Gonococcal resistance can be viewed productively as part of a syndemic of antimicrobial resistance: an ecological analysis of 30 European countries

Chris Kenyon,Sheeba S Manoharan-Basil,Christophe Van Dijck

doi:10.1186/s13756-020-00764-z

Chris Kenyon, Sheeba S Manoharan-Basil + Show 1 more

Open Access

https://doi.org/10.1186/s13756-020-00764-z

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Abstract

BackgroundIt is unclear how important bystander selection is in the genesis of antimicrobial resistance (AMR) in Neisseria gonorrhoeae.MethodsWe assessed bystander selection in a novel way. Mixed-effects linear regression was used to assess if country-level prevalence of gonococcal AMR in 30 European countries predicts homologous AMR in other bacteria. The data used was from the European Antimicrobial Resistance Surveillance Network.ResultsThe prevalence of gonococcal ciprofloxacin resistance was found to be positively associated with AMR prevalence in E. coli (coef. 0.52; P = 0.007), Acinetobacter spp. (coef. 0.13; P = 0.044) and Pseudomonas aeruginosa (coef. 0.36; P = 0.020) but not Klebsiella pneumoniae. Azithromycin resistance in N. gonorrhoeae was positively associated with macrolide resistance in Streptococcus pneumoniae (coef. 0.01; P = 0.018). No association was found for cephalosporins.ConclusionsGonococcal AMR is linked to that in other bacteria. This finding is likely explained by high antimicrobial consumption in affected populations and provides additional motivation for strengthening antimicrobial stewardship programs.

Highlights

It is unclear how important bystander selection is in the genesis of antimicrobial resistance (AMR) in Neisseria gonorrhoeae
The prevalence of fluoroquinolone resistance in N. gonorrhoeae declined over time
Association between Neisseria gonorrhoeae (Ng) AMR and other bacteria Fluoroquinolones The prevalence of gonococcal AMR was positively associated with AMR prevalence in E. coli, Acinetobacter spp. and P. aeruginosa but not K. pneumoniae (Table 2; Fig. 2)

Summary

Introduction

It is unclear how important bystander selection is in the genesis of antimicrobial resistance (AMR) in Neisseria gonorrhoeae. Understanding the determinants of AMR in N. gonorrhoeae is vital to prevent the future emergence of AMR. Other studies have suggested that antibiotic consumption for all indications plays a role (community bystander theory; Fig. 1) [7]. Understanding which of these theories is correct has important implications. If the former is true, preventing the further emergence of gonococcal AMR could be accomplished by interventions such as antimicrobial stewardship limited to within STI services. If total antibiotic consumption played a role, stewardship efforts to reduce antibiotic consumption in the whole community would be important [11]

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