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. 2023 Jul;42(7):883-893.
doi: 10.1007/s10096-023-04601-0. Epub 2023 May 10.

Epidemiology and antimicrobial resistance profile of Neisseria gonorrhoeae in Catalonia, Spain, 2016-2019

Mercè Herrero  1 , Sonia Broner  2 , Adrià Cruells  2 , Silvia Esteve  2 , Lourdes Ferré  2 , Jacobo Mendioroz  2   3 , Mireia Jané  2   4   5 , Pilar Ciruela  2   4 ; working group at MRSC
Collaborators, Affiliations

Epidemiology and antimicrobial resistance profile of Neisseria gonorrhoeae in Catalonia, Spain, 2016-2019

Mercè Herrero et al. Eur J Clin Microbiol Infect Dis. 2023 Jul.

Abstract

Antimicrobial resistance data for Neisseria gonorrhoeae is globally sparse and resistant strains are emerging in Catalonia. We aim to describe epidemiological and antimicrobial resistance in all patients infected with N. gonorrhoeae during the period from 2016 to 2019, using available antimicrobial susceptibility data. We retrospectively analysed confirmed N. gonorrhoeae cases notified to Catalonia's microbiological reporting system. Antibiotic susceptibility testing (azithromycin, cefixime, ceftriaxone, ciprofloxacin, penicillin, spectinomycin, and tetracycline) was assessed using clinical breakpoints published by the European Committee on Antimicrobial Susceptibility Testing. Incidence rates were calculated and proportions were compared using the χ2 test or Fisher's exact test, and analysed using the Statistical Package for Social Sciences (SPSS 18.0). A total of 14,251 confirmed cases of N. gonorrhoeae were notified. Incidence increased from 30.7 cases/100,000 person-years (p < 0.001) in 2016 to 64.7 in 2019. Culture was available in 6,292 isolates (44.2%), of which 5,377 (85.5%) were resistant to at least one of the antibiotics tested. Azithromycin resistance rose from 6.1% in 2016 to 16% in 2019 (p < 0.001). Only 1.0% (45 cases) were resistant to ceftriaxone. Multidrug-resistant N. gonorrhoeae increased from 0.25% in 2016 to 0.42% in 2019 (p = 0.521). One case presented extensively drug-resistant N. gonorrhoeae. In Catalonia, 10% of the N. gonorrhoeae isolates were resistant to azithromycin in the 2016-2019 period. According to World Health Organization guidelines, resistance above 5% indicates an alert to review treatment guidelines. Antimicrobial susceptibility testing in clinical practice followed by surveillance and interventions are essential to monitor trends and prevent the spread of antimicrobial resistance.

Keywords: Antimicrobial resistance; Azithromycin; Ceftriaxone; Multi-drug resistant; Neisseria gonorrhoeae.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Flowchart for determining index events for inclusion in outcome analyses. Catalonia, Spain, 2016–2019. Abbreviations: ATB, Antibiotic; PCR, Polymerase chain reaction; ESC, extended-spectrum cephalosporins; R, resistant
Fig. 2
Fig. 2
Multidrug-resistant and extensively drug-resistant Neisseria gonorrhoeae. Catalonia, Spain, 2016–2019. Abbreviations: n, number; MDR-NG, multidrug-resistant gonococci; XDR-NG, extensively drug-resistant gonococci. *Percentages based on total number of isolates of ceftriaxone by year (2016: 807 cases; 2017: 1,120 cases; 2018: 1,492 cases; 2019: 1,896 cases)
Fig. 3
Fig. 3
Neisseria gonorrhoeae reinfection episodes since primary infection by sex. Catalonia, Spain, 2016–2019
See this image and copyright information in PMC

References

    1. World Health Organization (2016) WHO Guidelines for the Treatment of Neisseria gonorrhoeae. https://www.who.int/publications/i/item/9789241549691. Accessed 17 Apr 2023 - PubMed
    1. Truong WR, Hidayat L, Bolaris MA, Nguyen L, Yamaki J. The antibiogram: key considerations for its development and utilization. JAC-Antimicrob Resist. 2021;3(2):1–6. doi: 10.1093/jacamr/dlab060. - DOI - PMC - PubMed
    1. Kirkcaldy RD, Weston E, Segurado AC, Hughes G. Epidemiology of gonorrhoea: a global perspective. Sex Health. 2019;16(5):401–411. doi: 10.1071/SH19061. - DOI - PMC - PubMed
    1. Ison CA, Town K, Obi C, Chisholm S, Hughes G, Livermore DM, et al. Decreased susceptibility to cephalosporins among gonococci: data from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) in England and Wales, 2007–2011. Lancet Infect Dis. 2013;13(9):762–768. doi: 10.1016/S1473-3099(13)70143-9. - DOI - PubMed
    1. World Health Organization (2016) WHO Guidelines for the Treatment of Neisseria gonorrhoeae. http://www.ncbi.nlm.nih.gov/pubmed/27512795. Accessed 17 Apr 2023 - PubMed