SIGoVA: Pushing Antimicrobial Stewardship Forward in Virginia

With Drs. Lee, Collins and Bucheit
(founding members of SIGoVA). 

I had the great opportunity to present today on Antimicrobial Stewardship (AS) at the Virginia Society of Health-System Pharmacists' Spring Conference. My talk was given in the context of several hours of talks and a panel discussion designed to raise awareness about AS and to promote a regional AS interest group that was created over the past year: the Stewardship Interest Group of Virginia (SIGoVA).

My talk focused on why AS is so important (the problem of antibiotic resistance and our dwindling arsenal of antibiotics) and current best strategies in AS practice as well as key challenges facing AS practitioners today.

The SIGoVA group was created to provide a forum for

Antimicrobial stewardship panel participants 

people in an around Virginia to discuss issues surrounding antibiotic resistance, stewardship and to share information and best practices.

You can find out more about the problem of antibiotic resistance here; you can find out more about antibiotic stewardship here. To find out more about SIGoVA please visit our website.

As the 'pipeline' of new antibiotics for key multi-drug resistant organisms has essentially run dry, it is now more important than ever that we preserve the antibiotics we have and prevent infections wherever possible. Groups such as SIGoVA can help facilitate AS by sharing knowledge, experience and ideas.

Are We Entering an Era of Untreatable Gonorrhea?

Here is an excellent article on the growing problem of multi-drug resistant gonorrhea that was recently published in the CDC's Morbidity and Mortality Weekly Report (MMWR).

"Gonorrhea" refers to infection with the bacterium Neisseria gonorrhoeae and is a common sexually transmitted disease (over 300,000 cases were reported in the United States in 2011). Gonorrhea can cause significant morbidity: infertility, ectopic pregnancy, infection can facilitate HIV transmission, et cetera. One of the challenges in addressing gonorrhea as a public health problem is that many people who are infected have no symptoms; despite being asymptomatic, these individuals can still transmit the disease on to others.

Prevalence of ciprofloxacin resistance in urethral gonorrhea
isolates in US men, 1990-2007 (source: cdc.gov, MMWR)

Antimicrobial susceptibility results are not commonly available to clinicians who manage these infections. The infections, once identified are usually treated empirically with antibiotics known to be active against the bacterium. The challenge with this approach is that the organism has acquired resistance to the various antimicrobials we use to treat it. For example, we use to use flouroquinolone antibiotics to treat gonorrhea, but these antibiotics are no longer recommended due to high levels of fluoroquinolone resistance (see the graph above).

We currently are using cephalosporins (such as cefixime and ceftriaxone) to treat these infections, although resistance data is now suggesting that we are seeing some resistance emerge to these agents, as well. The problem here is that if we lose the cephalosporins there are no reliable alternative drugs we can use for these infections.

The authors of the MMWR report highlight the need to ramp up gonorrhea prevention efforts, to screen high-risk patients for gonorrhea "at least annually," to treat patients with appropriate doses of antimicrobials (per the CDC guidelines), and for clinicians to be vigilant in looking for cases of resistant gonorrhea.