Can Ciprofloxacin be Used for Precision Treatment of Gonorrhea in Public STD Clinics? Assessment of Ciprofloxacin Susceptibility and an Opportunity for Point-of-Care Testing
<b>Background</b>: Given the lack of new antimicrobials to treat <i>Neisseria gonorrhoeae</i> (NG) infections, reusing previously recommended antimicrobials has been proposed as a strategy to control the spread of multi-drug-resistant NG. We assessed ciprofloxacin susceptibil...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2019-10-01
|
| Series: | Pathogens |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2076-0817/8/4/189 |
| _version_ | 1828276740536926208 |
|---|---|
| author | Johan H. Melendez Yu-Hsiang Hsieh Mathilda Barnes Justin Hardick Elizabeth A. Gilliams Charlotte A. Gaydos |
| author_facet | Johan H. Melendez Yu-Hsiang Hsieh Mathilda Barnes Justin Hardick Elizabeth A. Gilliams Charlotte A. Gaydos |
| author_sort | Johan H. Melendez |
| collection | DOAJ |
| description | <b>Background</b>: Given the lack of new antimicrobials to treat <i>Neisseria gonorrhoeae</i> (NG) infections, reusing previously recommended antimicrobials has been proposed as a strategy to control the spread of multi-drug-resistant NG. We assessed ciprofloxacin susceptibility in a large sample set of NG isolates and identified correlates associated with ciprofloxacin-resistant NG infections. <b>Methods</b>: NG isolates collected in Baltimore, Maryland between 2014 and 2016 were evaluated by Gyrase A (<i>gyrA</i>) PCR and E-test for susceptibility to ciprofloxacin. Clinical characteristics and demographics were evaluated by multivariate regression analysis to identify correlates of ciprofloxacin-resistant NG infections. <b>Results</b>: 510 NG isolates from predominately African American (96.5%), heterosexual (85.7%), and HIV-negative (92.5%) male subjects were included in the study. The overall percentage of isolates with mutant <i>gyrA</i> sequences, indicative of ciprofloxacin resistance, was 32.4%, and significantly increased from 24.7% in 2014 to 45.2% in 2016 (p < 0.001). Participants older than 35 years of age were 2.35 times more likely to have a <i>gyrA</i> mutant NG infection than younger participants (p < 0.001). Race, sexual orientation, symptomology, or co-infection the HIV or syphilis were not associated with a particular NG <i>gyrA</i> genotype. <b>Conclusions</b>: Resistance to ciprofloxacin in Baltimore is lower than other regions and indicates that in this environment, use of ciprofloxacin may be appropriate for targeted treatment provided utilization of enhanced surveillance tools. The targeted use of ciprofloxacin may be more beneficial for individuals under 35 years of age. Point-of-care tests for NG diagnosis and susceptibility testing are urgently needed to identify individuals who can be treated with this targeted approach. |
| first_indexed | 2024-04-13T07:01:59Z |
| format | Article |
| id | doaj.art-436561f5d9cd4a17b54d372d4bb71621 |
| institution | Directory Open Access Journal |
| issn | 2076-0817 |
| language | English |
| last_indexed | 2024-04-13T07:01:59Z |
| publishDate | 2019-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Pathogens |
| spelling | doaj.art-436561f5d9cd4a17b54d372d4bb716212022-12-22T02:57:05ZengMDPI AGPathogens2076-08172019-10-018418910.3390/pathogens8040189pathogens8040189Can Ciprofloxacin be Used for Precision Treatment of Gonorrhea in Public STD Clinics? Assessment of Ciprofloxacin Susceptibility and an Opportunity for Point-of-Care TestingJohan H. Melendez0Yu-Hsiang Hsieh1Mathilda Barnes2Justin Hardick3Elizabeth A. Gilliams4Charlotte A. Gaydos5Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD 21205, USADepartment of Emergency Medicine, Johns Hopkins University, Baltimore, MD 21205, USADivision of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD 21205, USADivision of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD 21205, USAJohns Hopkins School of Medicine, Baltimore, MD 21205, USADivision of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA<b>Background</b>: Given the lack of new antimicrobials to treat <i>Neisseria gonorrhoeae</i> (NG) infections, reusing previously recommended antimicrobials has been proposed as a strategy to control the spread of multi-drug-resistant NG. We assessed ciprofloxacin susceptibility in a large sample set of NG isolates and identified correlates associated with ciprofloxacin-resistant NG infections. <b>Methods</b>: NG isolates collected in Baltimore, Maryland between 2014 and 2016 were evaluated by Gyrase A (<i>gyrA</i>) PCR and E-test for susceptibility to ciprofloxacin. Clinical characteristics and demographics were evaluated by multivariate regression analysis to identify correlates of ciprofloxacin-resistant NG infections. <b>Results</b>: 510 NG isolates from predominately African American (96.5%), heterosexual (85.7%), and HIV-negative (92.5%) male subjects were included in the study. The overall percentage of isolates with mutant <i>gyrA</i> sequences, indicative of ciprofloxacin resistance, was 32.4%, and significantly increased from 24.7% in 2014 to 45.2% in 2016 (p < 0.001). Participants older than 35 years of age were 2.35 times more likely to have a <i>gyrA</i> mutant NG infection than younger participants (p < 0.001). Race, sexual orientation, symptomology, or co-infection the HIV or syphilis were not associated with a particular NG <i>gyrA</i> genotype. <b>Conclusions</b>: Resistance to ciprofloxacin in Baltimore is lower than other regions and indicates that in this environment, use of ciprofloxacin may be appropriate for targeted treatment provided utilization of enhanced surveillance tools. The targeted use of ciprofloxacin may be more beneficial for individuals under 35 years of age. Point-of-care tests for NG diagnosis and susceptibility testing are urgently needed to identify individuals who can be treated with this targeted approach.https://www.mdpi.com/2076-0817/8/4/189<i>neisseria gonorrhoeae</i>gonorrheaantimicrobial resistanceciprofloxacin resistanceprecision treatment |
| spellingShingle | Johan H. Melendez Yu-Hsiang Hsieh Mathilda Barnes Justin Hardick Elizabeth A. Gilliams Charlotte A. Gaydos Can Ciprofloxacin be Used for Precision Treatment of Gonorrhea in Public STD Clinics? Assessment of Ciprofloxacin Susceptibility and an Opportunity for Point-of-Care Testing Pathogens <i>neisseria gonorrhoeae</i> gonorrhea antimicrobial resistance ciprofloxacin resistance precision treatment |
| title | Can Ciprofloxacin be Used for Precision Treatment of Gonorrhea in Public STD Clinics? Assessment of Ciprofloxacin Susceptibility and an Opportunity for Point-of-Care Testing |
| title_full | Can Ciprofloxacin be Used for Precision Treatment of Gonorrhea in Public STD Clinics? Assessment of Ciprofloxacin Susceptibility and an Opportunity for Point-of-Care Testing |
| title_fullStr | Can Ciprofloxacin be Used for Precision Treatment of Gonorrhea in Public STD Clinics? Assessment of Ciprofloxacin Susceptibility and an Opportunity for Point-of-Care Testing |
| title_full_unstemmed | Can Ciprofloxacin be Used for Precision Treatment of Gonorrhea in Public STD Clinics? Assessment of Ciprofloxacin Susceptibility and an Opportunity for Point-of-Care Testing |
| title_short | Can Ciprofloxacin be Used for Precision Treatment of Gonorrhea in Public STD Clinics? Assessment of Ciprofloxacin Susceptibility and an Opportunity for Point-of-Care Testing |
| title_sort | can ciprofloxacin be used for precision treatment of gonorrhea in public std clinics assessment of ciprofloxacin susceptibility and an opportunity for point of care testing |
| topic | <i>neisseria gonorrhoeae</i> gonorrhea antimicrobial resistance ciprofloxacin resistance precision treatment |
| url | https://www.mdpi.com/2076-0817/8/4/189 |
| work_keys_str_mv | AT johanhmelendez canciprofloxacinbeusedforprecisiontreatmentofgonorrheainpublicstdclinicsassessmentofciprofloxacinsusceptibilityandanopportunityforpointofcaretesting AT yuhsianghsieh canciprofloxacinbeusedforprecisiontreatmentofgonorrheainpublicstdclinicsassessmentofciprofloxacinsusceptibilityandanopportunityforpointofcaretesting AT mathildabarnes canciprofloxacinbeusedforprecisiontreatmentofgonorrheainpublicstdclinicsassessmentofciprofloxacinsusceptibilityandanopportunityforpointofcaretesting AT justinhardick canciprofloxacinbeusedforprecisiontreatmentofgonorrheainpublicstdclinicsassessmentofciprofloxacinsusceptibilityandanopportunityforpointofcaretesting AT elizabethagilliams canciprofloxacinbeusedforprecisiontreatmentofgonorrheainpublicstdclinicsassessmentofciprofloxacinsusceptibilityandanopportunityforpointofcaretesting AT charlotteagaydos canciprofloxacinbeusedforprecisiontreatmentofgonorrheainpublicstdclinicsassessmentofciprofloxacinsusceptibilityandanopportunityforpointofcaretesting |