Cargando…

Exploring the Benefits of Molecular Testing for Gonorrhoea Antibiotic Resistance Surveillance in Remote Settings

BACKGROUND: Surveillance for gonorrhoea antimicrobial resistance (AMR) is compromised by a move away from culture-based testing in favour of more convenient nucleic acid amplification test (NAAT) tests. We assessed the potential benefit of a molecular resistance test in terms of the timeliness of de...

Descripción completa

Detalles Bibliográficos
Autores principales: Hui, Ben B., Ryder, Nathan, Su, Jiunn-Yih, Ward, James, Chen, Marcus Y., Donovan, Basil, Fairley, Christopher K., Guy, Rebecca J., Lahra, Monica M., Law, Mathew G., Whiley, David M., Regan, David G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504484/
https://www.ncbi.nlm.nih.gov/pubmed/26181042
http://dx.doi.org/10.1371/journal.pone.0133202
_version_ 1782381467019509760
author Hui, Ben B.
Ryder, Nathan
Su, Jiunn-Yih
Ward, James
Chen, Marcus Y.
Donovan, Basil
Fairley, Christopher K.
Guy, Rebecca J.
Lahra, Monica M.
Law, Mathew G.
Whiley, David M.
Regan, David G.
author_facet Hui, Ben B.
Ryder, Nathan
Su, Jiunn-Yih
Ward, James
Chen, Marcus Y.
Donovan, Basil
Fairley, Christopher K.
Guy, Rebecca J.
Lahra, Monica M.
Law, Mathew G.
Whiley, David M.
Regan, David G.
author_sort Hui, Ben B.
collection PubMed
description BACKGROUND: Surveillance for gonorrhoea antimicrobial resistance (AMR) is compromised by a move away from culture-based testing in favour of more convenient nucleic acid amplification test (NAAT) tests. We assessed the potential benefit of a molecular resistance test in terms of the timeliness of detection of gonorrhoea AMR. METHODS AND FINDINGS: An individual-based mathematical model was developed to describe the transmission of gonorrhoea in a remote Indigenous population in Australia. We estimated the impact of the molecular test on the time delay between first importation and the first confirmation that the prevalence of gonorrhoea AMR (resistance proportion) has breached the WHO-recommended 5% threshold (when a change in antibiotic should occur). In the remote setting evaluated in this study, the model predicts that when culture is the only available means of testing for AMR, the breach will only be detected when the actual prevalence of AMR in the population has already reached 8 – 18%, with an associated delay of ~43 – 69 months between first importation and detection. With the addition of a molecular resistance test, the number of samples for which AMR can be determined increases facilitating earlier detection at a lower resistance proportion. For the best case scenario, where AMR can be determined for all diagnostic samples, the alert would be triggered at least 8 months earlier than using culture alone and the resistance proportion will have only slightly exceeded the 5% notification threshold. CONCLUSIONS: Molecular tests have the potential to provide more timely warning of the emergence of gonorrhoea AMR. This in turn will facilitate earlier treatment switching and more targeted treatment, which has the potential to reduce the population impact of gonorrhoea AMR.
format Online
Article
Text
id pubmed-4504484
institution National Center for Biotechnology Information
language English
publishDate 2015
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-45044842015-07-17 Exploring the Benefits of Molecular Testing for Gonorrhoea Antibiotic Resistance Surveillance in Remote Settings Hui, Ben B. Ryder, Nathan Su, Jiunn-Yih Ward, James Chen, Marcus Y. Donovan, Basil Fairley, Christopher K. Guy, Rebecca J. Lahra, Monica M. Law, Mathew G. Whiley, David M. Regan, David G. PLoS One Research Article BACKGROUND: Surveillance for gonorrhoea antimicrobial resistance (AMR) is compromised by a move away from culture-based testing in favour of more convenient nucleic acid amplification test (NAAT) tests. We assessed the potential benefit of a molecular resistance test in terms of the timeliness of detection of gonorrhoea AMR. METHODS AND FINDINGS: An individual-based mathematical model was developed to describe the transmission of gonorrhoea in a remote Indigenous population in Australia. We estimated the impact of the molecular test on the time delay between first importation and the first confirmation that the prevalence of gonorrhoea AMR (resistance proportion) has breached the WHO-recommended 5% threshold (when a change in antibiotic should occur). In the remote setting evaluated in this study, the model predicts that when culture is the only available means of testing for AMR, the breach will only be detected when the actual prevalence of AMR in the population has already reached 8 – 18%, with an associated delay of ~43 – 69 months between first importation and detection. With the addition of a molecular resistance test, the number of samples for which AMR can be determined increases facilitating earlier detection at a lower resistance proportion. For the best case scenario, where AMR can be determined for all diagnostic samples, the alert would be triggered at least 8 months earlier than using culture alone and the resistance proportion will have only slightly exceeded the 5% notification threshold. CONCLUSIONS: Molecular tests have the potential to provide more timely warning of the emergence of gonorrhoea AMR. This in turn will facilitate earlier treatment switching and more targeted treatment, which has the potential to reduce the population impact of gonorrhoea AMR. Public Library of Science 2015-07-16 /pmc/articles/PMC4504484/ /pubmed/26181042 http://dx.doi.org/10.1371/journal.pone.0133202 Text en © 2015 Hui et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Hui, Ben B.
Ryder, Nathan
Su, Jiunn-Yih
Ward, James
Chen, Marcus Y.
Donovan, Basil
Fairley, Christopher K.
Guy, Rebecca J.
Lahra, Monica M.
Law, Mathew G.
Whiley, David M.
Regan, David G.
Exploring the Benefits of Molecular Testing for Gonorrhoea Antibiotic Resistance Surveillance in Remote Settings
title Exploring the Benefits of Molecular Testing for Gonorrhoea Antibiotic Resistance Surveillance in Remote Settings
title_full Exploring the Benefits of Molecular Testing for Gonorrhoea Antibiotic Resistance Surveillance in Remote Settings
title_fullStr Exploring the Benefits of Molecular Testing for Gonorrhoea Antibiotic Resistance Surveillance in Remote Settings
title_full_unstemmed Exploring the Benefits of Molecular Testing for Gonorrhoea Antibiotic Resistance Surveillance in Remote Settings
title_short Exploring the Benefits of Molecular Testing for Gonorrhoea Antibiotic Resistance Surveillance in Remote Settings
title_sort exploring the benefits of molecular testing for gonorrhoea antibiotic resistance surveillance in remote settings
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504484/
https://www.ncbi.nlm.nih.gov/pubmed/26181042
http://dx.doi.org/10.1371/journal.pone.0133202
work_keys_str_mv AT huibenb exploringthebenefitsofmoleculartestingforgonorrhoeaantibioticresistancesurveillanceinremotesettings
AT rydernathan exploringthebenefitsofmoleculartestingforgonorrhoeaantibioticresistancesurveillanceinremotesettings
AT sujiunnyih exploringthebenefitsofmoleculartestingforgonorrhoeaantibioticresistancesurveillanceinremotesettings
AT wardjames exploringthebenefitsofmoleculartestingforgonorrhoeaantibioticresistancesurveillanceinremotesettings
AT chenmarcusy exploringthebenefitsofmoleculartestingforgonorrhoeaantibioticresistancesurveillanceinremotesettings
AT donovanbasil exploringthebenefitsofmoleculartestingforgonorrhoeaantibioticresistancesurveillanceinremotesettings
AT fairleychristopherk exploringthebenefitsofmoleculartestingforgonorrhoeaantibioticresistancesurveillanceinremotesettings
AT guyrebeccaj exploringthebenefitsofmoleculartestingforgonorrhoeaantibioticresistancesurveillanceinremotesettings
AT lahramonicam exploringthebenefitsofmoleculartestingforgonorrhoeaantibioticresistancesurveillanceinremotesettings
AT lawmathewg exploringthebenefitsofmoleculartestingforgonorrhoeaantibioticresistancesurveillanceinremotesettings
AT whileydavidm exploringthebenefitsofmoleculartestingforgonorrhoeaantibioticresistancesurveillanceinremotesettings
AT regandavidg exploringthebenefitsofmoleculartestingforgonorrhoeaantibioticresistancesurveillanceinremotesettings