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Using rapid point-of-care tests to inform antibiotic choice to mitigate drug resistance in gonorrhoea
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Vegvari, Carolin, Grad, Yonatan H., White, Peter J., Didelot, Xavier, Whittles, Lilith K., Scangarella-Oman, Nicole E., Mitrani-Gold, Fanny S., Dumont, Etienne, Perry, Caroline R., Gilchrist, Kim, Hossain, Mohammad, Mortimer, Tatum D., Anderson, Roy M. and Gardiner, David (2020) Using rapid point-of-care tests to inform antibiotic choice to mitigate drug resistance in gonorrhoea. Eurosurveillance, 25 (43). doi:10.2807/1560-7917.ES.2020.25.43.1900210
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WRAP-using-rapid-point-care-tests-inform-antibiotic-choice-mitigate-drug-resistance-gonorrhoea-Didelot-2020.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons Attribution 4.0. Download (244Kb) | Preview |
Official URL: http://dx.doi.org/10.2807/1560-7917.ES.2020.25.43....
Abstract
Background:
The first cases of extensively drug resistant gonorrhoea were recorded in the United Kingdom in 2018. There is a public health need for strategies on how to deploy existing and novel antibiotics to minimise the risk of resistance development. As rapid point-of-care tests (POCTs) to predict susceptibility are coming to clinical use, coupling the introduction of an antibiotic with diagnostics that can slow resistance emergence may offer a novel paradigm for maximising antibiotic benefits. Gepotidacin is a novel antibiotic with known resistance and resistance-predisposing mutations. In particular, a mutation that confers resistance to ciprofloxacin acts as the ‘stepping-stone’ mutation to gepotidacin resistance.
Aim:
To investigate how POCTs detecting Neisseria gonorrhoeae resistance mutations for ciprofloxacin and gepotidacin can be used to minimise the risk of resistance development to gepotidacin.
Methods:
We use individual-based stochastic simulations to formally investigate the aim.
Results:
The level of testing needed to reduce the risk of resistance development depends on the mutation rate under treatment and the prevalence of stepping-stone mutations. A POCT is most effective if the mutation rate under antibiotic treatment is no more than two orders of magnitude above the mutation rate without treatment and the prevalence of stepping-stone mutations is 1–13%.
Conclusion:
Mutation frequencies and rates should be considered when estimating the POCT usage required to reduce the risk of resistance development in a given population. Molecular POCTs for resistance mutations and stepping-stone mutations to resistance are likely to become important tools in antibiotic stewardship.
| Item Type: | Journal Article | ||||||||||||||||||
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| Subjects: | Q Science > QR Microbiology R Medicine > RM Therapeutics. Pharmacology |
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| Divisions: | Faculty of Science > Life Sciences (2010- ) Faculty of Science > Statistics |
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| Library of Congress Subject Headings (LCSH): | Neisseria gonorrhoeae , Ciprofloxacin, Gonorrhea, Drug resistance in microorganisms, Antibiotics | ||||||||||||||||||
| Journal or Publication Title: | Eurosurveillance | ||||||||||||||||||
| Publisher: | Centre European pour la Surveillance Epidemiologique du SIDA | ||||||||||||||||||
| ISSN: | 1560-7917 | ||||||||||||||||||
| Official Date: | 29 October 2020 | ||||||||||||||||||
| Dates: |
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| Volume: | 25 | ||||||||||||||||||
| Number: | 43 | ||||||||||||||||||
| DOI: | 10.2807/1560-7917.ES.2020.25.43.1900210 | ||||||||||||||||||
| Status: | Peer Reviewed | ||||||||||||||||||
| Publication Status: | Published | ||||||||||||||||||
| Access rights to Published version: | Open Access | ||||||||||||||||||
| RIOXX Funder/Project Grant: |
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