trichomonas vaginalis antimicrobial resistance activity— ssun, 2008–2010 robert d. kirkcaldy,...

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