Antimicrobial resistance of Neisseria gonorrhoeae in Latin American countries: a systematic review

Abstract

Background Detailed information is needed on the dynamic pattern of antimicrobial resistance (AMR) in Neisseria gonorrhoeae in Latin America and the Caribbean (LAC). Objectives To conduct a systematic review of AMR in N. gonorrhoeae in LAC. Methods Electronic searches without language restrictions were conducted in PubMed, Embase, Cochrane Library, EconLIT, Cumulative Index of Nursing and Allied Health Literature, Centre for Reviews and Dissemination, and Latin American and Caribbean Literature in Health Sciences. Studies were eligible if published between 1 January 2011 and 13 February 2021, conducted in any LAC country (regardless of age, sex and population) and measured frequency and/or patterns of AMR to any antimicrobial in N. gonorrhoeae. The WHO Global Gonococcal Antimicrobial Surveillance Programme (WHO-GASP) for LAC countries and Latin American AMR Surveillance Network databases were searched. AMR study quality was evaluated according to WHO recommendations. Results AMR data for 38, 417 isolates collected in 1990–2018 were included from 31 publications, reporting data from Argentina, Brazil, Colombia, Peru, Uruguay, Venezuela and WHO-GASP. Resistance to extended-spectrum cephalosporins was infrequent (0.09%–8.5%). Resistance to azithromycin was up to 32% in the published studies and up to 61% in WHO-GASP. Resistance to penicillin, tetracycline and ciprofloxacin was high (17.6%–98%, 20.7%–90% and 5.9%–89%, respectively). Resistance to gentamicin was not reported, and resistance to spectinomycin was reported in one study. Conclusions This review provides data on resistance to azithromycin, potentially important given its use as first-line empirical treatment, and indicates the need for improved surveillance of gonococcal AMR in LAC. Trial registration: Registered in PROSPERO, CRD42021253342.

The Molecular Genetic Epidemiology and Antimicrobial Resistance of Neisseria gonorrhoeae Strains Obtained from Clinical Isolates in Central Panama

“…For the management of urethral discharge syndrome, the guidelines recommend ceftriaxone or ciprofloxacin in a single dose, plus doxycycline for 7 days or azithromycin in a single dose (for the treatment of Chlamydia trachomatis and gonorrhea). This study showed a high resistance to ciprofloxacin (30%) among the analyzed strains; a result that coincides with the information obtained from other regions of Latin America [22], so these findings should be considered in the empirical STI treatment guidelines in Panama [31].…”

“…Of the total N. gonorrhoeae strains analyzed, we found a resistance of 38%, 40%, and 30% for penicillin, tetracycline, and ciprofloxacin, respectively, which are results that generally coincide with information obtained from other regions of the world [8]. In Latin America, for example, a high resistance of N. gonorrhoeae to antibiotics such as penicillin has been described [22] which oscillates between 17.6% and 98%, to tetracycline of between 20.7% and 90%, and between 5.9% and 89% to ciprofloxacin. The results of this study show that resistance to these three types of antibiotics has been present in all the years of isolation of the strains (2013-2018).…”

“…The results of this study show that resistance to these three types of antibiotics has been present in all the years of isolation of the strains (2013-2018). Among the isolates analyzed, no resistance to azithromycin or ESCs was reported; however, in some countries of the region such as Argentina, Brazil, and Peru, strains of N. gonorrhoeae resistant to azithromycin [14] and ESCs (cefixime and ceftriaxone) have been identified [22][23][24]. It has also been highlighted that surveillance data for gonorrhea are nonexistent or very limited in some Latin American countries [25], which represents a great challenge for its surveillance.…”