Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Feb 7;45(2-3):45-53.
doi: 10.14745/ccdr.v45i23a01.

Multidrug-resistant and extensively drug-resistant Neisseria gonorrhoeae in Canada, 2012-2016

I Martin  1 , P Sawatzky  1 , V Allen  2 , B Lefebvre  3 , Lmn Hoang  4 , P Naidu  5 , J Minion  6 , P Van Caeseele  7 , D Haldane  8 , R R Gad  9 , G Zahariadis  10 , A Corriveau  11 , G German  12 , K Tomas  13 , M R Mulvey  1
Affiliations

Multidrug-resistant and extensively drug-resistant Neisseria gonorrhoeae in Canada, 2012-2016

I Martin et al. Can Commun Dis Rep. .

Abstract

Background: Neisseria gonorrhoeae have acquired resistance to many antimicrobials, including third generation cephalosporins and azithromycin, which are the current gonococcal combination therapy recommended by the Canadian Guidelines on Sexually Transmitted Infections.

Objective: To describe antimicrobial susceptibilities for N. gonorrhoeae circulating in Canada between 2012 and 2016.

Methods: Antimicrobial resistance profiles were determined using agar dilution of N. gonorrhoeae isolated in Canada 2012-2016 (n=10,167) following Clinical Laboratory Standards Institute guidelines. Data were analyzed by applying multidrug-resistant gonococci (MDR-GC) and extensively drug-resistant gonococci (XDR-GC) definitions.

Results: Between 2012 and 2016, the proportion of MDR-GC increased from 6.2% to 8.9% and a total of 19 cases of XDR-GC were identified in Canada (0.1%, 19/18,768). The proportion of isolates with decreased susceptibility to cephalosporins declined between 2012 and 2016 from 5.9% to 2.0% while azithromycin resistance increased from 0.8% to 7.2% in the same period.

Conclusion: While XDR-GC are currently rare in Canada, MDR-GC have increased over the last five years. Azithromycin resistance in N. gonorrhoeae is established and spreading in Canada, exceeding the 5% level at which the World Health Organization states an antimicrobial should be reviewed as an appropriate treatment. Continued surveillance of antimicrobial susceptibilities of N. gonorrhoeae is necessary to inform treatment guidelines and mitigate the impact of resistant gonorrhea.

Keywords: N. gonorrhoeae multidrug resistant; Neisseria gonorrhoeae; antimicrobial resistance; laboratory surveillance.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: None.

Figures

Figure 1
Figure 1. Multidrug-resistant and extensively drug-resistant Neisseria gonorrhoeae isolates in Canada, 2012–2016a
Abbreviations: MDR, multidrug-resistant gonococci; n, number; N, total number; XDR, extensively drug-resistant gonococci a Percentages are based on the total number of isolates tested nationally per year
Figure 2
Figure 2. Provincial distribution of multidrug-resistant gonococci by year, 2012–2016a
Abbreviation: n, number a Percentages are based on the total number of multidrug-resistant gonococci identified each year
Figure 3
Figure 3. Proportion of multidrug-resistant gonococci in each province from 2012 to 2016a
a Percentages are based on the total number of cultures in each province
Figure 4
Figure 4. Trends of antimicrobials associated with multidrug-resistant gonococci, 2012–2016a
Abbreviations: AziR, azithromycin resistant; CeDS, decreased susceptibility to cefixime; CeDS/CxDS, decreased susceptibility to cefixime and ceftriaxone; CxDS, decreased susceptibility to ceftriaxone; n, number a Percentages based on total number of multidrug-resistant gonococci per year
Figure 5
Figure 5. Trends of multidrug-resistant gonococci with resistance to two, three or four additional antimicrobialsa
Abbreviations: n, number; plus 2, multidrug-resistant gonococci with resistance to two antimicrobials not recommended for therapy; plus 3, multidrug-resistant gonococci with resistance to three antimicrobials not recommended for therapy; plus 4, multidrug-resistant gonococci with resistance to four antimicrobials not recommended for therapy a Percentages based on total number of multidrug-resistant gonococci per year
Figure 6
Figure 6. Decreased susceptibility to cefixime and ceftriaxone and resistance to azithromycin for Neisseria gonorrhoeae isolates in Canada, 2012–2016a
Abbreviations: mg/L, milligrams per litre; N, total number; ≥, superior or equal to a Percentage based on total number of isolates tested nationally
See this image and copyright information in PMC

References

    1. Public Health Agency of Canada. Reported cases from 1991 to 2016 in Canada - Notifiable diseases on-line. Ottawa (ON): Government of Canada; 2017. http://diseases.canada.ca/notifiable/charts?c=yl
    1. Bodie M, Gale-Rowe M, Alexandre S, Auguste U, Tomas K, Martin I. There’s no time like the present: prevention and control of the spread of antimicrobial resistant Gonorrhea. Can Commun Dis Rep 2019;45(2/3):54–62. 10.14745/ccdr.v45i23a02 - DOI - PMC - PubMed
    1. Newman L, Rowley J, Vander Hoorn S, Wijesooriya NS, Unemo M, Low N, Stevens G, Gottlieb S, Kiarie J, Temmerman M. Global estimates of the prevalence and incidence of four curable sexually transmitted infections in 2012 based on systematic review and global reporting. PLoS One 2015. Dec;10(12):e0143304. .10.1371/journal.pone.0143304 - DOI - PMC - PubMed
    1. Hook EW 3rd, Kirkcaldy RD. A brief history of evolving diagnostics and therapy for gonorrhea: lessons learned. Clin Infect Dis 2018. Sep;67(8):1294–9. .10.1093/cid/ciy271 - DOI - PMC - PubMed
    1. Public Health Agency of Canada. National Surveillance of Antimicrobial Susceptibilities of Neisseria gonorrhoeae in Canada - Annual Summary 2016. Ottawa (ON): Government of Canada; 2018. https://www.canada.ca/en/public-health/services/publications/drugs-healt...