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. 2018 Dec 3;18(1):609.
doi: 10.1186/s12879-018-3528-4.

Stably high azithromycin resistance and decreasing ceftriaxone susceptibility in Neisseria gonorrhoeae in 25 European countries, 2016

Michaela J Day  1 , Gianfranco Spiteri  2 , Susanne Jacobsson  3 , Neil Woodford  4 , Andrew J Amato-Gauci  2 , Michelle J Cole  4 , Magnus Unemo  3 ; Euro-GASP network
Collaborators, Affiliations

Stably high azithromycin resistance and decreasing ceftriaxone susceptibility in Neisseria gonorrhoeae in 25 European countries, 2016

Michaela J Day et al. BMC Infect Dis. .

Erratum in

Abstract

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.

Keywords: Antimicrobial resistance; Azithromycin; Ceftriaxone; Europe; European Economic Area (EEA); European Union (EU); European gonococcal antimicrobial surveillance Programme (Euro-GASP); Gonorrhoea; Surveillance; Treatment.

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Conflict of interest statement

Ethics approval and consent to participate

All examined gonococcal isolates were cultured and preserved as part of the routine diagnostics (standard care), and isolates or data were submitted to the Euro-GASP surveillance study with no patient identification information. Ethical approval was therefore not required.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Trends in resistant Neisseria gonorrhoeae isolates by antimicrobial and year, Euro-GASP, 2009–2016. Percentage of resistant isolates on logarithmic scale on y-axis. Number of ceftriaxone resistant isolates; 2009 and 2010 n = 0, 2011 n = 10, 2012 n = 3, 2013 n = 7, 2014 n = 5, 2015 n = 1, and 2016 n = 0
Fig. 2
Fig. 2
Azithromycin MIC distribution in Euro-GASP, 2011–2016
Fig. 3
Fig. 3
Ceftriaxone MIC distribution in Euro-GASP, 2009–2016
See this image and copyright information in PMC

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