DRUG RESISTANCE SCAN: Resistant gonorrhea in North America, needless antibiotics for C diff

Jan 10, 2013

Study reports first series of cefixime-resistant gonorrhea cases in North America
In the latest bad news about increasing drug resistance with gonorrhea, Canadian researchers have for the first time in North America identified a series of clinical gonorrhea cases resistant to cefixime, the only oral antibiotic option for treating the disease, according to a study yesterday in the Journal of the American Medical Association (JAMA). The study found that about 7% of patients treated for gonorrhea at a Toronto sexual health clinic serving primarily men who have sex with men were found to harbor Neisseria gonorrhoeae resistant to cefixime. Researchers followed 291 patients with lab-confirmed gonorrhea treated at the clinic from May 2010 through April 2011, 133 of whom returned for retesting to ensure that treatment worked. Among them, 13 were culture-positive, with 9 of them fitting the definition of cefixime treatment failure, for a 6.8% failure rate. As in other studies, increased minimum inhibitory concentrations of cefixime were associated with an increased risk of failure. US experts wrote in a related JAMA editorial, "Although this milestone was expected, its arrival is deeply troubling; clinicians now face the emergence of cephalosporin-resistant N gonorrhoeae without any well-studied, effective backup treatment options."
Jan 9 JAMA study
Jan 9 JAMA editorial

Study finds C difficile patients often receive needless antibiotics
In a retrospective study reported in Infection Control and Hospital Epidemiology, researchers found that many patients treated for Clostridium difficile infections were prescribed unnecessary antibiotics, increasing their risk for recurrent bouts with the potentially deadly pathogen. Researchers at the Minneapolis Veterans Affairs Medical Center reviewed the cases of 246 patients who had new-onset C difficile infections in 2004, 2005, and 2006. They found that 141 patients (57%) were treated with additional antimicrobials (not targeting C difficile) during or within 30 days after their initial infection. Of these 141 patients, 77% received at least one dose of unnecessary antibiotic, and 26% received unnecessary antibiotics exclusively. The leading reasons given for unnecessary antibiotic use were urinary tract infections and pneumonia, despite little or no evidence of either being present, according to a press release from the Society for Healthcare Epidemiology of America (SHEA). The drug classes often used unnecessarily included fluoroquinolines and beta-lactams. "Our findings serve as a reminder to both doctors and patients to use antibiotics only when absolutely necessary, particularly in patients with a history of C difficile," said lead author Megan K. Shaughnessy, MD, in the press release.
February Infect Control Hosp Epidemiol abstract
Jan 9 SHEA press release

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