Gonococcal antimicrobial resistance: challenges for public health control

Ndowa, Francis; Ison, Catherine; Cole, Michelle; Narasimhan, Manjulaa

doi:10.1136/sextrans-2013-051395

Cited by 5 publications

(3 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Antimicrobial treatment is essential to control this infectious disease. However, antimicrobial resistance (AMR) in N. gonorrhoeae is emerging as a significant public health problem worldwide [ 4 ],[ 5 ]. In most areas of the world, N. gonorrhoeae has developed resistance to sulfonamides, penicillins, tetracyclines, macrolides and fluoroquinolones [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Twenty-five-year changing pattern of gonococcal antimicrobial susceptibility in Shanghai: surveillance and its impact on treatment guidelines

Chen

Yang

et al. 2014

BMC Infect Dis

View full text Add to dashboard Cite

BackgroundAntimicrobial resistance of Neisseria gonorrhoeae is a serious health problem in China. Gonococcal antimicrobial susceptibility has been monitored in Shanghai since 1988. In this study, we examined the changing pattern of gonococcal antimicrobial susceptibility based on data from N. gonorrhoeae isolates collected over the past 25 years.MethodsApproximately 100–200 isolates each year (1988–2013) were tested for their susceptibility to penicillin (PEN), tetracycline (TET), ciprofloxacin (CIP), ceftriaxone (CRO) and spectinomycin (SPT), using the agar dilution method. Plasmid-mediated N. gonorrhoeae antimicrobial resistance, comprising penicillinase-producing N. gonorrhoeae (presumed PPNG) and high-level tetracycline resistance N. gonorrhoeae (presumed TRNG), were also determined. Breakpoints for susceptibilities followed those described by the Clinical and Laboratory Standard Institute and the European Committee on Antimicrobial Susceptibility Testing.ResultsA high proportion of isolates were resistant to PEN, TET and CIP, ranging from less than 20% at the beginning of the survey, increasing in the late 1990s and reaching over 90% in recent years. The proportion of isolates exhibiting plasmid-mediated resistance exceeded 38% for presumed PPNG and 20% for presumed TRNG in recent years. The proportion of CRO nonsusceptible isolates (MIC ≥ 0.125 mg/L) ranged from 7% to 13% in most of the study years. Almost all isolates were susceptible to SPT. The SPT MIC90 was 16–32 mg/L for 2008–2013. The proportion of CRO nonsusceptible-associated multiple-drug-resistant (MDR) isolates was over 5% in most of the study years.ConclusionsN. gonorrhoeae isolates in Shanghai were resistant to PEN, TET and CIP. Furthermore, CRO nonsusceptible and MDR isolates were prevalent. N. gonorrhoeae isolates were also found to be susceptible to SPT. It is recommended that the CRO dose be increased from currently recommended 250 mg to 500 mg and that SPT be an alternative in treating urogenital gonorrhea. Our findings highlight the importance of both regional and national surveillance programs for the prompt modification of treatment guidelines, vital in responding to the changing pattern of gonococcal antimicrobial susceptibility.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0731-9) contains supplementary material, which is available to authorized users.

show abstract

Section: Introductionmentioning

confidence: 99%

Twenty-five-year changing pattern of gonococcal antimicrobial susceptibility in Shanghai: surveillance and its impact on treatment guidelines

Chen

Yang

et al. 2014

BMC Infect Dis

View full text Add to dashboard Cite

show abstract

“…National and international surveillance of N. gonorrhoeae AMR (including collection of appropriate associated epidemiologic metadata), treatment failures and ideally also antimicrobial use/misuse, as well as implementation of recommended dual antimicrobial treatment regimens (ceftriaxone plus azithromycin) needs to be maintained and in several areas further strengthened to provide more reliable evidence for policy makers and to inform antibiotic prescription protocols. The work outlined in the European [ 24 ] and additional response plans [ 21 – 23 ] needs to be further implemented, and a close collaboration between the Euro-GASP and additional GASPs internationally [ 41 ] in liaison with the WHO Global GASP is crucial. The number of cases of gonorrhoea reported to the ECDC has been increasing annually since 2008; 52,995 cases were reported in 2013, which is an 11 % increase from the previous year (47,641 cases in 2012) [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Is the tide turning again for cephalosporin resistance in Neisseria gonorrhoeae in Europe? Results from the 2013 European surveillance

et al. 2015

View full text Add to dashboard Cite

BackgroundThe emerging resistance to the extended-spectrum cephalosporins (ESCs) in Neisseria gonorrhoeae together with increasing incidence of gonorrhoea cases in many countries have been global public health concerns. However, in recent years the levels of ESC resistance have decreased in several regions worldwide. We describe the European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP) data from 2013, and compare them to corresponding data from 2009–2012.MethodsDuring 2013, N. gonorrhoeae isolates from 21 participating countries were examined. Antimicrobial susceptibility testing (Etest or agar dilution) was performed for cefixime, ceftriaxone, ciprofloxacin, azithromycin, spectinomycin and gentamicin. Statistical analyses were performed to identify significant changes in resistance between years and to investigate associations between patients with resistant gonococcal isolates and collected epidemiological variables.ResultsIn total, 93 (4.7 %) of 1994 isolates displayed resistance to cefixime, representing an increase compared to the 3.9 % detected in 2012 (p = 0.23). Cefixime resistance was detected in 13 (61.9 %) of the 21 countries. Cefixime resistance among men who have sex with men was only 1.2 %, compared to 5.6 % and 6.1 % in females and male heterosexuals, respectively. The univariate analysis confirmed that isolates resistant to cefixime were more likely to be from females (OR 4.87, p < 0.01) or male heterosexuals (OR 5.32, p < 0.01). Seven (0.4 %) isolates displayed ceftriaxone resistance (in addition to cefixime resistance) compared to three and 10 isolates in 2012 and 2011, respectively. All 93 isolates with cefixime resistance were additionally resistant to ciprofloxacin and 16 (17.2 %) were also resistant to azithromycin. Among all tested isolates (n = 1994), the ciprofloxacin resistance level (52.9 %) was higher than in 2012 (50.1 %; p = 0.08), and azithromycin resistance (5.4 %) increased since 2012 (4.5 %; p = 0.16).ConclusionsIn 2013, the ESC resistance was again slightly increasing in Europe. This emphasises the importance of implementing the actions outlined in the European and additional response plans, particularly activities strengthening the surveillance of antimicrobial resistance. Ceftriaxone combined with azithromycin remains a satisfactory option for the first-line treatment of gonorrhoea. However novel antimicrobials (new derivatives of previously developed antimicrobials or newly developed antimicrobials) for effective monotherapy or at least inclusion in new dual antimicrobial therapy regimens (combined with previously developed antimicrobials or novel antimicrobials) will likely be required.

show abstract

“…A disease similar to gonorrhea has been described throughout human history (119). Gonorrhea is still prevalent worldwide today and the rise in antibiotic resistance makes gonorrhea a major public health concern (120). Gonococcal infection usually results in symptomatic disease in men, with an obvious purulent exudate and painful urination; but it is more linked to asymptomatic infections in women, with a less obvious exudate and little or no pain during uncomplicated infection (121,122).…”

Section: Introductionmentioning

confidence: 99%

Antigenic Variation in Bacterial Pathogens

2016

View full text Add to dashboard Cite

Antigenic variation is a strategy used by a broad diversity of microbial pathogens to persist within the mammalian host. Whereas viruses make use of a minimal proofreading capacity combined with large amounts of progeny to use random mutation for variant generation, antigenically variant bacteria have evolved mechanisms which use a stable genome, which aids in protecting the fitness of the progeny. Here, three well-characterized and highly antigenically variant bacterial pathogens are discussed: Anaplasma, Borrelia , and Neisseria . These three pathogens display a variety of mechanisms used to create the structural and antigenic variation needed for immune escape and long-term persistence. Intrahost antigenic variation is the focus; however, the role of these immune escape mechanisms at the population level is also presented.

show abstract

Gonococcal antimicrobial resistance: challenges for public health control

Cited by 5 publications

References 8 publications

Twenty-five-year changing pattern of gonococcal antimicrobial susceptibility in Shanghai: surveillance and its impact on treatment guidelines

Twenty-five-year changing pattern of gonococcal antimicrobial susceptibility in Shanghai: surveillance and its impact on treatment guidelines

Is the tide turning again for cephalosporin resistance in Neisseria gonorrhoeae in Europe? Results from the 2013 European surveillance

Antigenic Variation in Bacterial Pathogens

Contact Info

Product

Resources

About