Evaluating spatially adaptive guidelines for the treatment of gonorrhea to reduce the incidence of gonococcal infection and increase the effective lifespan of antibiotics.
Evaluating spatially adaptive guidelines for the treatment of gonorrhea to reduce the incidence of gonococcal infection and increase the effective lifespan of antibiotics.
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DOI：
10.1371/journal.pcbi.1009842
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发表时间：
2022-03
影响因子：
4.3
通讯作者：
Grad YH
中科院分区：
文献类型：
--
作者：
Yaesoubi R;Cohen T;Hsu K;Gift TL;St Cyr SB;Salomon JA;Grad YH
在缺乏报告抗生素敏感性的护理点淋病诊断的情况下，淋病治疗是经验性的并由标准化指南确定。这些指南是根据国家监测系统对耐药流行率的估计得出的。我们研究了当地（而不是国家）监测数据提供的指南是否可以降低淋病的发病率并延长治疗指南中使用的抗生素的有效寿命。我们使用美国 16 个大都市区男男性行为者 (MSM) 淋病传播动态模型来确定基于当地耐药率估计的空间适应性治疗指南是否可以延长假设抗生素的有效寿命。 2017 年，这些大都市地区的淋病病例率为每 10 万男男性行为者 5,548 例。根据当前耐药率超过 5% 时更新治疗指南的策略，我们发现空间自适应指南可以将每 10 万男男性行为者每年的淋病病例率降低 200 例（95% 不确定性区间：169、232 例），同时扩大使用范围一线抗生素的寿命延长了 0.75 (0.55, 0.95) 年。降低淋病发病率同时延长抗生素有效寿命的一项潜在策略是根据当地而不是全国的耐药率来制定治疗指南。抗生素耐药性威胁着全球越来越多感染的有效治疗。在缺乏确定抗生素敏感性的快速护理点诊断的情况下，细菌引起的几种感染（例如淋病和结核病）的治疗仍然是经验性的并遵循指南。这些指南通常是在国家一级根据全国耐药流行率的估计确定的。在这里，我们表明，如果治疗指南是在当地根据区域耐药率而不是单一的全国性建议确定的，则可以预防更多的淋病病例，并且可以延长适合治疗淋病的抗生素的有效寿命。我们的分析提供的证据强调了以下方面的重要性：1）维护当地的抗菌素耐药性监测系统；2）让政策制定者参与其中，利用这些监测系统的数据为地方层面的及时、有效的决策提供信息。
In the absence of point-of-care gonorrhea diagnostics that report antibiotic susceptibility, gonorrhea treatment is empiric and determined by standardized guidelines. These guidelines are informed by estimates of resistance prevalence from national surveillance systems. We examined whether guidelines informed by local, rather than national, surveillance data could reduce the incidence of gonorrhea and increase the effective lifespan of antibiotics used in treatment guidelines. We used a transmission dynamic model of gonorrhea among men who have sex with men (MSM) in 16 U.S. metropolitan areas to determine whether spatially adaptive treatment guidelines based on local estimates of resistance prevalence can extend the effective lifespan of hypothetical antibiotics. The rate of gonorrhea cases in these metropolitan areas was 5,548 cases per 100,000 MSM in 2017. Under the current strategy of updating the treatment guideline when the prevalence of resistance exceeds 5%, we showed that spatially adaptive guidelines could reduce the annual rate of gonorrhea cases by 200 cases (95% uncertainty interval: 169, 232) per 100,000 MSM population while extending the use of a first-line antibiotic by 0.75 (0.55, 0.95) years. One potential strategy to reduce the incidence of gonorrhea while extending the effective lifespan of antibiotics is to inform treatment guidelines based on local, rather than national, resistance prevalence. Antimicrobial resistance threatens the effective treatment of a growing number of infections worldwide. In the absence of rapid point-of-care diagnostics that determine antibiotic susceptibility, the treatment of several infections caused by bacteria (e.g., gonorrhea and tuberculosis) remain empiric and informed by guidelines. These guidelines are usually determined at the national level and based on the estimated resistance prevalence nationally. Here, we show that more cases of gonorrhea could be prevented and the effective lifespan of antibiotics suitable for the treatment of gonorrhea could be extended if treatment guidelines are determined locally and based on the regional resistance prevalence rather than on a single nationwide recommendation. Our analysis provides evidence to highlight the importance of 1) maintaining local surveillance systems of antimicrobial resistance and 2) engaged policymakers who use the data from these surveillance systems to inform timely and effective decisions at the local level.
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2020年CDC治疗指南的更新。
DOI：
10.15585/mmwr.mm6950a6
发表时间：
2020-12-18
期刊：
MMWR. Morbidity and mortality weekly report
影响因子：
--
作者：
St Cyr S;Barbee L;Workowski KA;Bachmann LH;Pham C;Schlanger K;Torrone E;Weinstock H;Kersh EN;Thorpe P
通讯作者：
Thorpe P
影响因子：
3.1
作者：
Spicknall, Ian H.;Mayer, Kenneth H.;Romero-Severson, Ethan O.
通讯作者：
Romero-Severson, Ethan O.
影响因子：
15.8
作者：
Yaesoubi, Reza;Cohen, Ted;Grad, Yonatan H.
通讯作者：
Grad, Yonatan H.
影响因子：
33.9
作者：
Jones, Michelle L. Johnson;Chapin-Bardales, Johanna;Kuo, Irene
通讯作者：
Kuo, Irene
影响因子：
4.4
作者：
Menzies NA;Soeteman DI;Pandya A;Kim JJ
通讯作者：
Kim JJ