1887
Research Open Access
Like 0

Abstract

Introduction

Increasing rates of antimicrobial resistance in cause problems for treating gonorrhoea.

Aim

This observational study aimed to describe isolates from all patients found infected with , in Barcelona, Spain, between 2013 and 2017, and with available antimicrobial susceptibility data.

Methods

Minimum inhibitory concentrations (MICs) of penicillin (PEN), cefixime (CFM), ceftriaxone (CRO), azithromycin (AZM), ciprofloxacin (CIP), spectinomycin (SPT), fosfomycin (FOF) and gentamicin (GEN) were determined by E-test. Susceptibility was assessed using clinical breakpoints from the European Committee on Antimicrobial Susceptibility Testing. Time trends for PEN, CFM, AZM and CIP were investigated using logistic regression.

Results

Of 1,979 patients with infection (2,036 isolates), 1,888 (95.4%) were men. Patient median age was 32 years. The proportions of isolates resistant to extended-spectrum cephalosporins were low, with 0.3% (5/1,982) resistant to CRO and 4.9% (98/1,985) to CFM. AZM resistance prevalence was 2.7% (52/1,981), including 16 isolates detected in 2016 and 2017, with high-level resistance. For CIP, 51.3% (1,018/1,986) of isolates were resistant, and for PEN, 20.1% (399/1,985). All isolates were susceptible to SPT. MIC and MIC values of GEN were 4 and 6 mg/L and of FOF 12 and 24 mg/L, respectively. Between 2013 and 2017, PEN and CFM resistance rates each decreased from 28.1% (92/327) to 12.2% (70/572) and from 8.3% (27/327) to 4.4% (25/572) (p ≤ 0.0073). In contrast, AZM resistance prevalence appeared to increase from 1.5% in 2014 (5/340) to 3.0% (17/572) in 2017. No trend was identified for CIP.

Conclusion

Antimicrobial susceptibility surveillance is important to timely detect new phenotypes and trends.

Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2020.25.42.1900576
2020-10-22
2020-12-02
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2020.25.42.1900576
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/25/42/eurosurv-25-42-5.html?itemId=/content/10.2807/1560-7917.ES.2020.25.42.1900576&mimeType=html&fmt=ahah

References

  1. European Centre for Disease Prevention and Control (ECDC). Gonorrhoea. Annual epidemiological report for 2017. Stockholm: ECDC; 2019.
  2. Unidad de vigilancia del VIH y conductas de riesgo. Vigilancia epidemiológica de las infecciones de transmisión sexual, 2017. [HIV and risk behaviors surveillance unit. Epidemiological surveillance of sexually transmitted infections, 2017]. Madrid: Centro Nacional de Epidemiología, Instituto de Salud Carlos III/Plan Nacional sobre el Sida, Dirección General de Salud Pública, Calidad e Innovación; 2019.
  3. Centre d’Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT). Vigilància epidemiològica de les infeccions de transmissió sexual a Catalunya. Informe anual 2017. [Center of Epidemiological Studies on Sexual Transmitted Infections and AIDS of Catalonia. Epidemiological surveillance of sexually transmitted infections in Catalonia. Annual report 2017] Badalona: CEEISCAT; 2018.
  4. Cámara J, Serra J, Ayats J, Bastida T, Carnicer-Pont D, Andreu A, et al. Molecular characterization of two high-level ceftriaxone-resistant Neisseria gonorrhoeae isolates detected in Catalonia, Spain. J Antimicrob Chemother. 2012;67(8):1858-60.  https://doi.org/10.1093/jac/dks162  PMID: 22566592 
  5. de Curraize C, Kumanski S, Micaëlo M, Fournet N, La Ruche G, Meunier F, et al. Ceftriaxone-resistant Neisseria gonorrhoeae isolates (2010 to 2014) in France characterized by using whole-genome sequencing. Antimicrob Agents Chemother. 2016;60(11):6962-4.  https://doi.org/10.1128/AAC.01568-16  PMID: 27600036 
  6. Lahra MM, Ryder N, Whiley DM. A new multidrug-resistant strain of Neisseria gonorrhoeae in Australia. N Engl J Med. 2014;371(19):1850-1.  https://doi.org/10.1056/NEJMc1408109  PMID: 25372111 
  7. European Centre for Disease Prevention and Control (ECDC). Gonococcal antimicrobial susceptibility surveillance in Europe – Results summary 2017. Stockholm: ECDC; 2019.
  8. Unemo M. Current and future antimicrobial treatment of gonorrhoea - the rapidly evolving Neisseria gonorrhoeae continues to challenge. BMC Infect Dis. 2015;15(1):364.  https://doi.org/10.1186/s12879-015-1029-2  PMID: 26293005 
  9. Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015;64(RR-03):1-137. PMID: 26042815 
  10. Public Health Agency of Canada (PHAC). Canadian Guidelines on Sexually Transmitted Infections. Ottawa: PHAC; 2013. Gonococcal Infections Chapter.
  11. Australian Sexual Health Alliance (ASHA). Australian STI Management Guidelines for Use in Primary Care. Sydney: ASHA. [Accessed 12 Jun 2019]. Available from: http://www.sti.guidelines.org.au/sexually-transmissible-infections/gonorrhoea#management
  12. Bignell C, Unemo M, Radcliffe K, Jensen JS, Babayan K, Barton S, et al. , European STI Guidelines Editorial Board. 2012 European guideline on the diagnosis and treatment of gonorrhoea in adults. Int J STD AIDS. 2013;24(2):85-92.  https://doi.org/10.1177/0956462412472837  PMID: 24400344 
  13. Unemo M, Workowski K. Dual antimicrobial therapy for gonorrhoea: what is the role of azithromycin? Lancet Infect Dis. 2018;18(5):486-8.  https://doi.org/10.1016/S1473-3099(18)30162-2  PMID: 29523498 
  14. Hofstraat SH, Götz HM, van Dam AP, van der Sande MA, van Benthem BH. Trends and determinants of antimicrobial susceptibility of Neisseria gonorrhoeae in the Netherlands, 2007 to 2015. Euro Surveill. 2018;23(36).  https://doi.org/10.2807/1560-7917.ES.2018.23.36.1700565  PMID: 30205870 
  15. Day MJ, Spiteri G, Jacobsson S, Woodford N, Amato-Gauci AJ, Cole MJ, et al. , Euro-GASP network. Stably high azithromycin resistance and decreasing ceftriaxone susceptibility in Neisseria gonorrhoeae in 25 European countries, 2016. BMC Infect Dis. 2018;18(1):609.  https://doi.org/10.1186/s12879-018-3528-4  PMID: 30509194 
  16. Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing. 29th ed. CLSI supplement M100. Wayne, PA: CLSI; 2019.
  17. The European Committee on Antimicrobial Susceptibility Testing (EUCAST). Breakpoints tables for interpretation of MICs and zone diameters. Version 9.0. Växjö: EUCAST; 2019.
  18. Cobo F, Cabezas-Fernández MT, Cabeza-Barrera MI. Antimicrobial susceptibility and typing of Neisseria gonorrhoeae strains from Southern Spain, 2012-2014. Enferm Infecc Microbiol Clin. 2016;34(1):3-7.  https://doi.org/10.1016/j.eimc.2015.01.017  PMID: 25735717 
  19. Fuertes de Vega I, Baliu-Piqué C, Bosch Mestres J, Vergara Gómez A, Vallés X, Alsina Gibert M. Risk factors for antimicrobial-resistant Neisseria gonorrhoeae and characteristics of patients infected with gonorrhea. Enferm Infecc Microbiol Clin. 2018;36(3):165-8.  https://doi.org/10.1016/j.eimc.2016.11.012  PMID: 28094065 
  20. GESIDA. Documento de consenso sobre diagnóstico y tratamiento de las infecciones de transmisión sexual en adultos, niños y adolescents. 2017. [Consensus document on diagnostic and treatment of adult and teenage/adolescent sexually transmitted infections]. [Accessed 09 Jul 2019]. Available from: http://gesida-seimc.org/category/guias-clinicas/otras-guias-vigentes/
  21. Barberá MJ, Fernández-Huerta M, Jensen JS, Caballero E, Andreu A. Mycoplasma genitalium Macrolide and Fluoroquinolone Resistance: Prevalence and Risk Factors Among a 2013-2014 Cohort of Patients in Barcelona, Spain. Sex Transm Dis. 2017;44(8):457-62.  https://doi.org/10.1097/OLQ.0000000000000631  PMID: 28703723 
  22. Fifer H, Saunders J, Soni S, Tariq Sadiq S, FitzGerald M. British Association for Sexual Health and HIV national guideline for the management of infection with Neisseria gonorrhoeae. 2019. [Accessed 04 Jul 2019]. Available from: https://www.bashh.org/guidelines
  23. Clifton S, Town K, Furegato M, Cole M, Mohammed H, Woodhall SC, et al. Is previous azithromycin treatment associated with azithromycin resistance in Neisseria gonorrhoeae? A cross-sectional study using national surveillance data in England. Sex Transm Infect. 2018;94(6):421-6.  https://doi.org/10.1136/sextrans-2017-053461  PMID: 29511067 
  24. Jennison AV, Whiley D, Lahra MM, Graham RM, Cole MJ, Hughes G, et al. Genetic relatedness of ceftriaxone-resistant and high-level azithromycin resistant Neisseria gonorrhoeae cases, United Kingdom and Australia, February to April 2018. Euro Surveill. 2019;24(8):1900118.  https://doi.org/10.2807/1560-7917.ES.2019.24.8.1900118  PMID: 30808445 
  25. Harris SR, Cole MJ, Spiteri G, Sánchez-Busó L, Golparian D, Jacobsson S, et al. , Euro-GASP study group. Public health surveillance of multidrug-resistant clones of Neisseria gonorrhoeae in Europe: a genomic survey. Lancet Infect Dis. 2018;18(7):758-68.  https://doi.org/10.1016/S1473-3099(18)30225-1  PMID: 29776807 
  26. Boiko I, Golparian D, Krynytska I, Bezkorovaina H, Frankenberg A, Onuchyna M, et al. Antimicrobial susceptibility of Neisseria gonorrhoeae isolates and treatment of gonorrhoea patients in Ternopil and Dnipropetrovsk regions of Ukraine, 2013-2018. APMIS. 2019;127(7):503-9.  https://doi.org/10.1111/apm.12948  PMID: 30903707 
  27. Mann LM, Kirkcaldy RD, Papp JR, Torrone EA. Susceptibility of Neisseria gonorrhoeae to Gentamicin-Gonococcal Isolate Surveillance Project, 2015-2016. Sex Transm Dis. 2018;45(2):96-8.  https://doi.org/10.1097/OLQ.0000000000000693  PMID: 29324629 
  28. Singh V, Bala M, Bhargava A, Kakran M, Bhatnagar R. In Vitro Synergy Testing of Gentamicin, an Old Drug Suggested as Future Treatment Option for Gonorrhoea, in Combination With Six Other Antimicrobials Against Multidrug-Resistant Neisseria gonorrhoeae Strains. Sex Transm Dis. 2018;45(2):127-31.  https://doi.org/10.1097/OLQ.0000000000000708  PMID: 28876284 
  29. Tesh LD, Shaeer KM, Cho JC, Estrada SJ, Huang V, Bland CM, et al. Neisseria gonorrhoeae and fosfomycin: Past, present and future. Int J Antimicrob Agents. 2015;46(3):290-6.  https://doi.org/10.1016/j.ijantimicag.2015.05.007  PMID: 26145201 
  30. Carmona G, Ruiz L, Fernández C, Jané M. Butlletí Epidemiològic de Catalunya. Març 2019. [Accessed 16 Jun 2019]. Available from: http://canalsalut.gencat.cat/web/.content/_Actualitat/Butlletins/Promocio_proteccio_salut/bec_butlleti_epidemiologic_de_catalunya/2019/bec-mar-2019.pdf
/content/10.2807/1560-7917.ES.2020.25.42.1900576
Loading

Data & Media loading...

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error