Publications

INTRODUCTION

Over the last several years, Neisseria gonorrhoeae has developed decreased susceptibility to extended-spectrum cephalosporins worldwide. Gonococcal antimicrobial surveillance programs in multiple regions have documented the rise in N. gonorrhoeae isolates' minimum inhibitory concentrations to cephalosporins, and the first cases of ceftriaxone treatment failure have been reported. These developments have prompted the use of the term 'superbug' and concerns about the emergence of untreatable gonococcal infections.

AREAS COVERED

Since the publication of the last detailed review of the use of cephalosporins for gonorrhea in 2009, several new developments have occurred, which are detailed in this review. A variety of treatment strategies have been proposed in response to this 'superbug' threat, including increasing the dose or providing multiple doses of cephalosporins, multidrug therapy, rotating therapeutic regimens and individualized treatment based on susceptibility testing.

EXPERT OPINION

A robust public health response is needed that includes better diagnosis and treatment of pharyngeal gonorrhea, improved surveillance of antimicrobial resistance, informed treatment approaches and reduction of the global burden of gonococcal infections.

BACKGROUND

Systemic lupus erythematosus (SLE) affects 1 in 2500 Americans and is associated with significant morbidity and mortality. The recent development of SLE quality measures provides an opportunity to understand gaps in clinical care and to identify modifiable factors associated with variations in quality.

OBJECTIVE

To evaluate performance on SLE quality measures as well as differences in quality of care by demographic, socioeconomic, disease, and health system characteristics.

DESIGN AND PATIENTS

Cross-sectional analysis of data derived from the Lupus Outcomes Study, a prospective, longitudinal study of 814 individuals. Principal data collection was through annual structured telephone surveys between 2009-2010. Data on 13 SLE quality measures was collected. We used regression models to estimate demographic, socioeconomic, disease, and health system characteristics associated with performance on individual and overall quality measures.

OUTCOME MEASURES

Performance on each quality measure and overall performance on all measures for which participants were eligible (pass rate).

RESULTS

Participants were eligible for a mean of five measures (range 2-12). Performance varied from 29 % (assessment of cardiovascular risk factors) to 90 % (sun avoidance counseling). The overall pass rate was 65 % (95 % CI 64 %, 65 %). In unadjusted analyses, younger age, minority race/ethnicity, poverty, shorter disease duration, fewer physician visits, and lack of health insurance, were associated with lower pass rates. Receiving care in public sector managed care organizations was associated with higher pass rates. After adjustment, younger age, having fewer physician visits and lacking health insurance remained significantly associated with lower performance; receiving care in public sector managed care organizations remained associated with higher performance.

CONCLUSIONS

We identified a number of gaps in clinical care for SLE. Factors associated with the health care system, including presence and type of health insurance, were the primary determinants of performance on quality measures in SLE.