The Public Health Agency of Canada (PHAC) last week reported an increase in antimicrobial-resistant gonococcal (AMR-GC) infections, including a near doubling of cases showing resistance or decreased susceptibility to two different antimicrobials.

The Enhanced Surveillance of Antimicrobial-Resistant Gonorrhea (ESAG) report summarizes data on 3,377 gonorrhea cases submitted for analysis in four Canadian provinces (Alberta, Manitoba, Novia Scotia, and the Northwest Territories) from 2018 through 2021. Most patients (80.2%) were male, of which an average of 55.5% were among men who have sex with men (MSM). 

From 2018 through 2020, the prevalence of AMR-GC (as indicated by resistance to at least one antibiotic) was stable, but it increased from 69.3% in 2020 to 77.4% in 2021, while GC cultures demonstrating resistance or decreased susceptibility to two different antimicrobials rose from 24.8% to 44.5%. In 2021, the AMR-GC burden was highest among MSM (85.2% of isolated cultures were resistant to at least one antimicrobial), followed by heterosexual men (73.5%) and women (66.7%). 

Recommended regimen remains effective

Of tested antimicrobials, resistance to ciprofloxacin was most prevalent, rising from 46.6% of cases in 2020 to 63.1% in 2021. Resistance to ciprofloxacin and tetracycline was high among all sexual behavior groups but highest among MSM. But no cases demonstrating combined resistance to azithromycin and ceftriaxone or cefixime (the gonorrhea treatment regimens recommended by PHAC) were reported. Decreased susceptibility to ceftriaxone or cefixime was detected in one case each in 2018, 2020, and 2021, and in three cases in 2019.

Fourteen cases were reported by public health authorities as treatment failures, but none demonstrated resistance or decreased susceptibility to prescribed treatment regimens.

PHAC says that, as gonorrhea cases rise across Canada and resistance continues to evolve, it's hoping to recruit additional ESAG sites to collect more representative data.

"The continuous monitoring of AMR-GC patterns via surveillance is of paramount importance to ensure the effectiveness of the recommended antimicrobials to treat GC infection," the agency said. "ESAG can play an important role in assessing and monitoring the effectiveness of GC treatment options and for the success of Canadian initiatives to combat AMR-GC."

A secondary analysis of a randomized clinical trial found that a probiotic supplement had only a minor and transient effect on the gut microbiome composition of children during and after antibiotic treatment, researchers reported late last week in JAMA Network Open.

The trial, which involved 350 children and was conducted at three hospitals in the Netherlands and two in Poland, found that a multispecies probiotic given to participants within 24 hours of initiating antibiotics had no effect on antibiotic-associated diarrhea (AAD), but did reduce the overall risk of diarrhea during and for 7 days after antibiotic treatment compared with placebo. For the secondary analysis, to better understand the underlying protective mechanism of probiotics, the investigators collected stool samples from 88 children in the trial (44 from the probiotics group and 44 from the placebo group) at four predefined times and conducted microbiota analysis.

Minimal effect on bacterial diversity

The stool samples were collected and analyzed at inclusion in the trial, on the last day of antibiotic use, on the last day of the study intervention, and 1 month after the intervention. Alpha diversity did not significantly differ between the probiotic and placebo groups during the first three collection times, and Beta diversity was not significantly different at any of the collection times. Shannon diversity (mean, 3.56 vs 3.09) and inverse Simpson diversity (mean, 3.75 vs –1.31) indices were higher in the placebo group compares with the probiotic group 1 month after intervention.

While the analysis did find that three of five bacterial genera contained in the probiotic—Ligilactobacillus, Lactiplantibacillus, and Lactobacillus—were more abundant in children from the probiotic group than the placebo group during supplementation, the difference between the groups disappeared after 1 month. 

"It therefore remains debated whether probiotics have beneficial effects on antibiotic-induced microbiota composition aberrations," the study authors wrote. They add that future studies are needed to assess whether the observed transient effects on taxonomic composition and on diversity play any role in preventing AAD and other adverse effects from antibiotics.

A new meta-analysis of 48 observational studies that included 8,664,026 people reveals that pre-existing sleep disturbances are tied to an increased risk of COVID-19 infection and worse outcomes if infected. The study is published in eClinicalMedicine. 

Previous studies have shown that up to 50% of COVID-19 patients experience sleep disturbances, and sleep disturbances are linked to "daytime drowsiness, work burnout, and low spirits but also induce immune deficiency and systematic inflammation," the authors note.

For the purposes of this study, sleep disturbances included obstructive sleep apnea (OSA), insomnia, abnormal sleep duration (less than 6 hours or more than 9), night-shift work, and restless legs syndrome already documented before infection with COVID-19 

The studies analyzed had sample sizes ranging from 118 to 4.9 million and were conducted in 15 countries, including 19 studies based on US patients. 

Pre-existing sleep disturbances were tied to an increased risk of COVID-19 infection of 12% (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.07 to 1.18), hospitalization of 25% (OR, 1.25; 95% CI, 1.15 to 1.36), death of 45% (OR, 1.45; 95% CI, 1.19 to 1.78), and long COVID of 36% (OR, 1.36; 95% CI, 1.17 to 1.57).

Findings differ by age, sex

Age and gender played a role in the findings, with men with sleep disturbances more likely to die from COVID than women with sleep disturbances. 

Young individuals with pre-existing sleep disturbances had a higher susceptibility and hospitalization for COVID-19 than those without.

"Young individuals with pre-existing sleep disturbances had a higher susceptibility and hospitalization for COVID-19 than those without. This finding further confirmed the compromised immune function induced by sleep disturbances," the authors wrote. "In old individuals, those with pre-existing sleep disturbances elevated the hospitalization and mortality of COVID-19 but did not increase the susceptibility compared with those without."