Rapid, portable PCR test for gonorrhea shows promise

A rapid, cartridge-based polymerase chain reaction (PCR) platform developed by scientists at Johns Hopkins University for detecting gonorrhea infections and providing antibiotic susceptibility results showed promising results in a study published this week in Science Translational Medicine.

In a study conducted using penile swab samples from sexual health clinics in Baltimore and Kampala, Uganda, researchers showed that the portable, rapid, on-cartridge multifluidic purification and testing (PROMPT) PCR test returned results in less than 15 minutes and had an overall sensitivity and specificity of 97.7% (95% confidence interval [CI], 94.7% to 100%) and 97.6% (95% CI, 94.1% to 100%), respectively, for Neisseria gonorrhoeae. The platform, which performs simultaneous genotyping of samples to detect the presence of resistance genes for ciprofloxacin, also showed 100% concordance with culture results for ciprofloxacin resistance.

The PROMPT platform was designed for automated testing at the point of care (POC) in confined workspaces in limited-resource settings, with a small footprint and minimal power needs. The test uses a portable mobile phone charger, which supplies power to conduct more than 20 tests. In a survey conducted among healthcare workers in Uganda after a demonstration of the platform, 29 of 30 respondents said they would “definitely” or “probably” use the platform if it was made available.

Although the performance of the test still needs to be validated with vaginal and extragenital swabs, the study authors believe the device, because it provides faster results and is cheaper than leading POC PCR diagnostics, could enable greater access to gonorrhea testing and bolster antimicrobial stewardship in low-resource settings. Limited screening for sexually transmitted infections and poor antimicrobial stewardship in such settings, particularly in sub-Saharan Africa, have contributed to a high prevalence of gonorrhea infections and antimicrobial resistance.

“Rapid identification of the bacterial pathogen N. gonorrhoeae and associated antimicrobial susceptibility will help to promote better antimicrobial stewardship to reduce selection of antimicrobial resistant bacterial strains,” the study authors wrote.
May 12 Sci Transl Med abstract

Outpatient stewardship initiative linked to reduced antibiotic prescribing for bronchitis

Implementation of a multifaceted outpatient antimicrobial stewardship initiative at ambulatory clinics in the Midwest was associated with a significant reduction in antibiotic prescribing for acute bronchitis, researchers reported today in Infection Control & Hospital Epidemiology.

The initiative, implemented at 10 clinics with the highest antibiotic prescribing rates and 5 additional clinics in the winter of 2018, included clinician- and patient-focused educational materials focused on appropriate prescribing for acute respiratory infections (ARIs). At all of the clinics, clinicians received educational videos via email. Ten received additional clinician-focused ARI management pocket cards and posters, and five were randomly selected to hand out “Be Antibiotics Aware” pledge cards to patients. Clinicians also received blinded report cards on antibiotic prescribing after the intervention was completed.

To evaluate the effectiveness of the initiative, researchers compared prescribing for acute bronchitis—which rarely requires antibiotics—during the preintervention period (January to April 2017), the intervention period (January to April 2018), and the postintervention period (January to April 2019).

The analysis evaluated 311 clinic visits for acute bronchitis during the preintervention period, 282 during the intervention period, and 256 during the postintervention period. At all clinics, overall antibiotic prescribing rates for acute bronchitis significantly decreased from 53.7% at baseline to 43.6% during the intervention period (relative reduction 18.8%). The prescribing reduction persisted during the postintervention period (relative reduction 25.9%).

Antibiotic prescribing rates in the clinics that only received education videos via email remained stable during the 3 periods: 40.8% at baseline, 41.5% during the intervention, and 42.3% postintervention. In contrast, clinics receiving more active interventions had a combined relative reduction of 20.1% during the intervention period and a significant relative reduction of 29.3% after the intervention period. A clinically relevant 12.3% absolute reduction in prescribing for acute bronchitis was observed in clinics that received more active interventions.

“In summary, a multifaceted approach including online antimicrobial stewardship education, clinician-directed and patient-directed interventions, and dissemination of blinded report cards to clinicians led to a sustained reduction in antibiotic prescribing for acute bronchitis,” the study authors wrote. “Addition of communication training to address patients’ expectation for antibiotic therapy may further reduce inappropriate antibiotic prescribing.”
May 14 Infect Control Hosp Epidemiol abstract