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Population-level antimicrobial consumption is associated with decreased antimicrobial susceptibility in Neisseria gonorrhoeae in 24 European countries: an ecological analysis
HIV/STI Unit, Institute of Tropical Medicine, Antwerp, Belgium; Division of Infectious Diseases and HIV Medicine, University of Cape Town, Anzio Road, Observatory, South Africa.
Clinical Trials Unit, Institute of Tropical Medicine, Antwerp, Belgium.
European Centre for Disease Prevention and Control, Stockholm, Sweden.
National Infection Service, Public Health England, London, United Kingdom.
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2019 (English)In: Journal of Infectious Diseases, ISSN 0022-1899, E-ISSN 1537-6613, article id jiz153Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVES: There are substantial variations in Neisseria gonorrhoeae susceptibility to antimicrobials between different populations, and the reasons for this are largely unexplored. We aimed to assess if the population level consumption of antimicrobials is a contributory factor.

METHODS: Using antimicrobial susceptibility data from 24 countries in the European Gonococcal Antimicrobial Surveillance Programme and antimicrobial consumption data from the IQVIA MIDAS database, we built mixed effects linear/logistic regression models with country-level cephalosporin, fluoroquinolone and macrolide consumption (standard doses/1000 population/year) as the explanatory variables (from 2009 to 2015) and 1-year lagged ceftriaxone, cefixime, azithromycin and ciprofloxacin geometric mean minimum inhibitory concentrations (MIC) as the outcome variables (2010 to 2016).

RESULTS: Positive correlations were found between the consumption of cephalosporins and geometric mean MIC of ceftriaxone and cefixime (both P's <0.05). Fluoroquinolone consumption was positively associated with the prevalence of resistance to ciprofloxacin (P<0.05).

CONCLUSIONS: Differences in population level consumption of particular antimicrobials may contribute to the variations in the level of antimicrobial resistance in N. gonorrhoeae in different settings. Further interventions to reduce misuse and overuse of antimicrobials in high-consumption populations and core-groups are required.

Place, publisher, year, edition, pages
Oxford University Press, 2019. article id jiz153
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Infectious Medicine
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URN: urn:nbn:se:oru:diva-73660DOI: 10.1093/infdis/jiz153PubMedID: 30957153OAI: oai:DiVA.org:oru-73660DiVA, id: diva2:1304195
Available from: 2019-04-11 Created: 2019-04-11 Last updated: 2019-04-11Bibliographically approved

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Unemo, Magnus

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