Post on 15-Jan-2016
Trichomonas Vaginalis Antimicrobial Resistance Activity—
SSuN, 2008–2010
Robert D. Kirkcaldy, MD, MPHEpidemic Intelligence Service (EIS) Officer
Division of STD Prevention
Objectives
• Identify prevalence of Trichomonas vaginalis (TV) among STD clinic attendees
• Describe demographic & clinical characteristics of TV cases, esp. those exhibiting resistance
• Identify prevalence of in vitro antimicrobial resistance among TV isolates
TV = Trichomonas vaginalis
Timing of TV Specimen Collection, 2009
A M J Jul Aug S O N D
San Francisco
Seattle
Philadelphia
Denver
New York City
Birmingham
Trichomonas Vaginalis Specimen Update*
Outcome n (%)
Specimens received at CDC 281
Specimens assayed 246 (88)
Non-viable 30 (11)
In culture 5 (2)
* As of 30 November, 2009
Percentage of T. Vaginalis Specimens Assayed at CDC, by site
0
20
40
60
80
100
NY PA AL CO SF WA Total
Per
cen
tag
e
SSuN Site
76%
93%
69%
90% 90%94%
88%
in vitro Metronidazole Resistance* among TV isolates
SSuN Site n (%)
NYC 1 (2)
Philadelphia 4 (8)
Birmingham 0 (0)
Denver 3 (7)
San Francisco 2 (4)
Seattle 3 (6)
Total 13 (5)* MLC ≥ 50 μg/mL under aerobic conditions
Frequencies of Metronidazole MLC* results (n=243)
0
10
20
30
40
50
60
0.4 0.8 1.6 3.1 6.3 12.5 25 50 100 200 400
MLC* (μg/mL)
Nu
mb
er
of
spe
cim
ens
Median = 6.3
* MLC = Minimum Lethal Concentration under aerobic conditions
In vitro resistance
Minimal Mod High
Challenges Faced
• CDC laboratory capacity was less than projected– Needed to cap number of specimens
• Transient poor survivability at selected sites
Looking Ahead to 2010
• Each site to collect additional 50 specimens
• CDC lab planning to increase capacity
• ‘Cap’ on specimen volume not planned– Except for very high volume site: ~ 10–15/week
Timing of TV Specimen Collection, 2010
A May Jun Jul Aug S
San Francisco
Seattle
Philadelphia
Denver
New York City
Birmingham
MarFJ
CDC. Public Health Image Library
Thank you!
Frequencies of MLC categories, NYC
0
2
4
6
8
10
12
14
16
0.4 0.8 1.6 3.1 6.3 12.5 25 50 100
Minimum Lethal Concentration (μg/mL)
Nu
mb
er o
f sp
ecim
ens
Median=3.1
Frequencies of MLC categories, Philadelphia
0
2
4
6
8
10
12
14
0.4 0.8 1.6 3.1 6.3 12.5 25 50 100
Minimum Lethal Concentration (μg/mL)
Nu
mb
er o
f sp
ecim
ens
Median=3.1
Frequencies of MLC categories, Birmingham
0
0.5
1
1.5
2
2.5
3
3.5
0.4 0.8 1.6 3.1 6.3 12.5 25 50 100
Minimum Lethal Concentration (μg/mL)
Nu
mb
er o
f sp
ecim
ens
Median=12.5
Frequencies of MLC categories, Denver
0
2
4
6
8
10
12
14
0.4 0.8 1.6 3.1 6.3 12.5 25 50 100
Minimum Lethal Concentration (μg/mL)
Nu
mb
er o
f sp
ecim
ens
Median=3.1
Frequencies of MLC categories, San Francisco
0
2
4
6
8
10
12
0.4 0.8 1.6 3.1 6.3 12.5 25 50 100
Minimum Lethal Concentration (μg/mL)
Nu
mb
er o
f sp
ecim
ens
Median=3.1
Frequencies of MLC categories, Seattle
0
2
4
6
8
10
12
14
0.4 0.8 1.6 3.1 6.3 12.5 25 50 100
Minimum Lethal Concentration (μg/mL)
Nu
mb
er o
f sp
ecim
ens
Median=6.3
Prevalence of in vitro Metronidazole Resistance*
0
5
10
15
20
NY PA AL CO SF WA Total
8%7% 6%
4%2%
* MLC ≥ 50 ug/dL
5%
Per
cen
tag
e
Include confidence intervals?
SSuN Site
Prevalence of in vitro Metronidazole Resistance* (n=243)
Colorado
Washington
CaliforniaSan Francisco
Seattle
Denver
New YorkNYC
PennsylvaniaPhiladelphia
AlabamaBirmingham
2%
8%
7%
4%
6%
0%* MLC ≥ 50 ug/dL
Total = 5%
Acknowledgements
• CDC• NYC• Philadelphia• Birmingham
• Denver• San Francisco• Seattle
The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of
the Centers for Disease Control and Prevention