Quantifying the Use of Epidemiologic Treatment and its Role in the Development of Antimicrobial-Resistant N. gonorrhoeae among Men who have Sex with Men (MSM)

项目总结 根据世界卫生组织的说法，耐药淋球菌(NG)是一个紧迫的公共卫生威胁 疾病控制和预防中心(CDC)1.淋球菌已对所有 自1930年代以来推荐的治疗方案。最近，对阿奇霉素(Azm)的耐药性是两种 用于治疗淋病的联合用药迅速增加，特别是在与男性发生性关系的男性中 男性(MSM)2根据疾控中心的监测数据，异性恋男性尿路NG在 2.4%的病例，而耐AZM的MSM尿路NG高出~3.5倍(8.2%)。 抗生素会导致抗生素耐药性。目前，阿兹姆是疾控中心推荐的治疗方案的一部分 NG和衣原体(CT)均为阳性。男男性接触者不成比例地感染了这些性传播感染 (STI)。鉴于高感染率，在密集的性网络中有大量的性伴侣，许多MSM 接受Azm，一种同时用于NG和CT的药物，无论是用于治疗已知的感染，还是用于可能的 在检测结果出来之前，从受感染的性伴那里接触到这些感染。这是一个公共卫生问题 这种做法被称为流行病学治疗，或“Epi-TX”。1，2该战略是在诊断为 测试结果不太理想，抗生素供应充足。然而，Epi-TX目前尚未进行检查 在这个时代，我们已经改善了STI诊断，但抗菌药物的开发管道正在减弱，而且 几乎没有关于Epi-TX在MSM中的使用的数据，也没有Epi-TX在AMR NG的发展中所起的作用。这个 这项建议的首要目标是：1)量化城市性传播感染诊所男男性接触者中Epi-TX的年使用量； 2)确定Azm广泛使用的程度，特别是Epi-TX在Azm开发中的作用- 耐药淋病和3)创建风险预测评分以确定临床、社会和行为 预测哪些MSM应该在临床就诊时接受Epi-TX以及哪些应该等待检测结果的决定因素。 性病门诊男男性接触者Epi-TX发生率及不必要抗生素使用程度的了解 与这种干预相关的暴露及其对耐AZM NG的发展的影响是第一步 来定义这个问题。为接受Epi-TX的人确定NG/CT检测阳性的预测因素将有助于限制 男男性接触不必要的抗生素。综上所述，这项提案产生的数据将有助于 CDC针对细菌性性病的抗生素处方政策有可能防止进一步 抗菌素耐药性的发展，不仅在淋球菌中，在其他细菌中也是如此。

PROJECT SUMMARY Antimicrobial resistant (AMR) Neisseria gonorrhoeae (NG) is an urgent public health threat according to the Centers for Disease Control and Prevention (CDC).1 The gonococcus has developed resistance to all recommended treatment regimens since the 1930s. Recently, resistance to azithromycin (AZM), one of two drugs used in combination to treat gonorrhea, has increased rapidly, particularly among men who have sex with men (MSM).2 According to CDC surveillance data, heterosexual male urethral NG harbored AZM resistance in 2.4% of cases, whereas MSM urethral NG with AZM-resistance was ~3.5 times higher (8.2%).3 Exposure to antibiotics leads to antibiotic resistance. At present, AZM is part of CDC recommended treatment regimens for both NG and chlamydia (CT). MSM are disproportionately infected with these sexually transmitted infections (STI). Given high rates of infection, high numbers of sexual partners in dense sexual networks, many MSM receive AZM, a drug used for both NG and CT, either for treatment of known infection or empirically, for possible exposures to these infections from an infected sex partner, prior to the results of their test. This is a public health practice known as epidemiologic treatment, or “Epi-Tx”. 1,2 The strategy was developed at a time when diagnostic tests were suboptimal, and antibiotics were in abundance. However, Epi-Tx has not been examined in the current era where we have improved STI diagnostics, yet a waning antimicrobial developmental pipeline, and there is little-to-no data on the use of Epi-Tx in MSM, nor the role that Epi-Tx plays in the development of AMR NG. The overarching goal of this proposal is to 1) quantify the annual use of Epi-Tx among MSM at an urban STI Clinic; 2) determine the extent to which AZM use, broadly, and Epi-Tx, in particular, play in the development of AZM- resistant gonorrhea and 3) to create a risk prediction score to determine clinical, social and behavioral determinants to predict which MSM should receive Epi-Tx at a clinic visit and which should wait for test results. Understanding the incidence of Epi-Tx among STD clinic attending MSM, the extent of unnecessary antibiotic exposure related to this intervention, and its impact on the development of AZM-resistant NG, are the first steps to defining the problem. Identifying predictors of positive NG/CT tests for those receiving Epi-Tx will help limit MSM's exposure to unnecessary antibiotics. Together, the data generated from this proposal will help inform the CDC's antibiotic prescribing policies for bacterial STDs which has the potential to prevent the further development of antimicrobial resistant, not only in N. gonorrhoeae, but in other bacteria as well.