Public Health Ontario Laboratories, 81 Resources Rd, Toronto, ON M9P 3T1, Canada.
JAMA. 2013 Jan 9;309(2):163-70. doi: 10.1001/jama.2012.176575.
Although cephalosporins are the cornerstone of treatment of Neisseria gonorrhoeae infections, cefixime is the only oral antimicrobial option. Increased minimum inhibitory concentrations (MICs) to cefixime have been identified worldwide and have been associated with reports of clinical failure.
To assess the risk of clinical treatment failure of N. gonorrhoeae infections associated with the use of cefixime.
DESIGN, SETTING, AND POPULATION: A retrospective cohort study of culture-positive N. gonorrhoeae infections at a single sexual health clinic in Toronto, Canada, that routinely performs test of cure. The cohort comprised N. gonorrhoeae culture-positive individuals identified between May 1, 2010, and April 30, 2011, treated with cefixime as recommended by Public Health Agency of Canada guidelines.
Cefixime treatment failure, defined as the repeat isolation of N. gonorrhoeae at the test-of-cure visit identical to the pretreatment isolate by molecular typing and explicit denial of reexposure.
There were 291 N. gonorrhoeae culture-positive individuals identified. Of 133 who returned for test of cure, 13 were culture positive; 9 patients were determined to have experienced cefixime treatment failure, involving urethral (n = 4), pharyngeal (n = 2), and rectal (n = 3) sites. The overall rate of clinical treatment failure among those who had a test of cure was 6.77% (95% CI, 3.14%-12.45%; 9/133). The rate of clinical failure associated with a cefixime MIC of 0.12 μg/mL or greater was 25.0% (95% CI, 10.69%-44.87%; 7/28) compared with 1.90% (95% CI, 0.23%-6.71%; 2/105) of infections with cefixime MICs less than 0.12 μg/mL, with a relative risk of 13.13 (95% CI, 2.88-59.72; P < .001).
The rate of clinical failure following treatment of N. gonorrhoeae infections with cefixime was relatively high at a Toronto clinic and was associated with elevated MICs.
虽然头孢菌素是淋病奈瑟菌感染治疗的基石，但头孢克肟是唯一的口服抗菌药物选择。已在全球范围内发现头孢克肟的最低抑菌浓度（MIC）增加，并与临床治疗失败的报告有关。
评估淋病奈瑟菌感染使用头孢克肟治疗相关的临床治疗失败风险。
设计、地点和人群：这是一项在加拿大多伦多一家性健康诊所进行的回顾性队列研究，该诊所常规进行治疗后检测。该队列包括 2010 年 5 月 1 日至 2011 年 4 月 30 日期间通过培养确定的淋病奈瑟菌培养阳性个体，他们按照加拿大公共卫生局指南推荐的头孢克肟治疗。
头孢克肟治疗失败，定义为通过分子分型，在治疗后检测中重复分离出与治疗前分离株相同的淋病奈瑟菌，并明确否认再次暴露。
共确定了 291 例淋病奈瑟菌培养阳性个体。在 133 例返回进行治疗后检测的患者中，有 13 例培养阳性；9 例患者被确定为经历了头孢克肟治疗失败，涉及尿道（n=4）、咽（n=2）和直肠（n=3）部位。进行治疗后检测的患者中，临床治疗失败的总体发生率为 6.77%（95%CI，3.14%-12.45%；9/133）。头孢克肟 MIC 为 0.12μg/mL 或更高的临床失败率为 25.0%（95%CI，10.69%-44.87%；7/28），而头孢克肟 MIC 低于 0.12μg/mL 的感染率为 1.90%（95%CI，0.23%-6.71%；2/105），相对风险为 13.13（95%CI，2.88-59.72；P<0.001）。
在多伦多诊所，淋病奈瑟菌感染使用头孢克肟治疗后的临床失败率相对较高，且与 MIC 升高有关。
