Australian Gonococcal Surveillance Programme Annual Report, 2020

Abstract

The Australian Gonococcal Surveillance Programme (AGSP), established in 1981, has continuously monitored antimicrobial resistance in clinical isolates of <i>Neisseria gonorrhoeae</i> for more than 40 years. In 2020, a total of 7,219 clinical isolates of gonococci from patients in the public and private sectors, in all jurisdictions, were tested for in vitro antimicrobial susceptibility by standardised methods. Current treatment recommendations for gonorrhoea, for the majority of Australia, continues to be dual therapy with ceftriaxone and azithromycin. In 2020, decreased susceptibility (DS) to ceftriaxone (minimum inhibitory concentration [MIC] value ≥ 0.06 mg/L) was found nationally in 0.9% of isolates. There was one isolate, reported from Victoria in 2020, that was resistant to ceftriaxone (MIC value ≥ 0.25 mg/L). Resistance to azithromycin (MIC value ≥ 1.0 mg/L) was found nationally in 3.9% of <i>N. gonorrhoeae</i> isolates, continuing a downward trend observed and reported since 2017. Isolates with high-level resistance to azithromycin (MIC value ≥ 256 mg/L) are identified sporadically in Australia; in 2020, there was one such isolate reported in Queensland. In 2020, penicillin resistance was found in 27% of gonococcal isolates nationally, and ciprofloxacin resistance in 36%; however, there is considerable variation by jurisdiction. In some remote settings, penicillin resistance remains low, and this drug continues to be recommended as part of an empiric therapy strategy. In 2020, in remote Northern Territory, no penicillin resistance was reported, and in remote Western Australia 5/116 of gonococcal isolates (4.3%) were penicillin resistant. There was one ciprofloxacin-resistant isolate reported from remote Northern Territory, and ciprofloxacin resistance rates remain comparatively low in remote Western Australia (4/116; 3.4%).

Markedly decreasing azithromycin susceptibility of Neisseria gonorrhoeae, Germany, 2014 to 2021

“…NG with high-level azithromycin resistance (> 256 mg/L) have been reported from several European countries and worldwide, and sustained transmission of these isolates has been described [4,10,[12][13][14][15][16]. Interestingly, these isolates remain rare in Germany.…”

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

“…High resistance to these drugs was also reported in Africa (resistance to penicillin 75%, to tetracycline 91.7% and to ciprofloxacin 37.5%) 73 and the Asia-Pacific region (resistance to ciprofloxacin >5% was reported by 88.7% of studies). 74 In 2020, Australia reported resistance to penicillin of 26.6%, to tetracycline 30% and to ciprofloxacin 36.4%, 75 and in the USA reported resistance to ciprofloxacin in 2019 was 35.4%, the highest recorded. 76 Europe reported high resistance to ciprofloxacin of 50.3% in 2018.…”

“…In Africa, the reported resistance was 4.2%, 73 and in the Asia-Pacific region the percentage of resistance was 0.1%–5%, with 23.5% of reports showing resistance >5%, and an increase in reports with resistance to azithromycin >5% from 14.3% in 2011 to 38.9% in 2016. 74 Australia reported a decrease in azithromycin resistance from 9.3% in 2017 to 3.9% in 2020, finding a single strain with high-level resistance (MIC ≥256 mg/L), 75 although the USA reported 5.1% of isolates with an elevated MIC to azithromycin. 76 In Europe, the resistance found was 7.6% (MIC >1 mg/L according to EUCAST) in 2018, and five strains had a MIC ≥256 mg/L.…”

Australian Gonococcal Surveillance Programme Annual Report, 2021

“…In addition, many NNN laboratories are testing gentamicin; these data were reported in the AGSP for the first time in 2020, and this reporting continues in 2021. 19 Antimicrobial susceptibility testing is performed using standardised methodology to determine the minimum inhibitory concentration (MIC) value, the lowest antibiotic concentration that…”