Abstract
BackgroundIn Poland, gonorrhoea has been a mandatorily reported infection since 1948, however, the reported incidences are likely underestimated. No antimicrobial resistance (AMR) data for Neisseria gonorrhoeae has been internationally reported in nearly four decades, and data concerning genetic characteristics of N. gonorrhoeae are totally lacking. The aims of this study were to investigate the AMR to previously and currently recommended gonorrhoea treatment options, the main genetic resistance determinant (penA) for extended-spectrum cephalosporins (ESCs), and genotypic distribution of N. gonorrhoeae isolates in Poland in 2010-2012.MethodsN. gonorrhoeae isolates cultured in 2010 (n = 28), 2011 (n = 92) and 2012 (n = 108) in Warsaw and Bialystok, Poland, were examined using antimicrobial susceptibility testing (Etest), pyrosequencing of penA and N. gonorrhoeae multi-antigen sequence typing (NG-MAST).ResultsThe proportions of N. gonorrhoeae isolates showing resistance were as follows: ciprofloxacin 61%, tetracycline 43%, penicillin G 22%, and azithromycin 8.8%. No isolates resistant to ceftriaxone, cefixime or spectinomycin were found. However, the proportion of isolates with an ESC MIC = 0.125 mg/L, i.e. at the resistance breakpoint, increased significantly from none in 2010 to 9.3% and 19% in 2012 for ceftriaxone and cefixime, respectively. Furthermore, 3.1% of the isolates showed multidrug resistance, i.e., resistance to ciprofloxacin, penicillin G, azithromycin, and decreased susceptibility to cefixime (MIC = 0.125 mg/L). Seventy-six isolates (33%) possessed a penA mosaic allele and 14 isolates (6.1%) contained an A501V/T alteration in penicillin-binding protein 2. NG-MAST ST1407 (n = 58, 25% of isolates) was the most prevalent ST, which significantly increased from 2010 (n = 0) to 2012 (n = 46; 43%).ConclusionsIn Poland, the diversified gonococcal population displayed a high resistance to most antimicrobials internationally previously recommended for gonorrhoea treatment and decreasing susceptibility to the currently recommended ESCs. The decreasing susceptibility to ESCs was mostly due to the introduction of the internationally spread multidrug-resistant NG-MAST ST1407 in 2011. It is essential to promptly revise the gonorrhoea treatment guidelines, improve the gonorrhoea laboratory diagnostics, and implement quality assured surveillance of gonococcal AMR (ideally also treatment failures) in Poland.
Highlights
In Poland, gonorrhoea has been a mandatorily reported infection since 1948, the reported incidences are likely underestimated
In 2011, 39 179 gonorrhoea cases were reported from 28 European Union (EU)/European Economic Area (EEA) countries, with an overall incidence of 12.6 cases per 100,000 population [2]
The World Health Organization (WHO) [20], European Centre for Disease Prevention and Control (ECDC) [21] and Centers for Disease Control and Prevention (CDC), USA [22] have published action/response plans to mitigate the spread of multidrug-resistant gonorrhoea
Summary
In Poland, gonorrhoea has been a mandatorily reported infection since 1948, the reported incidences are likely underestimated. The aims of this study were to investigate the AMR to previously and currently recommended gonorrhoea treatment options, the main genetic resistance determinant (penA) for extended-spectrum cephalosporins (ESCs), and genotypic distribution of N. gonorrhoeae isolates in Poland in 2010-2012. N. gonorrhoeae has developed antimicrobial resistance (AMR) to all drugs previously recommended for treatment of gonorrhoea. The first extensively-drug resistant (XDR) [3] gonococcal strains with high-level ESC resistance were described recently [9,17,19] In this worrying situation, the WHO [20], European Centre for Disease Prevention and Control (ECDC) [21] and Centers for Disease Control and Prevention (CDC), USA [22] have published action/response plans to mitigate the spread of multidrug-resistant gonorrhoea. For molecular epidemiological typing of gonococci, the N. gonorrhoeae multiantigen sequence typing (NG-MAST) has been used in many countries [31]
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