Abstract
Neisseria gonorrhoeae antimicrobial susceptibility is monitored in the European Union (EU) and the European Economic Area (EEA) by the European gonococcal antimicrobial surveillance programme (Euro-GASP). Results from 17 EU/EEA Member States in 2009 showed that 5% of isolates had decreased susceptibility to cefixime, an upward trend in the minimum inhibitory concentrations of ceftriaxone and a high prevalence of resistance to ciprofloxacin (63%)and azithromycin (13%). These results are of public health value and highlight the need for healthcare professionals to be aware of possible cefixime treatment failures. Euro-GASP is being implemented in additional EU/EEA Member States to achieve greater representativeness. In addition, Euro-GASP aims to set up a system which will allow biannual reporting of antimicrobial resistance in the EU/EEA, with a transition from centralised towards decentralised testing,and will link epidemiological data to laboratory data to enhance surveillance. The benefits of this approach include more timely detection of emerging trends in gonococcal resistance across the EU/EEA and the provision of a robust evidence base for informing national and European guidelines for therapy.
Highlights
Surveillance systems to detect the emergence and spread of Neisseria gonorrhoeae antimicrobial resistance (AMR) are essential to ensure patients receive the most appropriate therapy for gonorrhoea treatment
The gonococcus has demonstrated the ability to develop resistance to antimicrobial drugs used for therapy [1,2], and the subsequent worldwide spread of resistant strains [3,4,5,6,7,8] has shown that the antimicrobial susceptibility of this bacterium needs to be monitored closely to inform public health control
The current European recommended therapy for gonorrhoea [9] consists of the extended-spectrum cephalosporins (ESCs) ceftriaxone and cefixime, which are used in most other countries worldwide [1]
Summary
Surveillance systems to detect the emergence and spread of Neisseria gonorrhoeae antimicrobial resistance (AMR) are essential to ensure patients receive the most appropriate therapy for gonorrhoea treatment. Decreased susceptibility to ESCs was first recognised in 2001 in Japan [10] and subsequent reports of worldwide spread [1,11,12], including reports from Europe [6,13] are becoming more common. The danger that gonorrhoea may become untreatable is real, in light of treatment failure of cefixime first documented in Japan [14] and more recently in Norway and the United Kingdom [15,16] as well as the decreasing susceptibility to ceftriaxone globally [1,2]
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