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. 2018 Feb 6;15(2):e1002499.
doi: 10.1371/journal.pmed.1002499. eCollection 2018 Feb.

Susceptibility of Neisseria gonorrhoeae to azithromycin and ceftriaxone in China: A retrospective study of national surveillance data from 2013 to 2016

Yue-Ping Yin  1   2 , Yan Han  1   2 , Xiu-Qin Dai  1   2 , He-Ping Zheng  3   4 , Shao-Chun Chen  1   2 , Bang-Yong Zhu  5 , Gang Yong  6 , Na Zhong  7 , Li-Hua Hu  8 , Wen-Ling Cao  9 , Zhong-Jie Zheng  10 , Feng Wang  11 , Qi Zhi  12 , Xiao-Yu Zhu  1   2 , Xiang-Sheng Chen  1   2
Affiliations

Susceptibility of Neisseria gonorrhoeae to azithromycin and ceftriaxone in China: A retrospective study of national surveillance data from 2013 to 2016

Yue-Ping Yin et al. PLoS Med. .

Abstract

Background: Gonorrhea remains one of the most common sexually transmitted diseases worldwide. Successful treatment has been hampered by emerging resistance to each of the antibiotics recommended as first-line therapies. We retrospectively analyzed the susceptibility of gonorrhea to azithromycin and ceftriaxone using data from the China Gonococcal Resistance Surveillance Programme (China-GRSP) in order to provide evidence for updating the treatment recommendations in China.

Methods and findings: In this study, we included 3,849 isolates collected from patients with a confirmed positive Neisseria gonorrhoeae (N. gonorrhoeae) culture at clinic visits during the period of 1 January 2013 through 31 December 2016 in 7 provinces. Antimicrobial susceptibility testing of gonorrhea isolates using agar dilution was conducted to determine minimum inhibitory concentration (MIC). Resistance to azithromycin (RTA) was defined as MIC ≥ 1.0 mg/l, and decreased susceptibility to ceftriaxone (DSC) was defined as MIC ≥ 0.125 mg/l. The prevalence of isolates with RTA was 18.6% (710/3,827; 95% CI 17.4%-19.8%). The percentage of patients with DSC fluctuated between 9.7% and 12.2% over this period. The overall prevalence of isolates with both RTA and DSC was 2.3% (87/3,827; 95% CI 1.9%-2.8%) and it increased from 1.9% in 2013 to 3.3% in 2016 (chi-squared test for trend, P = 0.03). Study limitations include the retrospective study design and potential biases in the sample, which may overrepresent men with symptomatic infection, coastal residents, and people reporting as heterosexual.

Conclusions: To our knowledge, this is the first national study on susceptibility of N. gonorrhoeae to azithromycin and ceftriaxone in China. Our findings indicate high rates of RTA and DSC from 2013 to 2016. Although dual therapy with azithromycin and ceftriaxone has been recommended by WHO and many countries to treat gonorrhea, reevaluation of this therapy is needed prior to its introduction in China.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Geographic locations of the provinces where N. gonorrhoeae isolates were collected from patients.
The number of isolates from each province is given in parentheses.
Fig 2
Fig 2. Proportion of N. gonorrhoeae isolates with different minimum inhibitory concentrations (mg/l) for azithromycin, by year.
Fig 3
Fig 3. Proportion of N. gonorrhoeae isolates with different minimum inhibitory concentrations (mg/l) for ceftriaxone, by year.
Fig 4
Fig 4. Proportion of N. gonorrhoeae isolates with resistance to azithromycin (MIC ≥ 1.0 mg/l) and decreased susceptibility to ceftriaxone (MIC ≥ 0.125 mg/l) from 2013 to 2016.
MIC, minimum inhibitory concentration.
See this image and copyright information in PMC

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