High levels of susceptibility to new and older antibiotics in Neisseria gonorrhoeae isolates from Saskatchewan (2003–15): time to consider point-of-care or molecular testing for precision treatment?—authors’ response
Notice bibliographique
Résumé
Sir, In response to our article, ‘High levels of susceptibility to new and older antibiotics in Neisseria gonorrhoeae isolates from Saskatchewan (2003–15): time to consider point-of-care or molecular testing for precision treatment?’,1 Davido et al.2 have made an interesting suggestion regarding the re-evaluation of aztreonam as a treatment option for infections caused by N. gonorrhoeae. Aztreonam, a monobactam, has been used, in the past, as single-dose therapy to treat gonorrhoea.3–5 Since aztreonam is stable to β-lactamases, and does not induce the production of chromosomally mediated enzymes, the antibiotic can be used effectively against penicillinase-producing N. gonorrhoeae (PPNG).6 Aztreonam has been used against PPNG in the past with 100% efficacy, with no side effects in patients.4 In a study conducted in Thailand, in 1992, aztreonam was 100% effective against N. gonorrhoeae (n = 331), including β-lactamase-producing isolates (94 of 331 isolates).7 However, two studies from Japan reported high (8 mg/L, n = 2) MICs of aztreonam for N. gonorrhoeae isolates and treatment failures using a 1 g intramuscular dose (n = 3).8,9 Another study showed that aztreonam (1 g) is not 100% effective in treating pharyngeal (2 of 3 cases) and rectal (1 of 2 cases) gonorrhoea.3 In contrast, a later study reported >96% cure rates for treating uncomplicated gonorrhoea with 1 g of aztreonam, and 100% efficacy for patients with rectal (n = 14), pharyngeal (n = 8) and PPNG (n = 40) infections.10 Gottlieb and Mills11 also reported 100% cure rates for genital (n = 29) and rectal (n = 3) gonorrhoea. Evans et al.12 also reported 100% (n = 91) treatment of gonorrhoea with 1 g of aztreonam, including rectal (2 of 91 cases), pharyngeal (1 of 91 cases), PPNG (5 of 91 cases) and penicillin-resistant (non-PPNG, 5 of 91 cases) infections. Although studies testing the susceptibility of gonococci to aztreonam were conducted during the 1980s, a recent study in Canada determined that N. gonorrhoeae isolates, with different resistance phenotypes, were susceptible to aztreonam alone, or in combination with azithromycin.13 Furthermore, Davido et al.14 reported that, with either intramuscular or intravenous administration of aztreonam (1 g), all patients with gonorrhoea (n = 5) were successfully treated, including MSM (n = 3). More studies are required to determine the efficacy of aztreonam in treating pharyngeal and rectal gonococcal infections, since few studies have been conducted in the past.3,10–12 Aztreonam has also been suggested, in the past, for the treatment of acute cases of pelvic inflammatory disease (PID), caused by N. gonorrhoeae, because of its low toxicity and higher blood levels, as compared with aminoglycosides.15 Clindamycin with gentamicin are recommended in current Canadian treatment regimens for PID.16 Aztreonam is a parenteral antibiotic, and, for gonorrhoea, oral treatments are preferred. However, treatment options for infections caused by N. gonorrhoeae are becoming increasingly limited because N. gonorrhoeae has become resistant to all classes of antimicrobial agents and treatment failure with dual therapy comprising azithromycin and ceftriaxone had been reported.17,18 Thus aztreonam may be a viable treatment option to reconsider. However, the use of this antibiotic would require active antimicrobial susceptibility testing of gonococcal isolates globally and regionally to ascertain its current susceptibility status. Also, as suggested by Davido et al.,2 there is a need to develop susceptibility breakpoints for aztreonam and basic research should be completed to ascertain gonococcal mechanisms of resistance to this antibiotic. However, if N. gonorrhoeae isolates prove to be susceptible to this antibiotic, aztreonam might supplement spectinomycin (introduced initially to treat PPNG), or other treatment options, in gonococcal treatment guidelines. None to declare.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,029 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,002 |
| Communication savante | 0,003 | 0,002 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,017 | 0,013 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,009 | 0,004 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».