Common Patterns and Unique Threats in Antimicrobial Resistance as Demonstrated by Global Gonococcal Surveillance

Abstract

The rapid emergence of antimicrobial-resistant strains of Neisseria gonorrhoeae threatens treatment options and control efforts. The Uniformed Services University Gonococcal Reference Laboratory and Repository of the Global Emerging Infections Surveillance Program receives isolates from several geographically distinct regions worldwide. We analyzed 962 isolates collected during 2014-2022 for genomic and phenotypic antimicrobial resistance. Resistance to antimicrobial drugs previously used for gonococcal infections was high, but of most concern were increases of resistance to currently used antibiotic drugs, such as extended-spectrum cephalosporins and the alternative antibiotic treatment gentamicin. The percentage of isolates with reduced susceptibility to ceftriaxone was 3.6%, to cefixime was 2.5%, and to gentamicin was 15.0%. Although isolates were collected from populations of limited diversity, 706 (73.4%) of isolates demonstrated novel multiantigen sequence types, and 225 (23.4%) had novel multilocus sequence types. Continued surveillance of N. gonorrhoeae is essential to monitoring the prevalence and spread of resistant organisms worldwide.

Keywords: GEIS; Global Emerging Infections Surveillance; Neisseria gonorrhoeae; United States; antibiotic resistance; antimicrobial resistance; bacteria; global; gonococci; gonorrhea; sexually transmitted infections; surveillance.

Figure 1

Distribution of most prevalent NG-MAST, MLST, and NG-STAR schemes in Global Emerging Infections Surveillance isolates of Neisseria gonorrhoeae received at Uniformed Services University, Bethesda, Maryland, USA, from sites outside the United States (n = 962) in study of common patterns and unique threats in antimicrobial resistance as demonstrated by global gonococcal surveillance. A) Percentage of isolates assigned to the most common NG-MAST types in each region. B) Percentage of isolates assigned to the most common MLST types in each region. C) Percentage of isolates assigned to the most common NG-STAR types in each region. MLST, multilocus sequence typing; NG-MAST, N. gonorrhoeae multiantigen sequence typing; NG-STAR, N. gonorrhoeae sequence typing for antimicrobial resistance.

Figure 2

Minimum-spanning tree showing genome-based genetic relatedness of all N. gonorrhoeae isolates received at Uniformed Services University (n = 1,044), Bethesda, Maryland, USA, in study of common patterns and unique threats in antimicrobial resistance as demonstrated by global gonococcal surveillance. Tree was generated using core genome multilocus sequence typing. Each circle represents >1 isolates; isolates with 1–10 allelic differences are emphasized by gray shading around the lines and are considered highly genetically related with suspicion of nosocomial origin. Isolates are colored corresponding to their country of origin. Possible clonal isolates are shown with black arrows.