Antimicrobial resistance of Neisseria gonorrhoeae in Jakarta, Indonesia: a cross-sectional study

Abstract

Background Neisseria gonorrhoeae has developed resistance to various antimicrobials. At least 10 countries have reported treatment failures with extended-spectrum cephalosporins. Periodic surveillance is essential to determine local treatment guidelines. This study was conducted to determine the resistance of N. gonorrhoeae to penicillin, tetracycline, levofloxacin, cefixime and ceftriaxone among the high-risk population for acquiring STIs in Jakarta and to identify factors associated with resistance. Methods: A cross-sectional study was conducted in Jakarta, Indonesia, from September to November 2018. In all, 98 high-risk males and females who fulfilled the study criteria were included. Specimens were collected from urethral or endocervical swabs, put into Amies transport medium and then transported to the Laboratory of Clinical Microbiology, Universitas Indonesia for culture and identification. Proven gonococcal isolates were examined for susceptibility to various antimicrobials using the disk diffusion method according to Clinical and Laboratory Standard Institute guidelines. Results: Of the 98 specimens, 35 were confirmed to be N. gonorrhoeae. The proportion of N. gonorrhoeae specimens resistant to penicillin, tetracycline, levofloxacin, cefixime and ceftriaxone among the high-risk population was 97.1%, 97.1%, 34.3%, 0% and 0% respectively. The possible factors associated with resistance could only be analysed for levofloxacin. Age, sexual orientation and a history of orogenital sexual activity during the past month were not associated with N. gonorrhoeae resistance to levofloxacin. Conclusion: This study detected no resistance of N. gonorrhoeae to cefixime and ceftriaxone. Further studies with larger samples are needed to obtain more representative results of N. gonorrhoeae resistance and the possible factors associated with resistance.

Susceptibility of Neisseria gonorrhoeae against a dual treatment antibiotics regimen in primary health centres in Surabaya, Indonesia

“…18,19 Other studies from Jakarta and Thailand observed no isolates with RS to cefixime. 8,22 Our results demonstrated a lower mean IZD of cefixime (31.1 mm) compared to that reported for Vietnam (36.3 mm). 18 No gonococci isolates with resistance to azithromycin were observed in this study.…”

“…9 Other studies from Jakarta, Laos and Thailand observed no isolates with RS to ceftriaxone. 8,21,22 Our results show a lower mean IZD of ceftriaxone (37.5 mm) compared to that reported by Adamson et al for Vietnam (41.1 mm). 18 In our study, 31.6% of gonococci isolates had RS to cefixime.…”

“…The diameters were then interpreted according to CLSI criteria for ceftriaxone (susceptible ≥35 mm, decreased susceptibility <35 mm), cefixime (susceptible ≥31 mm, decreased susceptibility <31 mm) and tetracycline/doxycycline (susceptible ≥38 mm, intermediate 31-37 mm, resistant ≤30 mm) and the CDC Neisseria Reference Laboratory for azithromycin (resistant ≤30 mm and not resistant >30 mm). 8,15,18 The mean inhibition zone diameters (IZDs) were also calculated. N. gonorrhoeae ATCC 49226 was used for quality control.…”

“…3 In 2019, there were 97.1% gonococci isolates resistant to tetracycline but none with RS to ceftriaxone in Jakarta, Indonesia. 8 In 2021, the Australian Gonococcal Surveillance Program reported 0.9% gonococci isolates with RS, one isolate with resistance to ceftriaxone…”

Mekanisme resistensi antibiotik pada pengobatan Gonore

“…5 Penelitian Wresti dkk di Jakarta tahun 2018, pada 35 pasien didapatkan hasil kultur 97,1% resistensi terhadap penisilin dan 34,3% resistensi terhadap levofloksasin. 6 Berdasarkan penelitian Rizal Y tahun 2011 di RSUP Dr. M. Djamil Padang pada 26 pasien uretritis gonore, resistensi levofloksasin sebesar 73,1%, ofloksasin 61,5%, kanamisin 23,1%, sefiksim 73,1%, siprofloksasin 31,8%, seftriakson 53,8%, serta tiamfenikol 46,2%. 8 Luasnya resistensi antibiotik mengarah pada multidrug-resistant (MDR) atau extensively drugresistant (XDR).…”