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. 2022 Jul 5;4(4):dlac076.
doi: 10.1093/jacamr/dlac076. eCollection 2022 Aug.

National surveillance of Neisseria gonorrhoeae antimicrobial susceptibility and epidemiological data of gonorrhoea patients across Brazil, 2018-20

Hanalydia de Melo Machado  1 , Jéssica Motta Martins  1 , Marcos André Schörner  1 , Pamela Cristina Gaspar  2 , Alisson Bigolin  2 , Mauro Cunha Ramos  3 , Willian Antunes Ferreira  4 , Gerson Fernando Mendes Pereira  2 , Angélica Espinosa Miranda  2 , Magnus Unemo  5 , Maria Luiza Bazzo  1 ; Brazilian-GASP Network
Collaborators, Affiliations

National surveillance of Neisseria gonorrhoeae antimicrobial susceptibility and epidemiological data of gonorrhoea patients across Brazil, 2018-20

Hanalydia de Melo Machado et al. JAC Antimicrob Resist. .

Abstract

Objectives: To (i) describe the nationwide antimicrobial susceptibility of Neisseria gonorrhoeae (NG) isolates cultured across Brazil in 2018-20 and compare it with NG antimicrobial resistance data from 2015-16, and (ii) present epidemiological data of the corresponding gonorrhoea patients in 2018-20.

Methods: Twelve representative sentinel sites cultured NG isolates from men with urethral discharge. Susceptibility to eight antimicrobials was examined using agar dilution method, according to WHO standards. The consenting participants were invited to provide epidemiological data.

Results: In total, 633 NG isolates (one isolate per participant) were analysed, and 449 (70.9%) questionnaires were answered. Heterosexual (68.2%) and homosexual (23.1%) sexual orientations were common, and most prevalent types of unprotected sexual intercourse were vaginal insertive (69.9%), oral giving (56.6%) and anal insertive (47.4%). The levels of in vitro NG resistance to ciprofloxacin, tetracycline, benzylpenicillin, azithromycin, cefixime, gentamicin, spectinomycin and ceftriaxone were 67.3%, 40.0%, 25.7%, 10.6%, 0.3%, 0%, 0% and 0%, respectively. Compliance with the recommended first-line ceftriaxone 500 mg plus azithromycin 1 g therapy was high (90.9%).

Conclusions: Compared with 2015-16, ciprofloxacin resistance has remained high and azithromycin and cefixime resistance rates have increased in Brazil. Resistance remained lacking to ceftriaxone, gentamicin and spectinomycin, which all are gonorrhoea treatment options. The increasing azithromycin resistance in Brazil and internationally may threaten the future use of azithromycin in dual regimens for treatment of gonorrhoea. Consequently, continued and enhanced quality-assured surveillance of gonococcal AMR, and ideally also treatment failures and including WGS, is imperative in Brazil and worldwide.

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Figures

Figure 1.
Figure 1.
MIC distributions for azithromycin, cefixime, ceftriaxone and gentamicin in N. gonorrhoeae isolates collected across Brazil in 2018–20.
See this image and copyright information in PMC

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