Background: A wild-type gyrase A (gyrA) genotype of N. gonorrhoeae reliably predicts susceptibility to ciprofloxacin, which can reduce selection pressure for ceftriaxone-resistant infections, an urgent public health threat. In November 2015, UCLA Health began gyrA genotyping all N. gonorrhoeae positive specimens. In May 2016, we began sending reminder notifications of treatment recommendations to providers of patients with wild-type infections.
Methods: We reviewed records for all laboratory confirmed N. gonorrhoeae cases from November 1st 2015 - April 30th 2017. Infections in different anatomic sites were considered unique infections, while unique infections in a single patient on the same date were considered a case. Empiric therapy was defined as treatment within one day of specimen collection. We also collected test-of-cure data among patients with wild-type infections treated with ciprofloxacin.
Results: Among 423 patients (23% HIV infected) there were 460 cases and 514 anatomic site-specific N. gonorrhoeae infections. Of infections, 218 (43%) had a wild-type gyrA genotype, 138 (27%) mutant, 153 (30%) indeterminate; 4 were not attempted and one had missing data. There were 255 (55%) cases and 283 (55%) infections treated non-empirically. The median time-to-treatment among those cases was 4 days (interquartile range 3-6 days). Ciprofloxacin was used in 2 (3%) of 66 non-empirically treated infections prior to the start of reminder notifications, compared to 40 (18%) of 217 non-empirically treated infections after notifications began (p-value=0.002). Of the 55 providers who received an email on or before the day of treatment for non-empirically treated patients, 32 (58%) used ciprofloxacin. There was no ciprofloxacin use prior to assay implementation. The trend in treatment by quarter among non-empirically treated infections is shown the Figure.
Among 30 patients treated with ciprofloxacin, 6 had a test of cure at one week, and all (100%; 95% CI 61%-100%) of those tests were negative for N. gonorrhoeae; 5 were from urethral specimens, and 1 was from the pharynx.
Conclusion: Electronic provider notifications augmented targeted ciprofloxacin therapy for N. gonorrhoeae infections. Preliminary test-of-cure data are promising.
* Electronic reminder notifications began May 2016
L. T. Allan-Blitz,
P. Hemarajata, None
M. Kimble, None
S. Elias, None
J. Klausner, None