P638 Surveillance of gonococcal infection treatment failures 2015–2018 in québec, canada
Bibliographic record
Abstract
Background Incident cases of gonococcal infection are increasing. Antibiotic resistance may compromise the effectiveness of treatment. In 2017, the proportion of azithromycin-resistant strains reached 31% in Quebec and a first strain non-susceptible to ceftriaxone and cefixime was detected. Methods Since November 2014, public health departments are invited to report possible cases of treatment failures. Clinical and epidemiological information is collected using a standardized form for each report of gonococcal infection occurring <42 days after a previous episode in the same person. Antimicrobial susceptibility testing (AST) is conducted at the provincial reference laboratory (Laboratoire de santé publique du Québec) and the NG-MAST typing is performed at the National Microbiology Laboratory. Cases are classified as retained (presence of all definition criteria) or suspected (not meeting all criteria but reinfection unlikely). Cases classifications are validated by a group of experts. Lack of re-exposure is based on the respondent’s reported sexual history between the first treatment and the test of cure (TOC). Case definitions are consistent with those of Quebec and Canadian sentinel surveillance network for gonococcal infection. Results Between November 2014 and December 2018, 44 cases of possible treatment failures were reported. After exclusion of 9 cases, 35 were analysed (25 classified as retained and 10 as suspected). There were 10 women, 24 men (68% MSM) and one trans person. Pharynx was identified as site of treatment failure for 14 cases (40%). AST were available for 23 cases (66%): 78% were resistant to ciprofloxacin and 43% to azithromycin. All strains were susceptible to cephalosporins, but one strain showed reduced susceptibility to cefixime. Eleven cases (31%) received azithromycin monotherapy as initial therapy. Conclusion Treatment failure exist and is not always related to documented resistance. This analysis probably underestimates the real extent of treatment failures since it requires TOC that are not systematically collected. Reinfection cannot be completely excluded. Disclosure No significant relationships.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".