Bacterial STI prevention by doxycycline postexposure prophylaxis (DoxyPEP) in men who have sex with men (MSM) has raised concerns about antimicrobial drug resistance (AMR). We studied the impact of DoxyPEP on Neisseria gonorrhoeae (GC) AMR in the ANRS 174 DOXYVAC trial.MethodsMSM on HIV PrEP randomized to DoxyPEP (n= 362) or no-PEP (n=183) arms were tested for GC at baseline and every three months thereafter, by culture and NAAT. MICs were determined with Etest (Biomerieux) and interpreted according to EUCAST guidelines. We performed whole-genome sequencing and/or PCR sequencing on GC isolates and NAAT-positive samples, using Fisher’s exact tests for comparisons.ResultsFrom January 2021 to February 2023, MICs were determined for 78 GC isolates, and 233 NAAT only GC-positive samples were analysed to identify the molecular determinants of resistance. All GC isolates were resistant to tetracycline with a significant increase in rate of high-level tetracycline resistance mediated by the tetM gene in the DoxyPEP arm than in the no-PEP arm (35.5 vs. 12.5%, respectively p=0.043). The MICs of ceftriaxone, fluoroquinolones and azithromycin were similarly distributed in the DoxyPEP and no-PEP arms. All GC isolates were susceptible to ceftriaxone and cefixime, but isolates with decreased susceptibility to cefixime linked to the mosaic penA34.007 allele were more frequent in the DoxyPEP arm than the no-PEP arm (32.3% vs 10.0%, respectively p=0.033).ConclusionsDoxyPEP use was associated with a significant increase in high-level tetracycline resistance and decreased susceptibility to cefixime in GC. AMR should therefore be closely monitored when using this strategy.

In this study, we evaluated the clinical outcomes associated with the use of highly bioavailable oral antibiotics (fluoroquinolones and trimethoprim-sulfamethoxazole) compared with the less-bioavailab...

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.MethodsWe used Neisseria gonorrhoeae (NG) surveillance data from King County, Washington, USA, 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) in 703 MSM SHC patients, August 2023-July 2024.ResultsAmong 2312 MSM with NG, tetR was stable 2017 to quarter 1 (Q1) 2023 (mean = 27%) and thereafter rose to 70% in Q2 2024 (P < .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 < .0001). Taking >3 doses of doxy PEP/month was associated with both tetR and HL tetR (P ≤ .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 = .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 < .0001% and 9% vs 4%, P = .008, respectively).ConclusionsTetR 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.

This reanalysis of data from historical randomized, controlled trials, according to criteria published by the US Food and Drug Administration in 2019, conf

AbstractObjectivesTo explore the patient perspective on the administration of IV and oral antimicrobials.BackgroundImproving IV to Oral antimicrobial switch (IVOS) rates facilitates patient flow, reduces nursing time spent reconstituting iv antibiotics, increases the use of cost-effective antibiotics, reduces the ward level carbon footprint, and decreases the risk of developing line related infections. This work aims to explore patient experience, perception and views, in a secondary care setting, around the administration routes of antimicrobials.MethodsAfter patient consent, a semi-structured interview comprising both open and closed ended questions, was conducted. This allowed clarification or further explanation of answers, providing mid-level insights. Interviews were carried out with 31 patients who were randomly selected across medical wards over one week. Eligible participants were required to have mental capacity, must have received both IV and oral antibiotics for at least 48 h during their hospital admission, and consented to participate in the interview.ResultsOral antibiotics were preferred by 67% (16/24) of patients, as they enabled them to ‘move around and go to the shops’, they can ‘go home on them’, and many expressed a preference for avoiding needles when possible, stating they would ‘rather swallow a tablet than have a needle’. Those who preferred IV antibiotics felt IVs helped them ‘get better quicker’, and a patient felt ‘oral antibiotics disturbed my stomach’. When asked whether patients felt IV antibiotics were more effective than oral, 32% (12/31) patients were unsure, as ‘they did not know how they work’, 23% (7/31) patients felt that IV were not more effective as ‘they are the same thing’ and ‘oral is better’, and 39% (12/31) patients felt that IV antibiotics were more effective as they ‘go straight into the bloodstream’, and ‘have worked in the past’. When asked if they required more information on their prescribed antibiotics, 8/31 (23%) of patients felt they had been adequately informed. From the sample of 31 patients, 74% of participants expressed how they would like more information around the antibiotics prescribed for them, why and how they are given to them while in hospital.ConclusionsProviding patients with the opportunity to discuss and receive additional information regarding antimicrobials prescribed would be valued. The patients interviewed have built perceptions around antibiotic administration routes based on previous experiences. Patient targeted approaches to antimicrobial stewardship would be well received, potentially challenging existing beliefs and empowering patients.