Detection of antibiotic resistance is essential for gonorrhoea point-of-care testing: a mathematical modelling study.

Fingerhuth, Stephanie M.; Low, Nicola; Bonhoeffer, Sebastian; Althaus, Christian L. (2017). Detection of antibiotic resistance is essential for gonorrhoea point-of-care testing: a mathematical modelling study. BMC medicine, 15(1), p. 142. BioMed Central 10.1186/s12916-017-0881-x

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BACKGROUND Antibiotic resistance is threatening to make gonorrhoea untreatable. Point-of-care (POC) tests that detect resistance promise individually tailored treatment, but might lead to more treatment and higher levels of resistance. We investigate the impact of POC tests on antibiotic-resistant gonorrhoea. METHODS We used data about the prevalence and incidence of gonorrhoea in men who have sex with men (MSM) and heterosexual men and women (HMW) to calibrate a mathematical gonorrhoea transmission model. With this model, we simulated four clinical pathways for the diagnosis and treatment of gonorrhoea: POC test with (POC+R) and without (POC-R) resistance detection, culture and nucleic acid amplification tests (NAATs). We calculated the proportion of resistant infections and cases averted after 5 years, and compared how fast resistant infections spread in the populations. RESULTS The proportion of resistant infections after 30 years is lowest for POC+R (median MSM: 0.18%, HMW: 0.12%), and increases for culture (MSM: 1.19%, HMW: 0.13%), NAAT (MSM: 100%, HMW: 99.27%), and POC-R (MSM: 100%, HMW: 99.73%). Per 100 000 persons, NAAT leads to 36 366 (median MSM) and 1228 (median HMW) observed cases after 5 years. Compared with NAAT, POC+R averts more cases after 5 years (median MSM: 3353, HMW: 118). POC tests that detect resistance with intermediate sensitivity slow down resistance spread more than NAAT. POC tests with very high sensitivity for the detection of resistance are needed to slow down resistance spread more than by using culture. CONCLUSIONS POC with high sensitivity to detect antibiotic resistance can keep gonorrhoea treatable longer than culture or NAAT. POC tests without reliable resistance detection should not be introduced because they can accelerate the spread of antibiotic-resistant gonorrhoea.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine

UniBE Contributor:

Fingerhuth, Stephanie; Low, Nicola and Althaus, Christian

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1741-7015

Publisher:

BioMed Central

Language:

English

Submitter:

Tanya Karrer

Date Deposited:

05 Sep 2017 14:20

Last Modified:

29 Nov 2017 12:20

Publisher DOI:

10.1186/s12916-017-0881-x

PubMed ID:

28747205

Uncontrolled Keywords:

Bacterial drug resistance Epidemiology Gonorrhoea Mathematical model Point-of-care testing Sexually transmitted infection

BORIS DOI:

10.7892/boris.102385

URI:

https://boris.unibe.ch/id/eprint/102385

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