Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
Records 1-10 (of 10 Records) |
Query Trace: Holderman J[original query] |
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Antimicrobial susceptibility of urogenital and extragenital neisseria gonorrhoeae isolates among men who have sex with men - SURRG and eGISP, 2018-2019
Quilter LAS , St Cyr SB , Hong J , Asbel L , Bautista I , Carter B , Casimir Y , Denny M , Ervin M , Gomez R , Harvey A , Holderman JL , Johnson K , Kohn RP , Learner ER , Mauk K , Menza T , Mettenbrink C , Nettleton WD , Nicosia KR , Pham CD , Ried C , Schlanger K , Schneider A , Soge OO , Tabidze I , Taylor SN , Tilghman W , Toler C , Weinstock H , Torrone EA . Sex Transm Dis 2021 48 S111-S117 BACKGROUND: We investigated differences in gonococcal antimicrobial susceptibility by anatomic site among cisgender men who have sex with men (MSM) using specimens collected through CDC's enhanced Gonococcal Isolate Surveillance Project (eGISP) and Strengthening the U.S. Response to Resistant Gonorrhea (SURRG). METHODS: During January 1, 2018-December 31, 2019, 12 eGISP and 8 SURRG sites collected urogenital, pharyngeal, and rectal isolates from cisgender MSM in STD clinics. Gonococcal isolates were sent to regional laboratories for antimicrobial susceptibility testing by agar dilution. To account for correlated observations, linear mixed-effects models were used to calculate geometric mean minimum inhibitory concentrations (MICs) and mixed-effects logistic regression models were used to calculate the proportion of isolates with elevated or resistant MICs; comparisons were made across anatomic sites. RESULTS: Participating clinics collected 3,974 urethral, 1,553 rectal, and 1,049 pharyngeal isolates from 5,456 unique cisgender MSM. There were no significant differences in the geometric mean MICs for azithromycin, ciprofloxacin, penicillin, and tetracycline by anatomic site. For cefixime and ceftriaxone, geometric mean MICs for pharyngeal isolates were higher compared to anogenital isolates (p < 0.05). The proportion of isolates with elevated ceftriaxone MICs (≥0.125 μg/ml) at the pharynx (0.67%) was higher than at rectal (0.13%) and urethral (0.18%) sites (p < 0.05). CONCLUSIONS: Based on data collected from multi-jurisdictional sentinel surveillance projects, antimicrobial susceptibility patterns of N. gonorrhoeae isolates may differ among MSM at extragenital sites, particularly at the pharynx. Continued investigation into gonococcal susceptibility patterns by anatomic site may be an important strategy to monitor and detect the emergence of antimicrobial resistant gonorrhea over time. |
Strengthening the U.S. Response to Resistant Gonorrhea (SURRG): An overview of a multi-site program to enhance local response capacity for antibiotic-resistant Neisseria gonorrhoeae
Schlanger K , Learner ER , Pham CD , Mauk K , Golden M , Wendel KA , Amsterdam L , McNeil CJ , Johnson K , Nguyen TQ , Holderman JL , Hasty GL , St Cyr SB , Town K , Nash EE , Kirkcaldy RD . Sex Transm Dis 2021 48 S97-S103 BACKGROUND: In 2016, CDC initiated Strengthening the U.S. Response to Resistant Gonorrhea (SURRG) in multiple jurisdictions to enhance antibiotic resistant gonorrhea rapid detection and response infrastructure and evaluate the impact of key strategies. METHODS: Eight jurisdictions were funded to establish or enhance local gonococcal culture specimen collection in STD and community clinics, conduct rapid antimicrobial susceptibility testing (AST) in local laboratories, modify systems for enhanced data collection and rapid communication of results, and initiate enhanced partner services among patients with gonorrhea demonstrating elevated minimum inhibitory concentrations (MICs) to ceftriaxone, cefixime or azithromycin. RESULTS: Grantees incorporated genital, pharyngeal, and rectal gonococcal culture collection from all genders at participating clinics. During 2018-2019, grantees collected 58,441 culture specimens from 46,822 patients and performed AST on 10,814 isolates (representing 6.8% (3,412) and 8.9% (4,883) of local reported cases in 2018 and 2019 respectively). Of isolates that underwent AST, 11% demonstrated elevated azithromycin MICs; fewer than 0.5% demonstrated elevated ceftriaxone or cefixime MICs. Among patients whose infections demonstrated elevated MICs, 81.7% were interviewed for partner elicitation; however, limited new cases were identified among partners and contacts. CONCLUSIONS: As a public health model to build capacity to slow the spread of emerging resistance, SURRG successfully expanded culture collection, implemented rapid AST, and implemented an enhanced partner services investigation approach in participating jurisdictions. Findings from SURRG may enhance preparedness efforts and inform a longer-term, comprehensive, and evidence-based public health response to emerging gonococcal resistance. Continued development of innovative approaches to address emerging resistance is needed. |
The implementation of Strengthening the U.S. Response to Resistant Gonorrhea (SURRG) in the Emergency Department Setting: Successes and lessons learned in two jurisdictions
Holderman JL , McNeil CJ , Zavitz J , Black JM , Finney R , Dobre-Buonya O , Toler C . Sex Transm Dis 2021 48 S161-S166 BACKGROUND: Neisseria gonorrhoeae (NG) continues to develop antimicrobial-resistance (AR) and treatment options are limited. ARNG surveillance aids in identifying threats and guiding treatment recommendations but has traditionally been limited to sexually transmitted infection (STI) clinics. Large portions of STI care is delivered outside of STI clinics, such as emergency departments (ED). These facilities might provide additional venues to expand surveillance and outbreak preparedness. METHODS: Through the Strengthening the U.S. Response to Resistant Gonorrhea (SURRG) program, Greensboro, North Carolina, and Indianapolis, Indiana identified four EDs in high-morbidity areas to expand culture collection. Patient demographics, culture recovery rates, and antimicrobial-susceptibility results between EDs and local STI clinics were compared along with lessons learned from reviewing programmatic policies and discussions with key personnel. RESULTS: During 2018-2019, non-Hispanic Black patients were the most represented group at all six sites (73.6%). Age was also similar across sites (median range 23-27). Greensboro isolated 1039 cultures (STI clinic (Women: 141; Men: 612; Transwomen: 3); EDs: 283 (Women: 164, Men: 119)). Indianapolis isolated 1278 cultures (STI clinic: 1265 (Women: 125, Men: 1139, Transwomen: 1); ED: 13 all male). Reduced azithromycin susceptibility was found at the Indianapolis (n = 86) and Greensboro (n = 25) STI clinics, and one Greensboro ED (n = 8).Implementation successes included identifying an on-site "Champion", integrating with electronic medical records, and creating an online training hub. Barriers included cumbersome data collection tools, time constraints, and hesitancy from clinical staff. CONCLUSIONS: Partnering with EDs for ARNG surveillance poses both challenges and opportunities. Program success can be improved by engaging a local "champion" to help lead efforts. |
Enhancing U.S. local, state, and federal preparedness through simulated interactive tabletop exercises of a mock antibiotic-resistant gonorrhea outbreak, 2018-2019
Schlanger K , Black JM , Smith M , Ridpath A , Crause C , Holderman JL , Henderson K , Hardrick H , Pham CD , Howard G , Kirkcaldy RD . Sex Transm Dis 2021 48 S174-S179 BACKGROUND: Responding effectively to outbreaks of antibiotic-resistant gonorrhea (ARGC) in the future will likely prove challenging. Tabletop exercises (TTXs) may assist local, state, and federal public health officials evaluate existing ARGC outbreak response plans, strengthen preparedness and response effectiveness, and identify critical gaps to address prior to an outbreak. METHODS: In 2018-2019, CDC collaborated with state partners to develop and implement TTXs to simulate a public health emergency involving an ARGC outbreak. Prior to the TTXs, two state-local health department pairs developed ARGC outbreak response plans. During each one-day exercise (in Indiana and Illinois), participants discussed roles, clinical management, public health response, and communication based on pre-developed response plans. Observers identified outbreak response strengths and gaps, and participants completed feedback forms. RESULTS: Forty-one (Illinois) and 48 people (Indiana) participated in each TTX, including: STD clinical staff, laboratorians, public health infectious disease program staff, and CDC observers. Strengths and gaps varied by jurisdiction, but identified gaps included: (1) local access to gonorrhea culture and timely antimicrobial susceptibility testing (AST), (2) protocols for clinical management of suspected treatment failures, (3) communication plans, and (4) clarity regarding state and local responsibilities. CDC observers identified opportunities to provide national-level technical assistance, foster local AST, and develop further response guidance. TTX summary reports were used to guide modifications to local response plans to address gaps. CONCLUSIONS: The TTXs allowed participants to practice responding to a simulated public health emergency and may have enhanced local response capacity. CDC made TTX implementation materials publicly available. |
Outcomes of traditional and enhanced gonorrhea partner services in the strengthening the US Response to Resistant Gonorrhea Project, 2017- 2019
Learner ER , Schlanger K , Mauk K , Pham CD , Holderman JL , Kirkcaldy RD . Sex Transm Dis 2021 48 S124-S130 INTRODUCTION: The CDC implemented Strengthening the U.S. Response to Resistant Gonorrhea (SURRG) to build local detection and response capacity and evaluate responses to antibiotic-resistant gonorrhea outbreaks, including partner services for gonorrhea. We evaluated outcomes of traditional partner services conducted under SURRG, which involved (1) counseling index patients and eliciting sexual partners, (2) interviewing, testing and treating partners, and (3) providing partner services to partners newly diagnosed with gonorrhea. We also evaluated outcomes of enhanced partner services, which additionally involved interviewing and testing partners of persons who tested negative, and social contacts of index patients and partners. METHODS: We analyzed partner services investigation data from eight jurisdictions participating in SURRG from 2017 through 2019. We summed total index patients, partners from traditional partner services, and partners and contacts from enhanced partner services, and calculated partner services outcomes among partners and contacts. We also visualized sexual networks from partner services data. RESULTS: Of 1,242 index patients identified, 506 named at least one sexual partner. Traditional partner services yielded 1,088 sexual partners and 105 were newly diagnosed with gonorrhea. Enhanced partner services yielded an additional 59 sexual partners and 52 social contacts. Of those partners and contacts, 3 were newly diagnosed with gonorrhea. Network visualization revealed sparse networks with few complex partnership clusters. CONCLUSIONS: Traditional partner services for gonorrhea may be useful for eliciting, notifying, and diagnosing partners of index patients in an outbreak setting. Enhanced partner services are unlikely to be effective for eliciting, notifying, and diagnosing a substantial number of additional people. |
Sustained Transmission of Neisseria gonorrhoeae with High-Level Resistance to Azithromycin, Indianapolis, Indiana 2017-2018.
Holderman JL , Thomas JC , Schlanger K , Black JM , Town K , Cyr SB , Pham CD , Kirkcaldy RD . Clin Infect Dis 2021 73 (5) 808-815 ![]() BACKGROUND: Since 2014, Neisseria gonorrhoeae (Ng) azithromycin (AZM) susceptibility has declined in the United States, but high-level azithromycin resistance (HL-AZMR) has been infrequent and sporadic. We describe a cluster of 14 Ng isolates with HL-AZMR identified in Indianapolis over 13 months. METHODS: Ng culture specimens (genital and extragenital) were collected from attendees of the Bell Flower Clinic. Isolates underwent antimicrobial susceptibility testing (AST) by Etest . AZM minimum inhibitory concentrations 256 g/ml were classified as HL-AZMR. Local disease intervention specialists interviewed patients whose isolates demonstrated HL-AZMR and conducted partner services. Relatedness of isolates was investigated by genomic analyses. RESULTS: During 2017-2018, 1,016 Ng isolates collected at the Bell Flower Clinic underwent AST. Fourteen isolates (1.4%) from 12 men collected over 13 months demonstrated HL-AZMR; all were cephalosporin-susceptible. Of the 12 men, nine were white and reported male sex partners. Nine of the men were able to be re-tested; all were cured with 250mg ceftriaxone plus 1g azithromycin. Two men named each other as partners; no other partners in common were reported. Genomic analysis demonstrated close relatedness of the HL-AZMR isolates and a novel combination of a mosaic-mtrR promoter along with 23S rRNA mutations that appear to have emerged from circulating strains. CONCLUSIONS: The close genetic relatedness with limited epidemiological linkages between patients highlights the challenges of gonorrhea partner investigations and suggests undetected local transmission. Local AST, rapid public health action, and epidemiologic investigations combined with genomic analysis provides a multi-pronged approach to understanding an STD outbreak. |
Sustained Transmission of Neisseria gonorrhoeae with High-Level Resistance to Azithromycin, in Indianapolis, Indiana, 2017-2018.
Holderman JL , Thomas JC , Schlanger K , Black JM , Town K , Cyr SB , Pham CD , Kirkcaldy RD . Clin Infect Dis 2021 73 (5) 808-815 ![]() ![]() BACKGROUND: Since 2014, Neisseria gonorrhoeae (Ng) azithromycin (AZM) susceptibility has declined in the United States, but high-level azithromycin resistance (HL-AZMR) has been infrequent and sporadic. We describe a cluster of 14 Ng isolates with HL-AZMR identified in Indianapolis over 13 months. METHODS: Ng culture specimens (genital and extragenital) were collected from attendees of the Bell Flower Clinic. Isolates underwent antimicrobial susceptibility testing (AST) by Etest ®. AZM minimum inhibitory concentrations ≥256 µg/ml were classified as HL-AZMR. Local disease intervention specialists interviewed patients whose isolates demonstrated HL-AZMR and conducted partner services. Relatedness of isolates was investigated by genomic analyses. RESULTS: During 2017-2018, 1,016 Ng isolates collected at the Bell Flower Clinic underwent AST. Fourteen isolates (1.4%) from 12 men collected over 13 months demonstrated HL-AZMR; all were cephalosporin-susceptible. Of the 12 men, nine were white and reported male sex partners. Nine of the men were able to be re-tested; all were cured with 250 mg ceftriaxone plus 1g azithromycin. Two men named each other as partners; no other partners in common were reported. Genomic analysis demonstrated close relatedness of the HL-AZMR isolates and a novel combination of a mosaic-mtrR promoter along with 23S rRNA mutations that appear to have emerged from circulating strains. CONCLUSIONS: The close genetic relatedness with limited epidemiological linkages between patients highlights the challenges of gonorrhea partner investigations and suggests undetected local transmission. Local AST, rapid public health action, and epidemiologic investigations combined with genomic analysis provides a multi-pronged approach to understanding an STD outbreak. |
Gonorrhea testing, morbidity, and reporting using an integrated sexually transmitted disease registry in Indiana: 2004-2016
Ojo OC , Arno JN , Tao G , Patel CG , Zhang Z , Wang J , Holderman J , Dixon BE . Int J STD AIDS 2020 32 (1) 30-37 Surveillance of gonorrhea (GC), the second most common notifiable disease in the United States, depends on case reports. Population-level data that contain the number of individuals tested in addition to morbidity are lacking. We performed a cross-sectional analysis of data obtained from individuals tested for GC recorded in a sexually transmitted disease (STD) registry in the state of Indiana. Descriptive statistics were performed, and a Poisson generalized linear model was used to evaluate the number of individuals tested for GC and the positivity rate. GC cases from a subset of the registry were compared to CDC counts to determine the completeness of the registry. A total of 1,870,811 GC tests were linked to 627,870 unique individuals. Individuals tested for GC increased from 54,334 in 2004 to 269,701 in 2016; likewise, GC cases increased from 2,039 to 5,997. However, positivity rate decreased from 3.75% in 2004 to 2.22% in 2016. The difference in the number of GC cases captured by the registry and those reported to the CDC was not statistically significant (P = 0.0665). Population-level data from an STD registry combining electronic medical records and public health case data may inform STD control efforts. In Indiana, increased testing rates appeared to correlate with increased GC morbidity. |
Emergence of Neisseria gonorrhoeae Strains Harboring a Novel Combination of Azithromycin-Attenuating Mutations.
Pham CD , Sharpe S , Schlanger K , St Cyr S , Holderman J , Steece R , Soge OO , Masinde G , Arno J , Schmerer M , Kersh EN . Antimicrob Agents Chemother 2019 63 (4) ![]() ![]() The nimbleness of Neisseria gonorrhoeae to evade the effect of antibiotics has perpetuated the fight against antibiotic-resistant gonorrhea for more than 80 years. The ability to develop resistance to antibiotics is attributable to its indiscriminate nature in accepting and integrating exogenous DNA into its genome. Here, we provide data demonstrating a novel combination of the 23S rRNA A2059G mutation with a mosaic-multiple transferable resistance (mosaic-mtr) locus haplotype in 14 N. gonorrhoeae isolates with high-level azithromycin MICs (>/=256 mug/ml), a combination that may confer more fitness than in previously identified isolates with high-level azithromycin resistance. To our knowledge, this is the first description of N. gonorrhoeae strains harboring this novel combination of resistance determinants. These strains were isolated at two independent jurisdictions participating in the Gonococcal Isolate Surveillance Project (GISP) and in the Strengthening the U.S. Response to Resistant Gonorrhea (SURRG) project. The data suggest that the genome of N. gonorrhoeae continues to shuffle its genetic material. These findings further illuminate the genomic plasticity of N. gonorrhoeae, which allows this pathogen to develop mutations to escape the inhibitory effects of antibiotics. |
Notes from the field: Adverse event associated with unintentional exposure to the Brucella abortus RB51 vaccine - Oregon, December 2017
Hatcher SM , Shih D , Holderman J , Cossaboom C , Leman R , DeBess E . MMWR Morb Mortal Wkly Rep 2018 67 (26) 747 On December 7, 2017, a previously healthy, middle-aged male veterinarian was evaluated at an Oregon emergency department (ED) for cough, malaise, myalgia, fever, and arthralgia of 4 days’ duration. The patient reported having sustained a needle stick while administering the Brucella abortus strain RB51 vaccine (RB51) to cattle 3 weeks before symptom onset. While the patient was in the ED, a probable diagnosis of brucellosis was considered, but Brucella testing was not performed. After a chest radiograph, the patient was discharged with a doxycycline prescription for right upper lobe pneumonia. On December 11, the patient returned to the ED with worsening pneumonia. At that time, the Oregon Health Authority Public Health Division (OPHD) was notified of the probable brucellosis case. The patient was hospitalized and began oral rifampin and intravenous ceftriaxone and azithromycin, and continued oral doxycycline treatments. OPHD and the local health jurisdiction provided RB51-specific treatment and testing recommendations to clinicians and provided guidance for laboratory biosafety precautions through coordination with the Oregon State Public Health Laboratory. As a result, the hospitalist discontinued rifampin, continued doxycycline, and started trimethoprim-sulfamethoxazole (TMP/SMX). By 3 days after admission, the patient’s symptoms had improved, and he was discharged and prescribed doxycycline and TMP/SMX for 60 days, which is the recommended treatment for human RB51 infections (1). Blood and sputum cultures collected at admission were later negative for Brucella spp. During reinterview, the patient confirmed that his only known RB51 exposure was the needle stick. Although he administered the vaccine regularly and was aware of its potential for pathogenicity in humans, he had not sought the recommended postexposure prophylaxis of doxycycline and TMX/SMX for 21 days (1). |
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