PubMed STI Feed

PubMed STI Feed
NCBI: db=pubmed; Term=(sexually transmitted infections OR sexually transmitted diseases) AND (point of care diagnostics OR pregnancy outcomes OR antibiotic resistance) NOT hiv
Updated: 27 min 45 sec ago

Making the Most of Point-of-care Testing for Sexually Transmitted Diseases.

Wed, 09/11/2019 - 10:32

Making the Most of Point-of-care Testing for Sexually Transmitted Diseases.

Clin Infect Dis. 2019 Aug 29;:

Authors: Van Der Pol B

PMID: 31504333 [PubMed - as supplied by publisher]

Potential for Point-of-Care Tests to Reduce Chlamydia-associated Burden in the United States: A Mathematical Modeling Analysis.

Wed, 09/11/2019 - 10:32

Potential for Point-of-Care Tests to Reduce Chlamydia-associated Burden in the United States: A Mathematical Modeling Analysis.

Clin Infect Dis. 2019 Aug 29;:

Authors: Rönn MM, Menzies NA, Gift TL, Chesson HW, Trikalinos TA, Bellerose M, Malyuta Y, Berruti A, Gaydos CA, Hsu KK, Salomon JA

Abstract
BACKGROUND: Point-of-care testing (POCT) assays for chlamydia are being developed. Their potential impact on the burden of chlamydial infection in the United States, in light of suboptimal screening coverage, remains unclear.
METHODS: Using a transmission model calibrated to data in the United States, we estimated the impact of POCT on chlamydia prevalence, incidence, and chlamydia-attributable pelvic inflammatory disease (PID) incidence, assuming status quo (Analysis 1) and improved (Analysis 2) screening frequencies. We tested the robustness of results to changes in POCT sensitivity, the proportion of patients getting treated immediately, the baseline proportion lost to follow-up (LTFU), and the average treatment delay.
RESULTS: In Analysis 1, high POCT sensitivity was needed to reduce the chlamydia-associated burden. With a POCT sensitivity of 90%, reductions from the baseline burden only occurred in scenarios in which over 60% of the screened individuals would get immediate treatment and the baseline LTFU proportion was 20%. With a POCT sensitivity of 99% (baseline LTFU 10%, 2-week treatment delay), if everyone were treated immediately, the prevalence reduction was estimated at 5.7% (95% credible interval [CrI] 3.9-8.2%). If only 30% of tested persons would wait for results, the prevalence reduction was only 1.6% (95% CrI 1.1-2.3). POCT with 99% sensitivity could avert up to 12 700 (95% CrI 5000-22 200) PID cases per year, if 100% were treated immediately (baseline LTFU 20% and 3-week treatment delay). In Analysis 2, when POCT was coupled with increasing screening coverage, reductions in the chlamydia burden could be realized with a POCT sensitivity of 90%.
CONCLUSIONS: POCT could improve chlamydia prevention efforts if test performance characteristics are significantly improved over currently available options.

PMID: 31504314 [PubMed - as supplied by publisher]

Identification of Novel Neisseria gonorrhoeae Lineages Harboring Resistance Plasmids in Coastal Kenya.

Wed, 09/11/2019 - 10:32
Related Articles

Identification of Novel Neisseria gonorrhoeae Lineages Harboring Resistance Plasmids in Coastal Kenya.

J Infect Dis. 2018 07 24;218(5):801-808

Authors: Cehovin A, Harrison OB, Lewis SB, Ward PN, Ngetsa C, Graham SM, Sanders EJ, Maiden MCJ, Tang CM

Abstract
Background: Africa has the highest incidence of gonorrhea in the world. However, little is known about gonococcal populations in this continent or mechanisms of antimicrobial resistance (AMR).
Methods: Whole-genome sequence data were analyzed from 103 Neisseria gonorrhoeae isolates from 73 patients, mainly men who have sex with men, from coastal Kenya. We annotated loci, defined the core genome, defined mechanisms of AMR, and performed phylogenetic analysis. For patients with multiple episodes of gonorrhea, we determined whether infections occurred with related strains.
Results: We identified 3 clusters of isolates that are phylogenetically distinct from isolates found elsewhere. Plasmids were virtually ubiquitous: pTetM and pblaTEM were found in 97%, and 55% of isolates, respectively. This was associated with high doxycycline use for undiagnosed sexually transmitted infections. Twenty-three percent of multiple episodes of gonorrhea in the same individual were caused by a related strain, suggesting inadequate treatment or reinfection.
Conclusions: The prevalence of plasmid-mediated AMR in Kenyan gonococci contrasts with that in wealthy countries, where AMR is largely chromosomally mediated. Antimicrobials have a profound effect on the maintenance of lineages harboring plasmids. Doxycycline can select for tetracycline and penicillin resistance, through plasmid cooperation. Understanding the mechanisms of AMR in high-risk groups is required to inform treatment strategies.

PMID: 29701830 [PubMed - indexed for MEDLINE]

Putative vaccine candidates and drug targets identified by reverse vaccinology and subtractive genomics approaches to control Haemophilus ducreyi, the causative agent of chancroid.

Sat, 09/07/2019 - 07:24
Related Articles

Putative vaccine candidates and drug targets identified by reverse vaccinology and subtractive genomics approaches to control Haemophilus ducreyi, the causative agent of chancroid.

J R Soc Interface. 2018 05;15(142):

Authors: de Sarom A, Kumar Jaiswal A, Tiwari S, de Castro Oliveira L, Barh D, Azevedo V, Jose Oliveira C, de Castro Soares S

Abstract
Chancroid is a sexually transmitted infection (STI) caused by the Gram-negative bacterium Haemophilus ducreyi The control of chancroid is difficult and the only current available treatment is antibiotic therapy; however, antibiotic resistance has been reported in endemic areas. Owing to recent outbreaks of STIs worldwide, it is important to keep searching for new treatment strategies and preventive measures. Here, we applied reverse vaccinology and subtractive genomic approaches for the in silico prediction of potential vaccine and drug targets against 28 strains of H. ducreyi We identified 847 non-host homologous proteins, being 332 exposed/secreted/membrane and 515 cytoplasmic proteins. We also checked their essentiality, functionality and virulence. Altogether, we predicted 13 candidate vaccine targets and three drug targets, where two vaccines (A01_1275, ABC transporter substrate-binding protein; and A01_0690, Probable transmembrane protein) and three drug targets (A01_0698, Purine nucleoside phosphorylase; A01_0702, Transcription termination factor; and A01_0677, Fructose-bisphosphate aldolase class II) are harboured by pathogenicity islands. Finally, we applied a molecular docking approach to analyse each drug target and selected ZINC77257029, ZINC43552589 and ZINC67912117 as promising molecules with favourable interactions with the target active site residues. Altogether, the targets identified here may be used in future strategies to control chancroid worldwide.

PMID: 29792307 [PubMed - indexed for MEDLINE]

Impact of Deployment on Reproductive Health in U.S. Active-Duty Servicewomen and Veterans.

Thu, 09/05/2019 - 10:21
Related Articles

Impact of Deployment on Reproductive Health in U.S. Active-Duty Servicewomen and Veterans.

Semin Reprod Med. 2018 11;36(6):361-370

Authors: Gawron LM, Mohanty AF, Kaiser JE, Gundlapalli AV

Abstract
Reproductive-age women are a fast-growing component of active-duty military personnel who experience deployment and combat more frequently than previous service-era women Veterans. With the expansion of the number of women and their roles, the United States Departments of Defense and Veterans Affairs have prioritized development and integration of reproductive services into their health systems. Thus, understanding associations between deployments or combat exposures and short- or long-term adverse reproductive health outcomes is imperative for policy and programmatic development. Servicewomen and women Veterans may access reproductive services across civilian and military or Veteran systems and providers, increasing the need for awareness and communication regarding deployment experiences with a broad array of providers. An example is the high prevalence of military sexual trauma reported by women Veterans and the associated mental health diagnoses that may lead to a lifetime of high risk-coping behaviors that increase reproductive health risks, such as sexually transmitted infections, unintended pregnancies, and others. Care coordination models that integrate reproductive healthcare needs, especially during vulnerable times such as at the time of military separation and in the immediate postdeployment phase, may identify risk factors for early intervention with the potential to mitigate lifelong risks.

PMID: 31003251 [PubMed - indexed for MEDLINE]

Neisseria Gonorrhoae and their antimicrobial susceptibility patterns among symptomatic patients from Gondar town, north West Ethiopia.

Wed, 09/04/2019 - 07:19
Related Articles

Neisseria Gonorrhoae and their antimicrobial susceptibility patterns among symptomatic patients from Gondar town, north West Ethiopia.

Antimicrob Resist Infect Control. 2018;7:85

Authors: Yeshanew AG, Geremew RA

Abstract
Background: Neisseria gonorrhoeae, the causative agent of gonorrhoea, is a Gram negative, coffee-bean shaped facultative intracellular diplococcus bacterium, the classical sexually transmitted bacteria. Nowadays, N. gonorrhoeae has developed high-level resistance to all traditional antimicrobials used for the treatment of gonorrhoea and makes the treatment complicated. So, the aim of this study was to determine magnitude and antimicrobial resistance patterns of N. gonorrhoeae.
Methods: A cross sectional study was conducted between April and August 2016 among STI clinic clients in Gondar town hospitals and health centers. Urethral swab and cervical swab specimens were inoculated to Thayer Martin media (OXOID, UK) plates. Observation of Gram-negative intracellular diplococcic was a presumptive diagnosis of gonococcal infection. Finally, antimicrobial susceptibility was assessed by using a modified Kirby-Bauer disk diffusion test, with results indicating susceptible, intermediate or resistant. Data were entered and analyzed using SPSS version 20.
Results: The overall prevalence of laboratory confirmed N. gonorrhoeae was 25(20.8%). The isolated N. gonorrhoeae was resistant 100% to tetracycline, penicillin and 80% percent was multidrug resistant.
Conclusion: Prevalence and drug resistance of N. gonorrhoeae were high in the study area. A large study is needed in order to know the magnitude in the community as well as to increase awareness of both regional health bureaus and the Ministry of Health about the treatment guide-lines.

PMID: 30026943 [PubMed - indexed for MEDLINE]

Empiric antimicrobial treatment for asymptomatic sexual contacts of sexually transmitted infection in the era of antimicrobial resistance: time to rethink?

Tue, 09/03/2019 - 07:17
Related Articles

Empiric antimicrobial treatment for asymptomatic sexual contacts of sexually transmitted infection in the era of antimicrobial resistance: time to rethink?

Int J STD AIDS. 2019 02;30(2):137-139

Authors: Pearce E, Chan DJ, Smith DE

Abstract
Prudent prescribing of antimicrobials is essential in ameliorating the public health problem of antimicrobial resistance. This retrospective audit assesses whether empiric antimicrobial treatment for asymptomatic sexual contacts of sexually transmitted infection is appropriate based on laboratory confirmation.

PMID: 30293504 [PubMed - indexed for MEDLINE]

Diagnosing sexually transmitted infections in resource-constrained settings: challenges and ways forward.

Sat, 08/31/2019 - 07:11
Related Articles

Diagnosing sexually transmitted infections in resource-constrained settings: challenges and ways forward.

J Int AIDS Soc. 2019 Aug;22 Suppl 6:e25343

Authors: Wi TE, Ndowa FJ, Ferreyra C, Kelly-Cirino C, Taylor MM, Toskin I, Kiarie J, Santesso N, Unemo M

Abstract
INTRODUCTION: Sexually transmitted infections (STIs) remain prevalent and are increasing in several populations. Appropriate STI diagnosis is crucial to prevent the transmission and sequelae of untreated infection. We reviewed the diagnostic accuracy of syndromic case management and existing point-of-care tests (POCTs), including those in the pipeline, to diagnose STIs in resource-constrained settings.
METHODS: We prioritized updating the systematic review and meta-analysis of the diagnostic accuracy of vaginal discharge from 2001 to 2015 to include studies until 2018. We calculated the absolute effects of different vaginal flowcharts and the diagnostic performance of POCTs on important outcomes. We searched the peer-reviewed literature for previously conducted systematic reviews and articles from 1990 to 2018 on the diagnostic accuracy of syndromic management of vaginal and urethral discharge, genital ulcer and anorectal infections. We conducted literature reviews from 2000 to 2018 on the existing POCTs and those in the pipeline.
RESULTS AND DISCUSSIONS: The diagnostic accuracy of urethral discharge and genital ulcer disease syndromes is relatively adequate. Asymptomatic Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections limit the use of vaginal discharge and anorectal syndromes. The pooled diagnostic accuracy of vaginal syndromic case management for CT/NG is low, resulting in high numbers of overtreatment and missed treatment. The absolute effect of POCTs was reduced overtreatment and missed treatment. Findings of the reviews on syndromic case management underscored the need for low-cost and accurate POCTs for the identification, first, of CT/NG, and, second, of Mycoplasma genitalium (MG) and Trichomonas vaginalis (TV) and NG and MG resistance/susceptibility testing. Near-patient POCT molecular assays for CT/NG/TV are commercially available. The prices of these POCTs remain the barrier for uptake in resource-constrained settings. This is driving the development of lower cost solutions.
CONCLUSIONS: The WHO syndromic case management guidelines should be updated to raise the quality of STI management through the integration of laboratory tests. STI screening strategies are needed to address asymptomatic STIs. POCTs that are accurate, rapid, simple and affordable are urgently needed in resource-constrained settings to support the uptake of aetiological diagnosis and treatment.

PMID: 31468679 [PubMed - in process]

Substance Use Treatment Patient and Provider Perspectives on Accessing Sexual and Reproductive Health Services: Barriers, Facilitators, and the Need for Integration of Care.

Thu, 08/29/2019 - 07:07
Related Articles

Substance Use Treatment Patient and Provider Perspectives on Accessing Sexual and Reproductive Health Services: Barriers, Facilitators, and the Need for Integration of Care.

Subst Use Misuse. 2019 Aug 27;:1-13

Authors: MacAfee LK, Harfmann RF, Cannon LM, Minadeo L, Kolenic G, Kusunoki Y, Dalton VK

Abstract
Background: Women with substance use disorders have high rates of adverse sexual and reproductive health (SRH) outcomes, including unintended pregnancy, sexually transmitted infections, and contraceptive nonuse. Little research has explored barriers and facilitators to accessing SRH services experienced by women with substance use disorders. Objectives: To investigate barriers and facilitators to accessing SRH services experienced by women with substance use disorders. To assess perspectives on integration of SRH services into substance use treatment. Methods: Twenty-nine semi-structured interviews were conducted with female patients (N = 17) and providers (N = 12) at four substance use treatment facilities in Michigan between October 2015 and January 2016. Respondents were asked about experiences accessing SRH services and perspectives on integration of SRH services into substance use treatment. Data were analyzed using the constant comparative method. Results: Patients and providers discussed barriers to accessing SRH services, including competing priorities, structural barriers, lack of knowledge on SRH services and substance use, fear of Child Protective Services and law enforcement, and stigma. Facilitators included reprioritization of SRH, accessible transportation, insurance coverage and funding for SRH services, and education and training on SRH. Finally, participants expressed support for integration of SRH services into substance use treatment. Conclusions/Importance: Understanding the barriers to accessing SRH services is essential to reducing the adverse SRH outcomes experienced by women with substance use disorders. Substance use treatment is a critical time to offer SRH services. Integration of care is a potential model for improving the SRH of women with substance use disorders.

PMID: 31455128 [PubMed - as supplied by publisher]

Self-derived structure-disrupting peptides targeting methionine aminopeptidase in pathogenic bacteria: a new strategy to generate antimicrobial peptides.

Tue, 08/27/2019 - 06:17
Related Articles

Self-derived structure-disrupting peptides targeting methionine aminopeptidase in pathogenic bacteria: a new strategy to generate antimicrobial peptides.

FASEB J. 2019 02;33(2):2095-2104

Authors: Zhan J, Jia H, Semchenko EA, Bian Y, Zhou AM, Li Z, Yang Y, Wang J, Sarkar S, Totsika M, Blanchard H, Jen FE, Ye Q, Haselhorst T, Jennings MP, Seib KL, Zhou Y

Abstract
Bacterial infection is one of the leading causes of death in young, elderly, and immune-compromised patients. The rapid spread of multi-drug-resistant (MDR) bacteria is a global health emergency and there is a lack of new drugs to control MDR pathogens. We describe a heretofore-unexplored discovery pathway for novel antibiotics that is based on self-targeting, structure-disrupting peptides. We show that a helical peptide, KFF- EcH3, derived from the Escherichia coli methionine aminopeptidase can disrupt secondary and tertiary structure of this essential enzyme, thereby killing the bacterium (including MDR strains). Significantly, no detectable resistance developed against this peptide. Based on a computational analysis, our study predicted that peptide KFF- EcH3 has the strongest interaction with the structural core of the methionine aminopeptidase. We further used our approach to identify peptide KFF- NgH1 to target the same enzyme from Neisseria gonorrhoeae. This peptide inhibited bacterial growth and was able to treat a gonococcal infection in a human cervical epithelial cell model. These findings present an exciting new paradigm in antibiotic discovery using self-derived peptides that can be developed to target the structures of any essential bacterial proteins.-Zhan, J., Jia, H., Semchenko, E. A., Bian, Y., Zhou, A. M., Li, Z., Yang, Y., Wang, J., Sarkar, S., Totsika, M., Blanchard, H., Jen, F. E.-C., Ye, Q., Haselhorst, T., Jennings, M. P., Seib, K. L., Zhou, Y. Self-derived structure-disrupting peptides targeting methionine aminopeptidase in pathogenic bacteria: a new strategy to generate antimicrobial peptides.

PMID: 30260702 [PubMed - indexed for MEDLINE]

Mycoplasma genitalium macrolide resistance update: Rate among a 2016-2017 cohort of patients in Barcelona, Spain.

Mon, 08/26/2019 - 06:15
Related Articles

Mycoplasma genitalium macrolide resistance update: Rate among a 2016-2017 cohort of patients in Barcelona, Spain.

Enferm Infecc Microbiol Clin. 2019 Aug 21;:

Authors: Fernández-Huerta M, Vall M, Fernández-Naval C, Barberá MJ, Arando M, López L, Andreu A, Pumarola T, Serra-Pladevall J, Esperalba J, Espasa M

Abstract
INTRODUCTION: Mycoplasma genitalium is a major cause of urethritis and other genital syndromes. Antibiotic resistance, especially to macrolides, is increasing at an alarming rate worldwide. The aim of this study was to estimate the rate of macrolide resistance in M. genitalium among a 2016-2017 cohort of patients in Barcelona, Spain; and to compare this estimate with previous data from 2013 to 2014 in this region.
METHODS: The study was conducted retrospectively with M. genitalium-positive samples collected between December 2016 and February 2017 at the Hospital Vall d'Hebron Microbiology Department. Genotypic markers of macrolide resistance were primarily detected using the ResistancePlus® MG molecular assay (SpeeDx). Mutations were then confirmed by sequencing.
RESULTS: Macrolide resistance-mediating mutations were detected in 30/83 infections (36.1% [95% CI, 25.9%-47.4%]). This resistance was more frequent among men who have sex with men (55.0% [95% CI, 38.5%-70.7%]) compared to heterosexual men (27.3% [95% CI, 10.7%-50.2%]) and women (9.5% [95% CI, 1.3%-30.4%]), p<0.001. Additionally, macrolide resistance did not significantly increase in this cohort when compared with previous investigations.
CONCLUSION: Despite the current notable rate of macrolide resistance in M. genitalium, resistance did not significantly increase between 2013-2014 and 2016-2017 in our region. Nevertheless, strict local surveillance and the implementation of rapid diagnostic tests that combine the detection of the bacterium and resistance-mediating mutations may facilitate the optimization of antibiotic administration and reduce the transmission of resistance in M. genitalium.

PMID: 31445815 [PubMed - as supplied by publisher]

Azithromycin-liposomes as a novel approach for localized therapy of cervicovaginal bacterial infections.

Sat, 08/24/2019 - 06:11
Related Articles

Azithromycin-liposomes as a novel approach for localized therapy of cervicovaginal bacterial infections.

Int J Nanomedicine. 2019;14:5957-5976

Authors: Vanić Ž, Rukavina Z, Manner S, Fallarero A, Uzelac L, Kralj M, Amidžić Klarić D, Bogdanov A, Raffai T, Virok DP, Filipović-Grčić J, Škalko-Basnet N

Abstract
Background: Efficient localized cervicovaginal antibacterial therapy, enabling the delivery of antibiotic to the site of action at lower doses while escaping systemic drug effects and reducing the risk of developing microbial resistance, is attracting considerable attention. Liposomes have been shown to allow sustained drug release into vaginal mucosa and improve delivery of antibiotics to bacterial cells and biofilms. Azithromycin (AZI), a potent broad-spectrum macrolide antibiotic, has not yet been investigated for localized therapy of cervicovaginal infections, although it is administered orally for the treatment of sexually transmitted diseases. Encapsulation of AZI in liposomes could improve its solubility, antibacterial activity, and allow the prolonged drug release in the cervicovaginal tissue, while avoiding systemic side effects.
Purpose: The objective of this study was to develop AZI-liposomes and explore their potentials for treating cervicovaginal infections.
Methods: AZI-liposomes that differed in bilayer elasticity/rigidity and surface charge were prepared and evaluated under simulated cervicovaginal conditions to yield optimized liposomes, which were assessed for antibacterial activity against several planktonic and biofilm-forming Escherichia coli strains and intracellular Chlamydia trachomatis, ex vivo AZI vaginal deposition/penetration, and in vitro cytotoxicity toward cervical cells.
Results: Negatively charged liposomes with rigid bilayers (CL-3), propylene glycol liposomes (PGL-2) and deformable propylene glycol liposomes (DPGL-2) were efficient against planktonic E. coli ATCC 700928 and K-12. CL-3 was superior for preventing the formation of E. coli ATCC 700928 and K-12 biofilms, with IC50 values (concentrations that inhibit biofilm viability by 50%) up to 8-fold lower than those of the control (free AZI). DPGL-2 was the most promising for eradication of already formed E. coli biofilms and for treating C. trachomatis infections. All AZI-liposomes were biocompatible with cervical cells and improved localization of the drug inside vaginal tissue compared with the control.
Conclusion: The performed studies confirm the potentials of AZI-liposomes for localized cervicovaginal therapy.

PMID: 31440052 [PubMed - in process]

Neisseria gonorrhoeae host adaptation and pathogenesis.

Sat, 08/24/2019 - 06:11
Related Articles

Neisseria gonorrhoeae host adaptation and pathogenesis.

Nat Rev Microbiol. 2018 04;16(4):226-240

Authors: Quillin SJ, Seifert HS

Abstract
The host-adapted human pathogen Neisseria gonorrhoeae is the causative agent of gonorrhoea. Consistent with its proposed evolution from an ancestral commensal bacterium, N. gonorrhoeae has retained features that are common in commensals, but it has also developed unique features that are crucial to its pathogenesis. The continued worldwide incidence of gonorrhoeal infection, coupled with the rising resistance to antimicrobials and the difficulties in controlling the disease in developing countries, highlights the need to better understand the molecular basis of N. gonorrhoeae infection. This knowledge will facilitate disease prevention, surveillance and control, improve diagnostics and may help to facilitate the development of effective vaccines or new therapeutics. In this Review, we discuss sex-related symptomatic gonorrhoeal disease and provide an overview of the bacterial factors that are important for the different stages of pathogenesis, including transmission, colonization and immune evasion, and we discuss the problem of antibiotic resistance.

PMID: 29430011 [PubMed - indexed for MEDLINE]

Fluoroquinolones for the Treatment of Other Respiratory Tract Infections: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines

Thu, 08/22/2019 - 12:08

Fluoroquinolones for the Treatment of Other Respiratory Tract Infections: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines

Book. 2019 05 31

Authors: Cowling T, Farrah K

Abstract
Fluoroquinolones (FQs) are a common class of antibiotic used for the treatment of infections, including those of the respiratory tract. However, the use of FQs has been controversial as certain types are associated with antibiotic resistance and adverse events. Antibiotic resistance is of significant concern due to the broad-spectrum nature and common use of FQs, and FQ resistance occurs through a number of potential individual or combined mechanisms.1 Recent global surveillance studies have found increasing rates of FQ resistance among almost all species of bacteria, and this has been demonstrated in urinary tract infection, respiratory tract infections, intraabdominal infections, skin and skin structure infections, and sexually transmitted infections.2,3 FQ resistance has likely been driven by the widespread use of the antibiotic, and adjustments clinical practice guidelines may be warranted to limit misuse of FQs. Common adverse events include gastrointestinal and central nervous system toxicities, while other adverse events include rashes and other allergic reactions, tendinitis and tendon rupture, QT prolongation, hypoglycemia and hyperglycemia, and hematologic toxicity. Several FQs have been withdrawn from the market due to adverse events.4 In the United States, examples include the withdrawal of grepafloxacin in 1999 due to fatal cardiovascular events, temafloxacin in 1992 due to severe adverse reactions (e.g. hemolytic anemia, acute renal failure, hepatotoxicity, and death), and alatrofloxacin in 2006 due to liver toxicity and death.5 The association of FQ use with serious adverse events has led to reevaluations of the use of FQs for uncomplicated infections in several jurisdictions. In 2016, the United Sates Food and Drug Administration (FDA) released a statement advising the restriction of FQ use in patients with acute sinusitis, acute bronchitis, and uncomplicated urinary tract infections who have other treatment options, because the risk of serious side effects generally outweighed the benefits.6 As a result, Health Canada undertook a review of FQs and associated adverse events, and posted the results in their Summary Safety Review in January 2017. The review concluded that adverse events associated with FQ use may be persistent and disabling in rare cases, and that Health Canada would collaborate with drug manufacturers to update product safety information to reflect this potential risk.7 There remains uncertainty in the use of FQs for the treatment of infections. This report is an extension of a previous Rapid Response report,8 which identified evidence for the clinical effectiveness, cost-effectiveness, and guidelines for FQs in pneumonia and chronic obstructive pulmonary disease (COPD). The report found inconsistent results in the systematic reviews of the clinical effectiveness of FQ use in pneumonia, while there was a limited volume of evidence in the clinical effectiveness in COPD, and cost-effectiveness of FQ use in pneumonia. The current report aims to identify and synthesize the evidence describing the clinical effectiveness, cost-effectiveness and guidelines for the use of FQs in other respiratory tract infections (excluding COPD, pneumonia, cystic fibrosis and tuberculosis).


PMID: 31433606

Typing and antimicrobial susceptibility of 134 Neisseria gonorrhoeae strains from Southern Spain.

Tue, 08/20/2019 - 06:03
Related Articles

Typing and antimicrobial susceptibility of 134 Neisseria gonorrhoeae strains from Southern Spain.

Rev Esp Quimioter. 2019 Apr;32(2):114-120

Authors: Cobo F, Cabezas-Fernández MT, Avivar C

Abstract
OBJECTIVE: Last guidelines have recommended the introduction of dual antimicrobial therapy in order to avoid treatment failure. In the present report, the susceptibility to some antibiotics was evaluated, and the typing of Neisseria gonorrhoeae strains was performed.
METHODS: Gonococcal isolates were tested for susceptibility according to the recommendations of both CLSI and EUCAST. A total of 134 isolates were typed by the NG-MAST technique.
RESULTS: Seventy-two different N. gonorrhoeae types were found, and the most frequent types obtained were ST 1407, ST 14958, ST 7192, ST 13251 and ST 5405. If CLSI/EUCAST criteria were applied, a ST 9807 type was found nonsusceptible to ceftriaxone and cefixime (MIC 0.5 mg/L), and a ST 12800 type was found nonsusceptible only to cefixime (MIC 0.25 mg/L). When only EUCAST breakpoints were taken into account, three strains were also resistant to cefixime (MIC 0.25 mg/L) and three isolates were resistant to ceftriaxone (MIC 0.19, 0.16 and 0.25 mg/L, respectively). The majority of strains were resistant to ciprofloxacin (68.6%), and all N. gonorrhoeae strains were susceptible to spectinomycin; 9.7% of isolates were resistant to azithromycin.
CONCLUSIONS: Molecular typing may be a useful tool to predict antimicrobial resistance. High rates of resistance to penicillin, tetracycline and ciprofloxacin were found in this area. It is highly recommended to carry out antimicrobial susceptibility in all gonorrhoea cases and to identify treatment failures to verify emerging resistance.

PMID: 30727713 [PubMed - indexed for MEDLINE]

Pages