Sharp increase in ciprofloxacin resistance of Neisseria gonorrhoeae in Yaounde, Cameroon: analyses of a laboratory database period 2012–2018

Abstract

A previous study conducted in Yaoundé, Cameroon, showed a significant increase in ciprofloxacin-resistant Neisseria gonorrhoeae. Still, ciprofloxacin is the recommended first-line medication for gonorrhoea in Cameroon. We aimed to provide further evidence of increasing resistance of N. gonorrhoeae to ciprofloxacin. We conducted a retrospective study (2012–2018) and retrieved coded patient and specimen real-world data from the Centre Pasteur du Cameroun’s laboratory information system and laboratory worksheets. We included disc diffusion method results for tetracycline, azithromycin, and spectinomycin, and minimal inhibitory concentrations obtained by E-test for ciprofloxacin, ceftriaxone, and benzylpenicillin. A total of 449 N. gonorrhoeae were isolated; a higher proportion of them presented resistance to ciprofloxacin (64.4%), benzylpenicillin (80.1%), and tetracycline (58.4%). The resistance to ciprofloxacin increased significantly (p < 0.0001) from 15.0% in 2012 to 79.5% in 2018. Since 2016 a significant decrease (p = 0.002) in resistance to benzylpenicillin occurred and the resistance to tetracycline remained stable. The level of resistance to ceftriaxone (1.8%), azithromycin (2.1%), and spectinomycin (2.0%) was low. Our study confirms that ciprofloxacin is not recommended as a first-line treatment for gonorrhoea. It also illustrates the urgent need to establish a robust and sustainable gonococcal antimicrobial surveillance programme to guide national treatment guidelines in order to control gonorrhoea in Cameroon.

Antimicrobial Susceptibility Profile ofNeisseria gonorrhoeaefrom Patients Attending a Medical Laboratory, Institut Pasteur de Madagascar between 2014-2020: Phenotypic and Genomic characterization in a Subset ofNeisseria gonorrhoeaeIsolates

“…The almost complete resistance of N. gonorrhoeae against CIP did not come as a surprise and agrees with reports from other African countries (27,28). The reduced susceptibility to CRO may have jeopardized the treatment of gonorrhoea.…”

Prevalence and Risk Factors of Penicillinase-Type <i>β</i>-Lactamase Producing <i>Neisseria gonorrhoeae</i> Isolated from Patients Attending Health-Facilities in Yaounde, Cameroon

“…Moreover, another study conducted in Cameroon from 2012 to 2018 showed high proportions of resistant N. gonorrhoeae to ciprofloxacin (64.4%) [18]. The resistance to ciprofloxacin in this latter study had increased significantly from 15% in 2012 to 79.5% in 2018 [18].…”

“…More recently, isolates of Neisseria gonorrhoeae resistant to several antibiotics have been identified and included penicillin, azithromycin, ciprofloxacine and extended spectrum cephalosporins, such as ceftriaxone and cefixime [17]. Moreover, another study conducted in Cameroon from 2012 to 2018 showed high proportions of resistant N. gonorrhoeae to ciprofloxacin (64.4%) [18]. The resistance to ciprofloxacin in this latter study had increased significantly from 15% in 2012 to 79.5% in 2018 [18].…”

Phenotypic and genotypic characterization of Neisseria gonorrhoeae isolates from Yaoundé, Cameroon, 2019 to 2020

“…For example, in Vietnam in 2019, 98.3% of studied strains ( n =409) were resistant to ciprofloxacin [8], with the prevalence of gonococci resistant to ciprofloxacin remaining high in the USA [9]. A high prevalence of resistance to penicillin, tetracycline and ciprofloxacin has also been described in South Africa in 2018 [10] with similar patterns observed in Cameroon [11, 12].…”