title: Laboratory Capacity for Antimicrobial Susceptibility Surveillance of Neisseria gonorrhoeae-District of Columbia, 2007-2012.
abstract: BACKGROUND
  In the District of Columbia (DC), Neisseria gonorrhoeae (gonorrhea) infections accounted for more than 25% of 9321 incident sexually transmitted infections reported in 2011; untreated infections can lead to reproductive complications and a higher risk for HIV transmission. In DC, limited capacity to measure the prevalence of antibiotic-resistant N. gonorrhoeae is available; culture-based antibiotic susceptibility testing (AST) is needed to monitor antimicrobial resistance. We examined the capacity of laboratories that report to the DC Department of Health to perform AST for ongoing surveillance of antibiotic-resistant N. gonorrhoeae and to identify suspected treatment failures.
  
  
  METHODS
  We created a survey about diagnostic methods for gonorrhea testing and identified 33 laboratories that reported gonorrhea results to Department of Health in 2007 to 2012. Laboratories were assessed for use of bacterial culture or nucleic acid amplification testing (NAAT) for gonorrhea testing, prevalence of AST on gonorrhea-positive cultures, and types of antibiotics tested during AST. We estimated the prevalence of laboratory practices on the basis of self-report by staff.
  
  
  RESULTS
  Nineteen (58%) laboratories completed the survey, representing 92% of the gonorrhea reporting. Seventeen (89%) of 19 laboratories conducted testing by culture; only 6 (35%) performed AST; 79% performed NAAT. Barriers to AST included longer completion times and limited number of provider requests for AST. Commercial laboratories (32%) were more likely to conduct both culture and NAAT, compared with health care facilities (11%).
  
  
  CONCLUSIONS
  We report a low prevalence of laboratories performing AST because of multiple barriers. State-specific strategies addressing these barriers are needed to improve detection of antibiotic-resistant gonorrhea stains circulating among the population.
authors.affiliation: From the *Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA; †District of Columbia Department of Health, Washington, DC; and ‡Division of STD Prevention, NCHHSTP, CDC, Atlanta, GA.
authors.forename: Tiana A
authors.initials: TA
authors.lastname: Garrett
authors.forename: John
authors.initials: J
authors.lastname: Davies-Cole
authors.forename: Bruce
authors.initials: B
authors.lastname: Furness
mesh_terms: D000900:Anti-Bacterial Agents; D002487:Centers for Disease Control and Prevention, U.S.; D019411:Clinical Laboratory Techniques / Q000592:standards*; D004219:District of Columbia / Q000453:epidemiology; D006069:Gonorrhea / Q000175:diagnosis* / Q000453:epidemiology; D017408:Guidelines as Topic; D006801:Humans; D008826:Microbial Sensitivity Tests; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification*; D021141:Nucleic Acid Amplification Techniques; D015995:Prevalence; D018571:Sentinel Surveillance; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents