多西环素暴露后预防对淋病奈瑟菌四环素耐药性以及耐四环素金黄色葡萄球菌和A组链球菌定植的潜在影响。
Potential Impact of Doxycycline Post-Exposure Prophylaxis on Tetracycline Resistance in Neisseria gonorrhoeae and Colonization with Tetracycline-Resistant Staphylococcus aureus and Group A Streptococcus.
作者信息
Soge Olusegun O, Thibault Christina S, Cannon Chase A, McLaughlin Stephanie E, Menza Tim W, Dombrowski Julia C, Fang Ferric C, Golden Matthew R
机构信息
Department of Global Health, University of Washington, Seattle, WA, USA.
Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA.
出版信息
Clin Infect Dis. 2025 Feb 28. doi: 10.1093/cid/ciaf089.
BACKGROUND
Doxycycline post-exposure prophylaxis (doxy PEP) is increasingly used among men who have sex with men (MSM). Its impact on antimicrobial resistance and the microbiome is uncertain.
METHODS
We used Neisseria gonorrhoeae (NG) surveillance data from King County, WA and joinpoint regression to investigate trends in NG-tetracycline resistance (tetR), 2017-2024 and, among sexual health clinic (SHC) patients, evaluated the association of NG-tetR with doxy PEP use. We evaluated nasopharyngeal colonization with Staphylococcus aureus and Group A Streptococcus (GAS) 703 MSM SHC patients, August 2023-July 2024.
RESULTS
Among 2,312 MSM with NG, tetR was stable 2017 to quarter 1 (Q1) 2023 (mean=27%) and thereafter rose to 70% in Q2 2024 (p<0.0001). (King County released doxy PEP guidelines in Q2 2023.) NG with high-level (HL) tetR increased Q1 2021 to Q2 2024 (2% to 65%) (p<0.0001). Taking >3 doses of doxy PEP/month was associated with both tetR and HL tetR (p≤0.01 for both), though any use of doxy PEP was not associated with tetR or HL tetR. S. aureus colonization was less common among doxy PEP users than non-users (27% vs. 36%, p=0.02), but colonization with both tetracycline-resistant S. aureus and GAS were more common among doxy PEP users than non-users (18% vs. 8%, p<0.0001 and 9% vs. 4%, p=0.008, respectively).
CONCLUSIONS
TetR in NG rapidly increased from 2021 to 2024, and most NG among King County MSM now have HL tetR. Doxy PEP use is associated with colonization with GAS and tetracycline-resistant S. aureus, suggesting that doxy PEP impacts off-target bacteria.
背景
多西环素暴露后预防（多西环素PEP）在男男性行为者（MSM）中使用越来越广泛。其对抗菌药物耐药性和微生物群的影响尚不确定。
方法
我们使用了华盛顿州金县的淋病奈瑟菌（NG）监测数据，并采用连接点回归分析来调查2017 - 2024年NG对四环素耐药性（tetR）的趋势，并且在性健康诊所（SHC）患者中，评估了NG - tetR与多西环素PEP使用之间的关联。我们评估了2023年8月至2024年7月期间703名MSM SHC患者的金黄色葡萄球菌和A组链球菌（GAS）的鼻咽定植情况。
结果
在2312名感染NG的MSM中，tetR在2017年至2023年第一季度（Q1）保持稳定（平均=27%），此后在2024年第二季度升至70%（p<0.0001）。（金县在2023年第二季度发布了多西环素PEP指南。）高水平（HL）tetR的NG从2021年第一季度到2024年第二季度有所增加（从2%增至65%）（p<0.0001）。每月服用超过3剂多西环素PEP与tetR和HL tetR均相关（两者p≤0.01），不过多西环素PEP的任何使用与tetR或HL tetR均无关联。多西环素PEP使用者中金黄色葡萄球菌定植比非使用者少见（27%对36%，p = 0.02），但四环素耐药金黄色葡萄球菌和GAS的定植在多西环素PEP使用者中比非使用者更常见（分别为18%对8%，p<0.0001和9%对4%，p = 0.008）。
结论
2021年至2024年，NG中的tetR迅速增加，金县MSM中的大多数NG现在具有HL tetR。多西环素PEP的使用与GAS和四环素耐药金黄色葡萄球菌的定植相关，表明多西环素PEP会影响非目标细菌。
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