Introduction Multidrug-resistant N. gonorrhoeae infections are a threat to public health. In November 2015, UCLA Health began routine gyrase A (gyrA) genotyping all N. gonorrhoeae positive specimens, and reporting genotype and treatment recommendations for wild-type infections. Physicians were educated about wild-type gyrA genotypes predicting ciprofloxacin susceptibility. In May 2016 we began sending electronic reminders to providers of genotype results and treatment recommendations.
Methods We reviewed records for all laboratory confirmed N. gonorrhoeae cases from January 1st 2015 - November 30th2016. Infections in different anatomic sites were considered unique infections, while unique infections in a single patient on the same date were considered a case. Empiric therapy was defined as treatment within one day of specimen collection.
Results Among 381 patients (32% HIV infected) there were 411 cases and 459 anatomic site-specific N. gonorrhoeae infections. Of cases, 290 (71%) were treated non-empirically. The average time to treatment among non-empirically treated cases (n=256) was 5.2 days (SD 4 days). After November 2015, there were 319 infections: 131 (41%) were wild-type gyrA genotypes, 92 (29%) mutant, 92 indeterminate and 4 were not attempted. Of the 92 indeterminate results 68 (74%) were from the pharynx, compared to 24 (26%) from other sites (p-value<0.001). Among non-empirically treated cases, ceftriaxone was used in 119 (96%) of 124 before versus 132 (72%) of 184 after assay introduction (p-value<0.001). Among 59 non-empirically treated wild-type gyrA infections, 17 (29%) were treated with ciprofloxacin; 2 (9%) of 23 before electronic reminders began compared to 15 (50%) of 30 after (p-value=0.001), six cases had missing data. There was no ciprofloxacin use prior to assay implementation.
Conclusion A large health system successfully implemented routine N. gonorrhoeae gyrA genotyping with a reduction in ceftriaxone use. Targeted ciprofloxacin therapy increased with the use of electronic provider reminders.