Abstract
ObjectivesAntimicrobial resistance (AMR) in Neisseria gonorrhoeae, compromising gonorrhoea treatment, is a threat to reproductive health globally. South-East and East Asia have been major sources of emergence and subsequent international spread of AMR gonococcal strains during recent decades. We investigated gonococcal isolates from 2011 and 2015–16 in Vietnam using AMR testing, WGS and detection of AMR determinants.MethodsTwo hundred and twenty-nine gonococcal isolates cultured in 2015–16 (n = 121) and 2011 (n = 108) in Vietnam were examined. AMR testing was performed using Etest and WGS with Illumina MiSeq.ResultsResistance among the 2015–16 isolates was as follows: ciprofloxacin, 100%; tetracycline, 79%; benzylpenicillin, 50%; cefixime, 15%; ceftriaxone, 1%; spectinomycin, 0%; and 5% were non-WT to azithromycin. Eighteen (15%) isolates were MDR. The MIC range for gentamicin was 2–8 mg/L. Among the 2015–16 isolates, 27% (n = 33) contained a mosaic penA allele, while no isolates had a mosaic penA allele in 2011. Phylogenomic analysis revealed introduction after 2011 of two mosaic penA-containing clones (penA-10.001 and penA-34.001), which were related to cefixime-resistant strains spreading in Japan and Europe, and a minor clade (eight isolates) relatively similar to the XDR strain WHO Q.ConclusionsFrom 2011 to 2015–16, resistance in gonococci from Vietnam increased to all currently and previously used antimicrobials except ceftriaxone, spectinomycin and tetracycline. Two mosaic penA-containing clones were introduced after 2011, explaining the increased cefixime resistance. Significantly increased AMR surveillance, antimicrobial stewardship and use of WGS for molecular epidemiology and AMR prediction for gonococcal isolates in Vietnam and other Asian countries are crucial.
Highlights
Neisseria gonorrhoeae has developed antimicrobial resistance (AMR) to all drugs used in the treatment of gonorrhoea using mainly all known AMR mechanisms.[1,2,3]
The extended-spectrum cephalosporin (ESC) ceftriaxone is the last option for first-line empirical monotherapy; gonococcal resistance to ceftriaxone and occasional treatment failures with ceftriaxone have been verified.[3]
Our findings show that cefixime, azithromycin, benzylpenicillin, tetracycline and ciprofloxacin should not be used for empirical first-line monotherapy in Vietnam as in most other countries globally.[1,2,3]
Summary
Neisseria gonorrhoeae has developed antimicrobial resistance (AMR) to all drugs used in the treatment of gonorrhoea using mainly all known AMR mechanisms.[1,2,3] The extended-spectrum cephalosporin (ESC) ceftriaxone is the last option for first-line empirical monotherapy; gonococcal resistance to ceftriaxone and occasional treatment failures with ceftriaxone have been verified.[3]. 2015.11–18 The first gonorrhoea treatment failure with ceftriaxone plus azithromycin was reported in 2016,19 and in 2018 the first gonococcal strain with ceftriaxone resistance combined with highlevel azithromycin resistance was identified in the UK and Australia (WHO Q).[20,21,22] This development emphasizes the urgent need for new antimicrobials for gonorrhoea treatment[23] and increased AMR surveillance globally.[2,3]. During the past several decades, South-East and East Asia have had high gonorrhoea prevalences and been major sources of emergence and subsequent international spread of gonococcal AMR.[3,24,25,26] Most of the ceftriaxone-resistant cases during recent years have been associated with travel to South-East or East Asia.[3,10,11,12,13,14,15,16,17,18,19,20,21,22] In Vietnam, quality-assured surveillance of gonococcal
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