RAPID ASSESSMENT and RESPONSE to <I>Neisseria Gonorrhoeae</I> with DECREASED SUSCEPTIBILITY to CEPHALOSPORINS In California

Pandori, Mark

Tuesday, March 13, 2012: 10:15 AM

Nicollet Grand Ballroom (C/D)

Carol Kong, MPH, Epidemiology and Surveillance Section, California Department of Public Health, STD Control Branch, Richmond, CA, Heidi Bauer, MD, MS, MPH, Sexually Transmitted Disease (STD) Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, CA, Ina Park, MD, MS, Sexually Transmitted Disease (STD) Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, Cal, California Department of Public Health, Richmond, CA, Mark Pandori, PhD, HCLD(ABB), Laboratory, San Francisco Department of Public Health Laboratory, San Francisco, CA, Kyle Bernstein, PhD, ScM, STD Prevention and Control Services Program, San Francisco Department of Public Health, San Francisco, CA, Ellen Rudy, PhD, STD Program, Los Angeles County Department of Public Health, Los Angeles, CA, Elaine Pierce, MD, HIV/STD/Hepatitis Branch, County of San Diego Health and Human Services Agency, San Diego, CA, Christopher Ried, MD, STD/HIV Services, Orange County Health Care Agency, Santa Ana, CA, Paula Dixon, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, Olusegun Soge, PhD, Neisseria Reference Laboratory, University of Washington, Seattle, WA, Gail Bolan, MD, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA and Michael Samuel, DrPH, California Department of Public Health, STD Control Branch, Richmond, CA

Background: Gonorrhea (GC) persists as a common infection in California, and historically, Neisseria gonorrhoeae has been adept at developing resistance to antibiotics. Currently, there is growing concern of the emergence of strains that are resistant to cephalosporins, the only recommended class of drugs for GC treatment.

Objectives: To describe California trends in GC cephalosporin susceptibility using Gonococcal Isolate Surveillance Project (GISP) alert values, and to describe outcomes of a new statewide protocol implemented to respond to these trends.

Methods: We conducted an analysis of California GISP data, assessing trends in minimum inhibitory concentrations (MICs). We also examined data from a California protocol implemented in 2011, which includes rapid detection of alert values by an in-state reference laboratory using Etest strips and rapid, comprehensive follow-up of alert cases and partners by the four California GISP sites.

Results: From 1987 to mid-2011, 19,678 GISP isolates were tested (mean of 803 per year). Low numbers of alert values to cephalosporins were observed overall. However, there was an increasing trend in alert values from zero to 2.1% in the period of 1987 to 2008 to 3.0% in 2009, 7.9% in 2010 and 7.4% in 2011 (p<0.0001; trend test). Per statewide protocol, 338 isolates (from Jan to June) were tested and 23 cases with alert values were identified and contacted for follow-up. MICs were reported in a median of 16.0 days after specimen collection, and cases were interviewed in a median of 5.5 days after alert notification.

Conclusions: Worrisome trends in MICs were observed for cephalosporins. Implementation of standardized procedures yielded timely identification and follow-up of alert cases and their partners.

Implications for Programs, Policy, and Research: Enhanced efforts in monitoring gonorrhea resistance and increased capacity for coordinated rapid response may be valuable in delaying the emergence of cephalosporin-resistant strains.

A1.1 RAPID ASSESSMENT and RESPONSE to Neisseria Gonorrhoeae with DECREASED SUSCEPTIBILITY to CEPHALOSPORINS In California