Epidemiology, molecular characterisation and antimicrobial susceptibility of Neisseria gonorrhoeae isolates in Madrid, Spain, in 2016.

M D Guerrero-Torres,M Vera,J Del Romero,I Mozo,M B Menéndez,E Tello,R Abad,J C Carrio,C S Guerras,T Puerta,J A Vázquez,O Ayerdi,P Clavo,J Ballesteros

doi:10.1017/s095026881900150x

Abstract

With the aim to elucidate gonococcal antimicrobial resistance (AMR)-risk factors, we undertook a retrospective analysis of the molecular epidemiology and AMR of 104 Neisseria gonorrhoeae isolates from clinical samples (urethra, rectum, pharynx and cervix) of 94 individuals attending a sexually transmitted infection clinic in Madrid (Spain) from July to October 2016, and explored potential links with socio-demographic, behavioural and clinical factors of patients. Antimicrobial susceptibility was determined by E-tests, and isolates were characterised by N. gonorrhoeae multi-antigen sequence typing. Penicillin resistance was recorded for 15.4% of isolates, and most were susceptible to tetracycline, cefixime and azithromycin; a high incidence of ciprofloxacin resistance (~40%) was found. Isolates were grouped into 51 different sequence types (STs) and 10 genogroups (G), with G2400, ST5441, ST2318, ST12547 and G2992 being the most prevalent. A significant association (P = 0.015) was evident between HIV-positive MSM individuals and having a ciprofloxacin-resistant strain. Likewise, a strong association (P = 0.047) was found between patient age of MSM and carriage of isolates expressing decreased susceptibility to azithromycin. A decrease in the incidence of AMR gonococcal strains and a change in the strain populations previously reported from other parts of Spain were observed. Of note, the prevalent multi-drug resistant genogroup G1407 was represented by only three strains in our study, while the pan-susceptible clones such as ST5441, and ST2318, associated with extragenital body sites were the most prevalent.

Highlights

Transmitted infection (STI) caused by Neisseria gonorrhoeae is a major public health problem with a high global incidence
A randomly selected sample of 104 N. gonorrhoeae isolates recovered from patients attending an Sexually transmitted infection (STI) outpatient clinic in Madrid over a 4-month period in 2016 was investigated to determine their antimicrobial susceptibility and molecular epidemiology, and explore statistical associations of isolate characteristics with socio-demographic, behavioural and clinical factors of patients
According to the 2015 European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP) [8], the observed rates were similar to the European average, except for azithromycin (7.1%), and to the overall average for Spain, except for ciprofloxacin (65.3%)

Summary

Introduction

Transmitted infection (STI) caused by Neisseria gonorrhoeae is a major public health problem with a high global incidence. High rates of azithromycin resistance were reported [8] and the failure of dual therapy was observed in a number of studies [9,10,11,12] In response to this emergent public concern, action plans to detect and prevent the emergence and spread of antimicrobial resistance (AMR) in N. gonorrhoeae have been recommended by both the WHO [13,14] and the European Centre for Disease Prevention and Control (ECDC) [15]. In this way, monitoring of strain populations by molecular techniques and determination of antimicrobial susceptibility of N. gonorrhoeae isolates became imperative, as well as gathering of data on clinical and social risk factors associated with AMR in order to identify at-risk patient groups and provide evidence-based data for the implementation of public health control programmes [16]

Methods

Results

Conclusion