P70 A Longitudinal Evaluation of Quinolone Resistant N. Gonorrhoeae and Effects of Treatment Change

Wednesday, March 10, 2010
Pre-Function Lobby & Grand Ballroom D2/E (M4) (Omni Hotel)
Jyl Madlem, MSM, MT, (AMT), Bell FLower STD Control Program, Marion County Health Department, Indianpolis, IN, Coya Campbell II, BS, Bell FLower STD Control Program, Marion County Health Department, Indianapolis, IN, Barbara van Der Pol, PhD, MPH, Bell FLower STD Control Progam, Marion County Health Department, Indianapolis, IN and Janet Arno, MD, Department of Medicine, Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN

Background: Quinolone resistant N. gonorrhoeae (QRNG) has steadily increased with widespread use of fluoroquinolones, prompting a CDC-recommended change in treatment strategies.  Such change in policy would not be possible without monitoring the rates of resistant strains.

Objectives: To review the rates of QRNG before and after the CDC recommended changes in treatment therapies in conjunction with reduced surveillance activities.

Methods: The Marion County Health Department (MCHD) laboratory routinely assesses all positive N. gonorrhoeae cultures for quinolone resistance. The CDC recommended change from fluoroquinolones to cefixime was adopted by the MCHD STD clinic in the third quarter of 2007. Beginning in 2008, gonorrhea culture targeted to clients considered to be at risk for QRNG while DNA-based diagnostics were used for other clients.  The rates of resistant isolates identified before and after the shift in treatment paradigm and samples submitted by the STD clinic and other clinics were compared.

Results: The rate of QRNG in Marion County prior to the treatment change was 2.7%, 95% CI (2.01, 3.32) while the rate after treatment change is 4.5%, 95% CI (3.37, 5.56).  The proportion of QRNG isolates obtained from non-STD clinics has remained steady (19%) over the period of evaluation.  Use of targeted testing has allowed the MCHD STD Clinic to continue to identify approximately 86% of the county’s QRNG isolates.  Overall, a steady increase in the number of resistant isolates was noted.

Conclusions: Changing the treatment protocol has not resulted in a reduction in the frequency of QRNG in Marion County Indiana.

Implications for Programs, Policy, and/or Research:As diagnostic screening moves to DNA-based testing, it is important for public health laboratories to maintain capacity for N. gonorrhoeae culture and resistance monitoring that can be targeted to samples from high-risk populations.  Targeted screening for resistance may be an effective and cost efficient surveillance tool.

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