Stewardship / Resistance Scan for Jan 09, 2019

Highly resistant gonorrhea in the UK
Penicillin allergy testing

Two cases of extensively drug-resistant gonorrhea reported in the UK

Public Health England (PHE) is investigating two cases of extensively drug-resistant Neisseria gonorrhoeae.

The cases, which were resistant to the first-line antibiotics ceftriaxone and azithromycin, involved heterosexual women. PHE said one of the women appeared to have acquired the infection in Europe, while the other has links to Europe but acquired the infection in the United Kingdom. Both infections were successfully treated, and PHE is following up with sexual contacts to see if there are any links between the two women and to stem any onward transmission.

PHE officials say the cases are a good reminder of the need to practice safe sex to lower their risk of sexually transmitted infections (STIs).

"Everyone can substantially reduce their risk by using condoms consistently and correctly with all new and casual partners," Nick Phin, deputy director of PHE's National Infection Service, said in a statement. "Anyone who thinks they may have been at risk of getting an STI should seek an STI screen at a sexual health clinic."

In March 2018, UK officials reported a case of gonorrhea with combined high-level resistance to ceftriaxone and azithromycin in a heterosexual man. It was the first known case of high-level resistance to the dual therapy, which is the last remaining recommended treatment for gonorrhea. PHE says the type of resistance seen in these two cases is different and therefore unrelated.

England has also been seeing a rise in cases of azithromycin-resistant gonorrhea, highlighted by an outbreak of a highly azithromycin-resistant strain that originated in Leeds in 2015 and has spread to other parts of the country.

The agency says it has introduced enhanced surveillance to identify and manage resistant gonorrhea strains promptly and help reduce further spread.
Jan 9 PHE news release


Study shows penicillin skin testing cost effective for Staph bacteremia

An economic analysis in PLOS One by University of Maryland experts estimates that inpatient penicillin skin testing (PST) services that confirm penicillin allergy as part of an antimicrobial stewardship program are cost-effective for patients with methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia.

In the single-center study, the investigators used a decision analytic model to compare an acute care PST intervention to a scenario with no confirmatory allergy testing. They used quality-adjusted life years (QALYs) to measure for effectiveness.

Over a 1-year time study period, PST services applied to all MSSA bacteremia patients reporting a PCN-positive allergy would result in a cost per patient of $12,559 and 0.73 QALYs, while no PST services would cost $13,219 and 0.66 QALYs per patient. This resulted in a cost-effectiveness estimate of -$9,429 per QALY gained, demonstrating the cost-effectiveness of the intervention.
Jan 7 PLOS One study

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