Estimating the fitness cost and benefit of cefixime resistance in Neisseria gonorrhoeae to inform prescription policy: A modelling study

PLoS Medicine
Lilith K WhittlesXavier Didelot

Abstract

Gonorrhoea is one of the most common bacterial sexually transmitted infections in England. Over 41,000 cases were recorded in 2015, more than half of which occurred in men who have sex with men (MSM). As the bacterium has developed resistance to each first-line antibiotic in turn, we need an improved understanding of fitness benefits and costs of antibiotic resistance to inform control policy and planning. Cefixime was recommended as a single-dose treatment for gonorrhoea from 2005 to 2010, during which time resistance increased, and subsequently declined. We developed a stochastic compartmental model representing the natural history and transmission of cefixime-sensitive and cefixime-resistant strains of Neisseria gonorrhoeae in MSM in England, which was applied to data on diagnoses and prescriptions between 2008 and 2015. We estimated that asymptomatic carriers play a crucial role in overall transmission dynamics, with 37% (95% credible interval CrI 24%-52%) of infections remaining asymptomatic and untreated, accounting for 89% (95% CrI 82%-93%) of onward transmission. The fitness cost of cefixime resistance in the absence of cefixime usage was estimated to be such that the number of secondary infections caused by resistant s...Continue Reading

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Citations

Dec 28, 2017·PLoS Medicine·Nicola Low, Nathalie J Broutet
Jun 8, 2018·Annals of the New York Academy of Sciences·Tatum D Mortimer, Yonatan H Grad
Mar 9, 2019·PLoS Computational Biology·Lilith K WhittlesXavier Didelot
Sep 14, 2019·The American Journal of Tropical Medicine and Hygiene·Hui-Han ChenSachiko Ozawa
Feb 13, 2020·Systematic Biology·Erik M VolzXavier Didelot
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Jul 6, 2019·Nature Medicine·Xavier Didelot, Koen B Pouwels
Jan 7, 2020·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Lilith K WhittlesXavier Didelot
Jul 18, 2018·Antibiotics·Lilith K WhittlesXavier Didelot
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Oct 31, 2020·Euro Surveillance : Bulletin Européen Sur Les Maladies Transmissibles = European Communicable Disease Bulletin·Carolin VegvariDavid Gardiner

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Methods Mentioned

BETA
PCR

Software Mentioned

R package pomp
GRASP
GUMCAD
R package coda

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