Monitoring Antimicrobial Susceptibility of &lt;i&gt;Neisseria gonorrhoeae&lt;/i&gt; Isolated from Bangladesh during 1997-2006: Emergence and Pattern of Drug-resistant Isolates

Monir Uddin Ahmed,Gazi Salahuddin,Faisal Arif Hasan Chawdhury,Shamsun Nahar,Khairun Nessa,Ashraful Alam,Anadil Alam,Maqsud Hossain,Shama A-Waris,Mansur Alam,Syed Zafar Sultan,Motiur Rahman

doi:10.3329/jhpn.v28i5.6152

Abstract

Gonorrhoea is one of the most common sexually transmitted infections (STIs) in developing countries, and the emergence of resistance to antimicrobial agents in Neisseria gonorrhoeae is a major obstacle in the control of gonorrhoea. Periodical monitoring of antimicrobial susceptibility of N. gonorrhoeae is essential for the early detection of emergence of drug resistance. In total, 1,767 gonococcal strains isolated from males and females (general population and those with high-risk behaviour) from different parts of Bangladesh were studied during 1997-2006. Minimum inhibitory concentrations of penicillin, tetracycline, ciprofloxacin, ceftriaxone, spectinomycin, and azithromycin for the isolates were determined by the agar dilution method. Isolates resistant to three or more antimicrobial agents are considered multidrug-resistant. The prevalence of plasmid-mediated penicillinase-producing N. gonorrhoeae (PPNG) and plasmid-mediated tetracycline-resistant N. gonorrhoeae (TRNG) was determined. Nine percent of the isolates were resistant to ciprofloxacin in 1997 compared to 87% in 2006. Multidrug-resistant N. gonorrhoeae have emerged in 1997, and 44% of the strains (n = 66) isolated during 2006 were multidrug-resistant. Forty-two percent of the isolates in 2006 were both PPNG- and TRNG-positive compared to none in 1997. The rapidly-changing pattern of gonococcal antimicrobial susceptibility warrants the need for an antimicrobial susceptibility-monitoring programme, and periodical analysis and dissemination of susceptibility data are essential to guide clinicians and for successful STI/HIV intervention programmes.

Highlights

Gonorrhoea is one of the classical sexually transmitted infections (STIs) with humans as the only host for the causative agent Neisseria gonorrhoeae
We report the antimicrobial susceptibility of N. gonorrhoeae in Bangladesh during 1997-2006 and, in particular, the emergence and spread of multidrugresistant N. gonorrhoeae in Bangladesh
In 1997, the antimicrobial susceptibility-monitoring programme for N. gonorrhoeae was introduced in Dhaka, the capital of Bangladesh, and was later (1999-2003) extended to three major cities (Chittagong, Jessore, and Sylhet), in southeast, southwest and northeast parts of Bangladesh respectively

Summary

Introduction

Gonorrhoea is one of the classical sexually transmitted infections (STIs) with humans as the only host for the causative agent Neisseria gonorrhoeae. In the absence of any effective vaccine against N. gonorrhoeae, control of gonococcal infection mainly depends on the identification and treatment of infected individuals. An early and successful antibiotic treatment of gonococcal infection is important for cure of the individual patient, prevention of complications, and reduction of transmission [3]. Information on antimicrobial susceptibility of N. gonorrhoeae is, important for the selection of an appropriate antimicrobial agent [5]. The versatile nature of the gonococcus and its capacity to cope with changing conditions in microenvironment is a major challenge in the prevention and control of gonococcal infection [6]. The continuous emergence of resistance to antimicrobial agents has made the treatment of gonorrhoea expensive, prolonged, and unpredictable. A single organism can have both the mechanisms of resistance, and resistance to multiple antibiotics is often common [8,9]

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