Abstract
Non-pathogenic Neisseria are a reservoir of antimicrobial resistance genes for pathogenic Neisseria meningitidis and Neisseria gonorrhoeae. Men who have sex with men (MSM) are at risk of co-colonization with resistant non-pathogenic and pathogenic Neisseria. We assessed if the antimicrobial susceptibility of non-pathogenic Neisseria among MSM differs from a general population and if antimicrobial exposure impacts susceptibility. We recruited 96 participants at our center in Belgium: 32 employees, 32 MSM who did not use antibiotics in the previous 6 months, and 32 MSM who did. Oropharyngeal Neisseria were cultured and identified with MALDI-TOF–MS. Minimum inhibitory concentrations for azithromycin, ceftriaxone and ciprofloxacin were determined using E-tests® and compared between groups with non-parametric tests. Non-pathogenic Neisseria from employees as well as MSM were remarkably resistant. Those from MSM were significantly less susceptible than employees to azithromycin and ciprofloxacin (p < 0.0001, p < 0.001), but not ceftriaxone (p = 0.3). Susceptibility did not differ significantly according to recent antimicrobial exposure in MSM. Surveilling antimicrobial susceptibility of non-pathogenic Neisseria may be a sensitive way to assess impact of antimicrobial exposure in a population. The high levels of antimicrobial resistance in this survey indicate that novel resistance determinants may be readily available for future transfer from non-pathogenic to pathogenic Neisseria.
Highlights
Neisseria gonorrhoeae and N. meningitidis are becoming increasingly resistant to antimicrobials
We found that contemporary oropharyngeal non-pathogenic Neisseria in men who have sex with men (MSM) were less susceptible to antimicrobials than those from employees representing the general population
Recent antimicrobial exposure did not entirely explain the observed differences in susceptibility. This suggests that long-term participant- or populationlevel antimicrobial exposure plays an important role[29]
Summary
Neisseria gonorrhoeae and N. meningitidis are becoming increasingly resistant to antimicrobials. Two other studies were surveys among men who have sex with men (MSM) visiting a sexual health clinic in Vietnam in 2016 and Belgium in 20198,16,17 Both reported reduced susceptibility of non-pathogenic Neisseria to the antimicrobials currently used to treat gonorrhoea—azithromycin, and ceftriaxone. MSM are often co-colonised by N. meningitidis and N. gonorrhoeae in their pharynx[21,22,23,24,25,26] Beyond these studies, very little is known about the epidemiology of antimicrobial susceptibilities in nonpathogenic Neisseria. Little is known about their susceptibility in contemporary general adult populations It is not even known if the non-pathogenic Neisseria are more or less resistant in MSM than the general population and how MICs vary in relation to recent antimicrobial consumption
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