Analysis of the potential for point-of-care test to enable individualised treatment of infections caused by antimicrobial-resistant and susceptible strains of Neisseria gonorrhoeae: a modelling study.
Analysis of the potential for point-of-care test to enable individualised treatment of infections caused by antimicrobial-resistant and susceptible strains of Neisseria gonorrhoeae: a modelling study.
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DOI：
10.1136/bmjopen-2016-015447
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发表时间：
2017-06-14
期刊：
影响因子：
2.9
通讯作者：
Woodford N
中科院分区：
文献类型：
--
作者：
Turner KM;Christensen H;Adams EJ;McAdams D;Fifer H;McDonnell A;Woodford N
创建一个数学模型，以调查引入淋病抗菌素耐药点检测（AMR POCT）作为延长当前最后一线治疗寿命的一种方式的治疗影响和经济影响。造型研究。英格兰。获得性健康服务的患者。与目前所有患者都接受头孢曲松和阿奇霉素治疗的情况相比，引入一种假设的AMR POCT的增量影响，该POCT可以检测对先前一线抗生素（如环丙沙星或青霉素）的敏感性，从而使患者得到更有针对性的治疗。使用Excel中开发的数学模型对假设干预进行评估。该模型包括初始和随访的出席率、随访损失、使用标准或定制治疗、治疗所需的时间以及检测和治疗的费用。节省的头孢曲松剂量数，到最适当治疗的平均时间，每个（感染）患者的平均就诊次数，失去随访的患者人数和检测的总费用。在目前的情况下，每年估计有33431例头孢曲松治疗，792例淋球菌感染由于缺乏随访而未得到治疗。对环丙沙星使用AMR POCT可使头孢曲松治疗减少66%，对青霉素使用AMR POCT可使头孢曲松治疗减少79%。在包括POCT在内的情况下，患者接受抗生素治疗的平均时间减少了2天，并且通过消除随访损失，没有阳性患者继续接受治疗。据估计，此类poct增加了3400万英镑的检测成本，但这还没有考虑到重复就诊成本的减少和旧的、更便宜的抗菌素的重复使用。AMR POCT的引入可以让临床医生区分大多数淋病阳性患者，这些患者的菌株可以用以前放弃的较老的一线治疗方法治疗，而那些需要我们目前的最后一线双重治疗。这种测试可以延长头孢曲松和阿奇霉素双重治疗的使用寿命，从而推迟淋病可能无法治愈的时间。
To create a mathematical model to investigate the treatment impact and economic implications of introducing an antimicrobial resistance point-of-care test (AMR POCT) for gonorrhoea as a way of extending the life of current last-line treatments. Modelling study. England. Patients accessing sexual health services. Incremental impact of introducing a hypothetical AMR POCT that could detect susceptibility to previous first-line antibiotics, for example, ciprofloxacin or penicillin, so that patients are given more tailored treatment, compared with the current situation where all patients are given therapy with ceftriaxone and azithromycin. The hypothetical intervention was assessed using a mathematical model developed in Excel. The model included initial and follow-up attendances, loss to follow-up, use of standard or tailored treatment, time taken to treatment and the costs of testing and treatment. Number of doses of ceftriaxone saved, mean time to most appropriate treatment, mean number of visits per (infected) patient, number of patients lost to follow-up and total cost of testing. In the current situation, an estimated 33 431 ceftriaxone treatments are administered annually and 792 gonococcal infections remain untreated due to loss to follow-up. The use of an AMR POCT for ciprofloxacin could reduce these ceftriaxone treatments by 66%, and for an AMR POCT for penicillin by 79%. The mean time for patients receiving an antibiotic treatment is reduced by 2 days in scenarios including POCT and no positive patients remain untreated through eliminating loss to follow-up. Such POCTs are estimated to add £34 million to testing costs, but this does not take into account reductions in costs of repeat attendances and the reuse of older, cheaper antimicrobials. The introduction of AMR POCT could allow clinicians to discern between the majority of gonorrhoea-positive patients with strains that could be treated with older, previously abandoned first-line treatments, and those requiring our current last-line dual therapy. Such tests could extend the useful life of dual ceftriaxone and azithromycin therapy, thus pushing back the time when gonorrhoea may become untreatable.
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影响因子：
4.8
作者：
Régnier SA;Huels J
通讯作者：
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影响因子：
3.6
作者：
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