(P71-LB) Implementing increased gonococcal culture surveillance in Massachusetts

Project: 

On January 19, 2023, Massachusetts Department of Public Health (MDPH) released a Clinical Alert recommending culture in addition to nucleic acid amplification testing (NAAT) for symptomatic patients suspected of gonorrhea. The Alert was emailed to all licensed clinicians in Massachusetts following detection of two cases of a novel U.S. strain of Neisseria gonorrhoeae (NG) carrying the penA60.001 allele indicative of ceftriaxone non-susceptibility.



Issue:  Since 2013, MDPH regulation has required NG isolate submission to the State Public Health Laboratory (SPHL) on all culture-positive cases in Massachusetts, to provide standardized antimicrobial susceptibility testing. Few isolates were received, given widespread use of NAAT to diagnose gonorrhea, thus laboratory capacity to obtain and perform gonorrhea culture was uncertain prior to the Alert. We monitored volume of isolates received by SPHL before and after the Alert. Additionally, we reviewed email communications with clinicians and laboratorians prompted by the Alert release.



Results: Between January 19 and February 18, 2023, SPHL received 37 isolates from 12 clinical microbiology labs embedded in 4 academic medical centers, 5 community hospitals, 2 commercial labs, and a large multi-specialty group practice; 14 (38%) of isolates were submitted by commercial labs. Only 10 isolates were received in the same time period in 2022 from 9 clinical microbiology labs embedded in 3 academic medical centers, 5 community hospitals, and the Veterans Administration. MDPH provided email technical assistance regarding NG culture including best practices in specimen collection, processing, transfer, and results interpretation to 21 clinical sites (e.g. academic medical centers, community health centers and hospitals, group practices, and community-based organizations) and 7 microbiology laboratories, 3 of which were among those submitting isolates, post-Alert.



Lessons Learned:  Preliminary information from the month after the Alert indicates NG isolate submission increased relative to the same time the year prior, particularly from commercial labs which also report the greatest number of NG+ NAAT cases. Achieving representative culture surveillance may hinge upon additional outreach to clinical sites and microbiology laboratories to identify systems that could benefit from technical assistance to implement culture more widely.