Global health organization Unitaid last week called for a "concerted global effort" to introduce accurate and affordable diagnostic tests in low-resource countries to address the rising number of gonorrhea infections and antimicrobial resistance (AMR).

In a report released ahead of the United Nations High-Level Meeting on AMR, Unitaid highlights the diagnostic access gaps that results in both undertreatment and overtreatment of gonorrhea infections in low- and middle-income countries (LMICs) with a high burden of gonorrhea. Because of the lack of affordable, rapid point-of-care (POC) diagnostic tests in these settings, treatment decisions are based on observed signs and reported symptoms. Yet more than half of gonorrhea cases are asymptomatic, resulting in a high number of untreated, missed infections. Conversely, lack of gonorrhea-specific diagnostics means patients with symptoms often receive several treatments.

Tests are in development, but may remain inaccessible

The report provides an overview of the 75 POC and near-POC tests currently in development that have the potential to turn test results around in less than 30 minutes and improve antibiotic selection, including three that have already been cleared by the US Food and Drug Administration. It also lays out the barriers in LMICs that are preventing these tests from reaching those who need them, such as affordability, limited resources and healthcare infrastructure, and prioritization of higher mortality diseases by policymakers.

"Despite the need and the promise of new technologies, significant market challenges impede test accessibility in LMICs," the report states. "There is a high risk that products will become readily available in well-resourced settings and remain largely inaccessible in LMICs."

To address these barriers, the report highlights opportunities for intervention, including market-shaping strategies, product development support, and integrating gonorrhea and other sexually transmitted infection testing into reproductive, maternal, and HIV healthcare services. 

“Early work to implement testing will provide valuable evidence and experience to build demand and guide countries on feasible and cost-effective ways to introduce gonorrhea testing and improve health outcomes, particularly for vulnerable populations," Kelsey Barrett, Unitaid’s Technical Manager for Maternal and Child Health, said in a press release.

The use of fidaxomicin for Clostridioides difficile infection (CDI) has increased significantly since 2021 but it remains underutilized, researchers reported today in Clinical Infectious Diseases.

Using the PINC AI Healthcare database, researchers from Washington University School of Medicine and Merck examined records on adults who received CDI treatment before and after 2021, when updated guidelines from the Infectious Diseases Society of America (IDSA) recommended fidaxomicin as the only first-line agent for CDI, with vancomycin as an alternative option. Prior to 2021 vancomycin and metronidazole had been the recommended first-line agents for CDI, which is the most common healthcare-associated infection in adults and affects an estimated 460,000 US patients each year. Evidence on how CDI treatment patterns have changed since the 2021 guidelines has been limited.

Fidaxomicin use more than doubles

A total of 45,049 patients from 779 US hospitals were included in the study, with 29,520 in the pre-period (January 2020 to June 2021) and 15,529 in the post-period (October 2021 to September 2022). From the pre-period to the post-period, fidaxomicin use increased from 5.9% to 13.7%, while vancomycin used declined from 87.9% to 82.9% and metronidazole from 21.6% to 17.2%. Among census regions, increases in fidaxomicin use were smallest in the northeast, and greatest in the south.

In a secondary analysis that compared clinical and cost outcomes among patients treated exclusively with fidaxomicin versus vancomycin, fidaxomicin was associated with lower CDI recurrence (6.1% vs 10.2%) and higher sustained clinical response (91.7% vs 87.9%), while 90-day post-discharge costs were similar. The study authors note that these findings are consistent with prior research.

"While fidaxomicin use for CDI increased (and more than doubled) since the publication of the updated IDSA guidelines, it remained low relative to vancomycin and metronidazole use," the study authors wrote. "These novel findings imply that a substantial number of patients could have received the benefits of fidaxomicin if more hospitals had followed the ISDA 2021 guidelines."

• The Los Angeles Department of Public Health said it is investigating a fourth local dengue case, which involves a resident of Panorama City. It noted that the case isn't related to a local dengue cluster in Baldwin Park. Panorama City is about 40 miles west of Baldwin Park. Local dengue cases are extremely rare in Los Angeles County, and health officials urged area residents to take precautions such as wearing mosquito repellent and removing mosquito-breeding sites. 
• The US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) has confirmed three more H5N1 avian flu outbreaks in dairy herds, two in California and one in Idaho. The latest outbreaks push the national total to 242 across 14 states. Also, APHIS confirmed one more H5N1 outbreak in poultry, this time at a farm in Idaho’s Lincoln County that has 700 birds.
• The Minnesota Department of Health (MDH) announced that it is investigating a fatal rabies case involving a person older than 65 years who was exposed to a bat in July in the western part of the state. The latest case is Minnesota’s fourth since 2000. The patient's diagnosis was confirmed on September 20 based on testing at the Centers for Disease Control and Prevention (CDC). The MDH said it is working with the patient's family and healthcare facilities where the patient was treated to assess if any others were potentially exposed and may need treatment.