West of Scotland Specialist Virology Centre, NHS Greater Glasgow and Clyde, Glasgow, UK
Sandyford Sexual Health Services, NHS Greater Glasgow and Clyde, Glasgow, UK.
Sex Transm Infect. 2024 May 31;100(4):226-230. doi: 10.1136/sextrans-2023-056099.
Antibiotic resistance in gonorrhoea is of significant public health concern with the emergence of resistance to last-line therapies such as ceftriaxone. Despite around half of isolates tested in the UK being susceptible to ciprofloxacin, very little ciprofloxacin is used in clinical practice. Testing for the S91F mutation associated with ciprofloxacin resistance is now available in CE-marked assays and may reduce the requirement for ceftriaxone, but many patients are treated empirically, or as sexual contacts, which may limit any benefit. We describe the real-world impact of such testing on antimicrobial use and clinical outcomes in people found to have gonorrhoea in a large urban UK sexual health clinic.
Molecular ciprofloxacin resistance testing ( GC assay (SpeeDx)) was undertaken as an additional test after initial diagnosis (2000 Realtie CT/NG assay (Abbott Molecular)) in those not already known to have had antimicrobial treatment. Data from a 6-month period (from March to September 2022) were analysed to determine treatment choice and treatment outcome.
A total of 998 clinical samples tested positive for in 682 episodes of infection. Of the 560 (56%) samples eligible for resistance testing, 269 (48.0%) were reported as wild-type, 180 (32.1%) were predicted to be resistant, 63 (11.3%) had an indeterminate resistance profile, and in 48 (8.6%) samples, . was not detected. Ciprofloxacin was prescribed in 172 (75%) of 228 episodes in which the wild-type strain was detected. Four (2%) of those treated with ciprofloxacin had a positive test-of-cure sample by NAAT, with no reinfection risk. All four had ciprofloxacin-susceptible infection by phenotypic antimicrobial susceptibility testing.
In routine practice in a large UK clinic, molecular ciprofloxacin resistance testing led to a significant shift in antibiotic use, reducing use of ceftriaxone. Testing can be targeted to reduce unnecessary additional testing. Longer term impact on antimicrobial resistance requires ongoing surveillance.
淋病的抗生素耐药性是一个重大的公共卫生问题，因为已经出现了对最后一线治疗药物（如头孢曲松）的耐药性。尽管在英国，大约一半的 分离株对环丙沙星敏感，但在临床实践中很少使用环丙沙星。目前已有获得 CE 认证的检测方法可用于检测与环丙沙星耐药性相关的 S91F 突变，这可能减少对头孢曲松的需求，但许多患者接受经验性治疗或作为性接触者治疗，这可能限制任何益处。我们描述了在一家大型英国性健康诊所中，对大量淋病患者进行这种检测对抗菌药物使用和临床结果的实际影响。
在最初诊断（2000 年的 Realtie CT/NG 检测（雅培分子））后，对那些已知未接受过抗菌药物治疗的患者进行了分子环丙沙星耐药性检测（GC 检测（SpeeDx）），作为附加检测。对 2022 年 3 月至 9 月的 6 个月期间的数据进行了分析，以确定治疗选择和治疗结果。
998 份临床样本中，682 例感染检测出 阳性。在 560 份（56%）符合耐药性检测条件的样本中，269 份（48.0%）报告为野生型，180 份（32.1%）预测为耐药型，63 份（11.3%）耐药性检测结果不确定，48 份（8.6%）样本中未检测到 。在检测出野生型菌株的 228 例感染中，172 例（75%）处方了环丙沙星。在接受环丙沙星治疗的 4 例患者中，有 4 例（2%）通过 NAAT 检测到治疗后样本呈阳性，无再感染风险。所有 4 例患者的表型抗菌药物敏感性试验均显示对环丙沙星敏感。
在一家大型英国诊所的常规实践中，分子环丙沙星耐药性检测显著改变了抗生素的使用，减少了头孢曲松的使用。可以针对检测进行靶向，以减少不必要的额外检测。对抗生素耐药性的长期影响需要持续监测。
