Antibiotic Resistance Threats in the United States, 2013 report

DRUG-RESISTANT
NEISSERIA GONORRHOEAE
FIGHTING THE SPREAD OF RESISTANCE
Cephalosporin-resistant N. gonorrhoeae is often resistant to multiple classes of other antibiotics
and as a result, infections caused by these bacteria will likely fail empiric treatment regimens. If
cephalosporin-resistant N. gonorrhoeae becomes widespread, the public health impact during a
10-year period is estimated to be 75,000 additional cases of pelvic inflammatory disease (a major
cause of infertility), 15,000 cases of epididymitis, and 222 additional HIV infections because HIV is
transmitted more readily when someone is co-infected with gonorrhea. In addition, the estimated
direct medical costs would total $235 million. Additional costs are anticipated to be incurred as a
result of increased susceptibility monitoring, provider education, case management, and the need
for additional courses of antibiotics and follow-up.
Gonorrhea is a global problem, requiring a global approach. Action in the United States alone
is unlikely to prevent resistance from developing, but rapid detection and effective treatment
of patients and their partners might slow the spread of resistance. Preventing gonorrhea is
critical. Screening, rapid detection, prompt treatment, and partner services are the foundations of
gonorrhea control in the United States. Effectively addressing the heavy burden of gonorrhea and
anticipated arrival of cephalosporin resistance requires continued use of these strategies as well
as the use of expedited partner therapy, promotion of safer sexual behaviors such as abstinence,
mutual monogamy, and correct and consistent condom use, and activities designed to rapidly
detect and respond to antibiotic-resistant infections
WHAT CDC IS DOING
CDC is closely monitoring resistance in N. gonorrhoeae in the United States and actively
collaborating with the World Health Organization to enhance global surveillance. In the
United States, CDC recently released a national response plan and is working closely with
local and state STD programs to enhance preparedness. CDC recently updated its gonorrhea
treatment recommendations to stay a step ahead of this rapidly evolving bacterium, and is
collaborating with the NIH National Institute of Allergy and Infectious Diseases to find new
treatment options.
New resistance
patterns have
developed over
time. Resistance
to previously
used antibiotics,
such as penicillin,
remains common.
These trends are
an early warning
of cephalosporin
resistance.
Prevalence of Penicillin, Tetracycline and Fluoroquinolone
Resistance and Reduced Cefixime Susceptibility in
N. gonorrhoeae isolates, U.S., 1987-2011
Source: The Gonococcal Isolate Surveillance Project (GISP).
Prevalence of N. gonorrhoeae isolates with reduced cefixime
(MICs ≥ 0.25μg/ml) and ceftriaxone (MICs ≥ 0.125μg/ml)
susceptibility, U.S. 2006–2011
Source: The Gonococcal Isolate Surveillance Project (GISP).
ONLINE RESOURCES
CDC’s gonorrhea website
http://www.cdc.gov/std/gonorrhea/default.htm
CDC’s Antibiotic-Resistant Gonorrhea website:
http://www.cdc.gov/std/Gonorrhea/arg/default.htm
New Treatment Guidelines for Gonorrhea: Antibiotic Change. MedScape CDC
Expert Commentary, 2012. http://www.medscape.com/viewarticle/768883
Kirkcaldy RD, Bolan GA, Wasserheit JN. Cephalosporin-Resistant Gonorrhea in
North America. JAMA 2013;209(2):185-187.
http://jama.jamanetwork.com/article.aspx?articleid=1556135
CDC. Update to CDC’s Sexually Transmitted Diseases Treatment Guidelines,
2010: Oral cephalosporins no longer a recommended treatment for gonococcal
infections. MMWR 2012;61(31):590-594.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6131a3.htm?
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