Potential Impact of Doxycycline Post-Exposure Prophylaxis on Tetracycline Resistance in Neisseria gonorrhoeae and Colonization with Tetracycline-Resistant Staphylococcus aureus and Group A Streptococcus

IF 8.2 1区医学 Q1 IMMUNOLOGY

Clinical Infectious Diseases Pub Date : 2025-03-04 DOI:10.1093/cid/ciaf089

Olusegun O Soge, Christina S Thibault, Chase A Cannon, Stephanie E McLaughlin, Tim W Menza, Julia C Dombrowski, Ferric C Fang, Matthew R Golden

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引用次数: 0

Abstract

Background Doxycycline post-exposure prophylaxis (doxy PEP) is increasingly used among men who have sex with men (MSM). Its impact on antimicrobial resistance and the microbiome is uncertain. Methods We used Neisseria gonorrhoeae (NG) surveillance data from King County, WA and joinpoint regression to investigate trends in NG-tetracycline resistance (tetR), 2017-2024 and, among sexual health clinic (SHC) patients, evaluated the association of NG-tetR with doxy PEP use. We evaluated nasopharyngeal colonization with Staphylococcus aureus and Group A Streptococcus (GAS) 703 MSM SHC patients, August 2023-July 2024. Results Among 2,312 MSM with NG, tetR was stable 2017 to quarter 1 (Q1) 2023 (mean=27%) and thereafter rose to 70% in Q2 2024 (p<0.0001). (King County released doxy PEP guidelines in Q2 2023.) NG with high-level (HL) tetR increased Q1 2021 to Q2 2024 (2% to 65%) (p<0.0001). Taking >3 doses of doxy PEP/month was associated with both tetR and HL tetR (p≤0.01 for both), though any use of doxy PEP was not associated with tetR or HL tetR. S. aureus colonization was less common among doxy PEP users than non-users (27% vs. 36%, p=0.02), but colonization with both tetracycline-resistant S. aureus and GAS were more common among doxy PEP users than non-users (18% vs. 8%, p<0.0001 and 9% vs. 4%, p=0.008, respectively). Conclusions TetR in NG rapidly increased from 2021 to 2024, and most NG among King County MSM now have HL tetR. Doxy PEP use is associated with colonization with GAS and tetracycline-resistant S. aureus, suggesting that doxy PEP impacts off-target bacteria.

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背景多西环素暴露后预防疗法（doxy PEP）越来越多地用于男男性行为者（MSM）。它对抗菌药耐药性和微生物组的影响尚不确定。方法我们利用华盛顿州金县的淋病奈瑟菌（NG）监测数据和连接点回归法调查了 2017-2024 年 NG-四环素耐药性（tetR）的趋势，并在性健康诊所（SHC）患者中评估了 NG-tetR 与强力 PEP 使用的相关性。我们对 2023 年 8 月至 2024 年 7 月期间 703 名 MSM SHC 患者的金黄色葡萄球菌和 A 组链球菌（GAS）鼻咽部定植情况进行了评估。结果在 2312 名患有 NG 的 MSM 患者中，tetR 在 2017 年至 2023 年第 1 季度（Q1）期间保持稳定（平均值=27%），此后在 2024 年第 2 季度上升至 70%（p<0.0001）。(金县于 2023 年第 2 季度发布了强力 PEP 指南。）2021 年第 1 季度至 2024 年第 2 季度，患有高水平 (HL) tetR 的 NG 增加（2% 至 65%）（p<0.0001）。每月服用>3次强力PEP与tetR和HL tetR有关（两者的p均≤0.01），但任何强力PEP的使用均与tetR或HL tetR无关。金黄色葡萄球菌定植在多西 PEP 使用者中的发生率低于非使用者（27% 对 36%，p=0.02），但耐四环素金黄色葡萄球菌和 GAS 定植在多西 PEP 使用者中的发生率高于非使用者（分别为 18% 对 8%，p<0.0001 和 9% 对 4%，p=0.008）。结论从 2021 年到 2024 年，NG 中的 TetR 迅速增加，目前金县 MSM 中的大多数 NG 都有 HL tetR。强力杀菌剂 PEP 的使用与 GAS 和耐四环素金黄色葡萄球菌的定植有关，这表明强力杀菌剂 PEP 会对非目标细菌产生影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Infectious Diseases 医学-传染病学

CiteScore

25.00

自引率

2.50%

发文量

900

审稿时长

3 months

期刊介绍： Clinical Infectious Diseases (CID) is dedicated to publishing original research, reviews, guidelines, and perspectives with the potential to reshape clinical practice, providing clinicians with valuable insights for patient care. CID comprehensively addresses the clinical presentation, diagnosis, treatment, and prevention of a wide spectrum of infectious diseases. The journal places a high priority on the assessment of current and innovative treatments, microbiology, immunology, and policies, ensuring relevance to patient care in its commitment to advancing the field of infectious diseases.