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Stably high azithromycin resistance and decreasing ceftriaxone susceptibility in Neisseria gonorrhoeae in 25 European countries, 2016
National Infection Service, Public Health England, London, UK.
European Centre for Disease Prevention and Control, Stockholm, Sweden.
Örebro University, School of Medical Sciences. Örebro University Hospital. WHO Collaborating Centre for Gonorrhea and other STIs.
National Infection Service, Public Health England, London, UK.
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Number of Authors: 582018 (English)In: BMC Infectious Diseases, ISSN 1471-2334, E-ISSN 1471-2334, Vol. 18, no 1, article id 609Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP) performs annual sentinel surveillance of Neisseria gonorrhoeae susceptibility to therapeutically relevant antimicrobials across the European Union/European Economic Area (EU/EEA). We present the Euro-GASP results from 2016 (25 countries), linked to patient epidemiological data, and compared with data from previous years.

METHODS: Agar dilution and minimum inhibitory concentration (MIC) gradient strip methodologies were used to determine the antimicrobial susceptibility (using EUCAST breakpoints) of 2660 N. gonorrhoeae isolates from 25 countries across the EU/EEA. Significance of differences compared with Euro-GASP results in previous years was analysed using Z-tests.

RESULTS: No isolates with resistance to ceftriaxone (MIC > 0.125 mg/L) were detected in 2016 (one in 2015). However, the proportion of isolates with decreased susceptibility to ceftriaxone (MICs from 0.03 mg/L to 0.125 mg/L) increased significantly (p = 0.01) from 2015 to 2016. There were 14 (0.5%) isolates with ceftriaxone MICs 0.125 mg/L (on the resistance breakpoint), of which one isolate was resistant to azithromycin and four showed intermediate susceptibility to azithromycin. Cefixime resistance was detected in 2.1% of isolates in 2016 compared with 1.7% in 2015 (p = 0.26) and azithromycin resistance in 7.5% in 2016 compared with 7.1% in 2015 (p = 0.74). Seven (0.3%) isolates from five countries displayed high-level azithromycin resistance (MIC≥256 mg/L) in 2016 compared with five (0.2%) isolates in 2015. Resistance rate to ciprofloxacin was 46.5% compared with 49.4% in 2015 (p = 0.06). No isolates were resistant to spectinomycin and the MICs of gentamicin remained stable compared with previous years.

CONCLUSIONS: Overall AMR rates in gonococci in EU/EEA remained stable from 2015 to 2016. However, the ceftriaxone MIC distribution shifted away from the most susceptible (≤0.016 mg/L) and the proportion of isolates with decreased susceptibility to ceftriaxone increased significantly. This development is of concern as current European gonorrhoea management guideline recommends ceftriaxone 500 mg plus azithromycin 2 g as first-line therapy. With azithromycin resistance at 7.5%, the increasing ceftriaxone MICs might soon threaten the effectiveness of this therapeutic regimen and requires close monitoring.

Place, publisher, year, edition, pages
BioMed Central, 2018. Vol. 18, no 1, article id 609
Keywords [en]
Antimicrobial resistance, Azithromycin, Ceftriaxone, Europe, European Economic Area (EEA), European Union (EU), European gonococcal antimicrobial surveillance Programme (Euro-GASP), Gonorrhoea, Surveillance, Treatment
National Category
Biochemistry and Molecular Biology Infectious Medicine
Identifiers
URN: urn:nbn:se:oru:diva-70516DOI: 10.1186/s12879-018-3528-4ISI: 000451979600006PubMedID: 30509194Scopus ID: 2-s2.0-85057607331OAI: oai:DiVA.org:oru-70516DiVA, id: diva2:1268416
Note

Funding Agency:

European Centre for Disease Prevention and Control  ECDC/2013/015

Available from: 2018-12-05 Created: 2018-12-05 Last updated: 2019-01-07Bibliographically approved

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Jacobsson, SusanneUnemo, Magnus

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