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

BMC Medicine

Research Article

Sebastian Bonhoeffer¹  Stephanie M. Fingerhuth²  Nicola Low³  Christian L. Althaus³ 

[1] Institute of Integrative Biology, ETH Zurich, 8092, Zurich, Switzerland;Institute of Integrative Biology, ETH Zurich, 8092, Zurich, Switzerland;Institute of Social and Preventive Medicine, University of Bern, 3012, Bern, Switzerland;Institute of Social and Preventive Medicine, University of Bern, 3012, Bern, Switzerland;

关键词: Gonorrhoea;    Bacterial drug resistance;    Point-of-care testing;    Mathematical model;    Sexually transmitted infection;    Epidemiology;   

DOI  :  10.1186/s12916-017-0881-x

 received in 2017-03-09, accepted in 2017-05-19,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundAntibiotic 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.MethodsWe 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.ResultsThe 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.ConclusionsPOC 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.

【 授权许可】

CC BY   
© The Author(s) 2017

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