Neisseria gonorrhoeae antimicrobial resistance in Spain: a prospective multicentre study

Abstract

Objectives Gonococcal infection is one of the most reported sexually transmitted infections and antimicrobial resistance in Neisseria gonorrhoeae (NG) is challenging for the treatment of this infection. This observational study aimed to describe antimicrobial resistance of NG and epidemiological data from patients with gonococcal infection in eight regions of Spain, for updating the local therapeutic guidelines. Methods MICs of penicillin, cefixime, ceftriaxone, azithromycin, ciprofloxacin, fosfomycin and gentamicin were determined by Etest for all NG isolates recovered from 1 April 2018 to 30 September 2019 from 10 hospitals in Spain. Resistance determinants were identified using logistic regression analysis. Differences with a P value <0.05 were considered statistically significant. Results Antimicrobial susceptibility testing was performed for 2571 gonococci isolated from 2429 patients. 44.5% (945/2124) of patients were MSM. The resistance rate to extended-spectrum cephalosporins was low, with 0.2% (6/2561) of isolates resistant to ceftriaxone and 1.7% (44/2517) of isolates resistant to cefixime. The overall azithromycin resistance rate was 12.1% (310/2560), but differed greatly depending on the area. 56.2% (1366/2429) of the strains studied were ciprofloxacin resistant. MIC50 and MIC90 values of gentamicin and fosfomycin were 4 and 8 mg/L and 24 and 48 mg/L, respectively. Conclusions Our study shows that NG susceptibility to extended-spectrum cephalosporins remains high in Spain. The azithromycin resistance rate questions the suitability of dual therapy. This study provides data of interest for updating the national treatment guidelines and highlights the need to develop and implement a national sentinel gonococcal antimicrobial susceptibility programme.

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

“…Dual therapy was introduced to mitigate a possible development of resistances, especially against ceftriaxone, and to target possible co-infections with Chlamydia trachomatis and Mycoplasma genitalium [9]. According to our current observations and data described by others, we may not be fully able to rely on azithromycin as a therapeutic agent for the treatment of gonorrhoea [4,10,11]. Antimicrobial susceptibility testing of all isolates in clinical practice and follow-up of the patients including test of cure are highly recommended and indispensable in particular for cases where monotherapeutic treatment with ceftriaxone is applied in accordance with the currently valid German guideline.…”

Genome‐based epidemiology and antimicrobial resistance of Neisseria gonorrhoeae in Spain: A prospective multicentre study

“…The relationship between antimicrobial resistance and the sexual behaviour of the patients was reported by Salmerón et al 42 in a study describing the susceptibility of NG in Spain. These authors observed that cefixime and azithromycin resistance was less frequent in MSM while, on the contrary, ciprofloxacin resistance was significantly associated with MSM patients.…”

Mycoplasma genitalium and sexually transmitted infections: evidences and figures in a tertiary hospital

“…In the study of Salmeron et al [ 5 ], a prospective multicentre study in ten hospitals in Spain (including ours), only 49% of gonococcal infections had a positive culture available for antimicrobial susceptibility testing. Azithromycin resistance was found in 12% and high-level resistance (MIC>256 mg/L) was detected in 0.1% of all cases.…”