 paired duplicates, were tested by eight laboratories for antibiotic susceptibility to ceftriaxone, cefixime and azithromycin using Etest strips.Results/Key findings. Overall, >80 % of the paired Etest MIC values were within one log2 dilution of the replicate. When compared to the agar dilution reference method, the cefixime Etest MIC values were consistently underreported by one dilution (seven laboratories) or two dilutions (one laboratory). The azithromycin Etest MIC values agreed 90.7 % with the agar dilution MIC values while the agreement with ceftriaxone was 90.9 %. CONCLUSION: Overall, the Etest method yielded reproducible MIC values within each laboratory with the azithromycin and ceftriaxone MIC results consistent to the reference agar dilution method while the cefixime result tended to provide a lower MIC value. [Mh] Termos MeSH primário: Antibacterianos/farmacologia Farmacorresistência Bacteriana/efeitos dos fármacos Neisseria gonorrhoeae/efeitos dos fármacos Neisseria gonorrhoeae/isolamento & purificação [Mh] Termos MeSH secundário: Azitromicina/farmacologia Cefixima/farmacologia Ceftriaxona/farmacologia Gonorreia/microbiologia Seres Humanos Testes de Sensibilidade Microbiana/métodos Reprodutibilidade dos Testes [Pt] Tipo de publicação: JOURNAL ARTICLE [Nm] Nome de substância: 0 (Anti-Bacterial Agents); 75J73V1629 (Ceftriaxone); 83905-01-5 (Azithromycin); 97I1C92E55 (Cefixime) [Em] Mês de entrada: 1712 [Cu] Atualização por classe: 171227 [Lr] Data última revisão: 171227 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 171209 [St] Status: MEDLINE [do] DOI: 10.1099/jmm.0.000651

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[PMID]: 29088226 [Au] Autor: Whittles LK; White PJ; Didelot X [Ad] Endereço: Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom. [Ti] Título: Estimating the fitness cost and benefit of cefixime resistance in Neisseria gonorrhoeae to inform prescription policy: A modelling study. [So] Source: PLoS Med;14(10):e1002416, 2017 Oct. [Is] ISSN: 1549-1676 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND: Gonorrhoea is one of the most common bacterial sexually transmitted infections in England. Over 41,000 cases were recorded in 2015, more than half of which occurred in men who have sex with men (MSM). As the bacterium has developed resistance to each first-line antibiotic in turn, we need an improved understanding of fitness benefits and costs of antibiotic resistance to inform control policy and planning. Cefixime was recommended as a single-dose treatment for gonorrhoea from 2005 to 2010, during which time resistance increased, and subsequently declined. METHODS AND FINDINGS: We developed a stochastic compartmental model representing the natural history and transmission of cefixime-sensitive and cefixime-resistant strains of Neisseria gonorrhoeae in MSM in England, which was applied to data on diagnoses and prescriptions between 2008 and 2015. We estimated that asymptomatic carriers play a crucial role in overall transmission dynamics, with 37% (95% credible interval CrI 24%-52%) of infections remaining asymptomatic and untreated, accounting for 89% (95% CrI 82%-93%) of onward transmission. The fitness cost of cefixime resistance in the absence of cefixime usage was estimated to be such that the number of secondary infections caused by resistant strains is only about half as much as for the susceptible strains, which is insufficient to maintain persistence. However, we estimated that treatment of cefixime-resistant strains with cefixime was unsuccessful in 83% (95% CrI 53%-99%) of cases, representing a fitness benefit of resistance. This benefit was large enough to counterbalance the fitness cost when 31% (95% CrI 26%-36%) of cases were treated with cefixime, and when more than 55% (95% CrI 44%-66%) of cases were treated with cefixime, the resistant strain had a net fitness advantage over the susceptible strain. Limitations include sparse data leading to large intervals on key model parameters and necessary assumptions in the modelling of a complex epidemiological process. CONCLUSIONS: Our study provides, to our knowledge, the first estimates of the fitness cost and benefit associated with resistance of the gonococcus to a clinically relevant antibiotic. Our findings have important implications for antibiotic stewardship and public health policies and, in particular, suggest that a previously abandoned antibiotic could be used again to treat a minority of gonorrhoea cases without raising resistance levels. [Mh] Termos MeSH primário: Antibacterianos/uso terapêutico Cefixima/uso terapêutico Resistência às Cefalosporinas Gonorreia/tratamento farmacológico Política de Saúde Neisseria gonorrhoeae/fisiologia [Mh] Termos MeSH secundário: Infecções Assintomáticas Bissexualidade Análise Custo-Benefício Inglaterra Gonorreia/transmissão Homossexualidade Masculina Seres Humanos Masculino Modelos Biológicos [Pt] Tipo de publicação: JOURNAL ARTICLE [Nm] Nome de substância: 0 (Anti-Bacterial Agents); 97I1C92E55 (Cefixime) [Em] Mês de entrada: 1711 [Cu] Atualização por classe: 171110 [Lr] Data última revisão: 171110 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 171101 [St] Status: MEDLINE [do] DOI: 10.1371/journal.pmed.1002416

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