Abstract
Background Neisseria gonorrhoeae antibiotic resistance surveillance is important to maintain adequate treatment. We analysed 2007–15 data from the Gonococcal Resistance to Antimicrobials Surveillance (GRAS), which currently includes 19 of 25 sexually transmitted infection (STI) centres in the Netherlands. Methods: From each patient with a gonorrhoea culture, the minimum inhibitory concentration (MIC) for several antibiotics was determined. Time trends were assessed by geometric means and linear regression of logarithmic MIC. Determinants for decreased susceptibility to ceftriaxone (MIC > 0.032 mg/L) and resistance to cefotaxime (MIC > 0.125 mg/L) and azithromycin (MIC > 0.5 mg/L) were assessed using stratified logistic regression. Results: 11,768 isolates were analysed. No ceftriaxone resistance was found. In 2015, 27 of 1,425 isolates (1.9%) were resistant to cefotaxime and 176 of 1,623 (10.9%) to azithromycin. Ceftriaxone susceptibility showed no trend (p = 0.96) during the study period, but cefotaxime MIC decreased (p < 0.0001) and azithromycin MIC increased (p < 0.0001) significantly. Concerning ceftriaxone, isolates of men who have sex with men (MSM) from 2013 (p = 0.0005) and 2014 (p = 0.0004) were significantly associated with decreased susceptibility. Significant determinants for cefotaxime resistance were having ≥ 6 partners for women (p = 0.0006). For azithromycin,isolates from MSM collected in 2012 (p = 0.0035), 2013 (p = 0.012), and 2014 (p = 0.013), or from non-Dutch (p < 0.0001) or older (≥ 35 years; p = 0.01) MSM were significantly associated with susceptibility. Resistance in heterosexual men was significantly associated with being ≥ 25 years-old (p = 0.0049) or having 3–5 partners (p = 0.01). Conclusions: No ceftriaxone resistance was found, but azithromycin MIC increased in 2007–15. Resistance determinants could help with focused intervention strategies.
Highlights
Gonorrhoea, caused by Neisseria gonorrhoeae, is one of the most common sexually transmitted infections (STI) and, with increasing resistance, a major public health concern globally [1]
Under the national sentinel surveillance programme in STI centres, 5,391 cases were reported in 2015, and gonorrhoea was most prevalent among men who have sex with men (MSM): 10.7 per cent tested positive for gonorrhoea compared with 1.9 per cent and 1.6 per cent in heterosexual men and women respectively [2]
Analysis of Gonococcal Resistance to Antimicrobials Surveillance (GRAS), the nationwide surveillance network focused on N. gonorrhoeae resistance, shows that resistance to ceftriaxone has not yet been reported in the Netherlands, despite the current increase of ceftriaxone resistance outside the Netherlands [25,29,30]
Summary
Gonorrhoea, caused by Neisseria gonorrhoeae, is one of the most common sexually transmitted infections (STI) and, with increasing resistance, a major public health concern globally [1]. Third generation (3G) cephalosporins, such as ceftriaxone and cefixime (and cefotaxime in the Netherlands), are routinely used for the treatment of gonorrhoea in most countries. The susceptibility of gonococci to these cephalosporins has been decreasing and N. gonorrhoeae has developed antimicrobial resistance (AMR) to most drugs used for treatment. Determinants for decreased susceptibility to ceftriaxone (MIC > 0.032 mg/L) and resistance to cefotaxime (MIC > 0.125 mg/L) and azithromycin (MIC > 0.5 mg/L) were assessed using stratified logistic regression. Ceftriaxone susceptibility showed no trend (p = 0.96) during the study period, but cefotaxime MIC decreased (p < 0.0001) and azithromycin MIC increased (p < 0.0001) significantly. Concerning ceftriaxone, isolates of men who have sex with men (MSM) from 2013 (p = 0.0005) and 2014 (p = 0.0004) were significantly associated with decreased susceptibility. Conclusions: No ceftriaxone resistance was found, but azithromycin MIC increased in 2007–15
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