Abstract
BackgroundAntimicrobial resistance (AMR) in Neisseria gonorrhoeae is an emerging global health threat. Surveillance of AMR in N. gonorrhoeae in the Western Pacific Region is important, as resistant strains have typically emerged from this region. There are sparse data regarding antibiotic susceptibility of N. gonorrhoeae from Vietnam. This study aimed to provide updated data on antibiotic susceptibilities in N. gonorrhoeae isolates from Hanoi, Vietnam.MethodsFrom 2017 to 2019, 409 N. gonorrhoeae clinical isolates were collected at the National Hospital for Venereology and Dermatology in Hanoi, Vietnam. Antibiotic susceptibility testing was performed by disk diffusion method according to the Clinical and Laboratory Standards Institute (CLSI) protocol. The zone diameters of inhibition were recorded and interpreted according to standard CLSI criteria, except for azithromycin, due to the absence of CLSI interpretation. Categorical variables were analyzed by Chi-square and Fisher’s exact tests. Linear regression was used to evaluate zones of inhibition by year.ResultsAmong the 409 isolates, no isolates were susceptible to penicillin, 98.3% were resistant to ciprofloxacin, and all isolates were susceptible to spectinomycin. There were 122/407 (30.0%) isolates resistant to azithromycin and there was an association between resistance and year (p < 0.01), ranging from 15.3% of isolates in 2017 to 46.7% of the isolates in 2018. Resistance to cefixime was found in 13/406 (3.2%) of isolates and there was no association by year (p = 0.30). Resistance to ceftriaxone occurred in 3/408 (0.7%) of isolates. Linear regression indicated the zone of inhibition diameters decreased by 0.83 mm each year for ceftriaxone (95% CI: − 1.3, − 0.4; p < 0.01) and decreased by 0.83 mm each year (95% CI: − 1.33, − 0.33; p < 0.01) for azithromycin; the association was not significant for cefixime (p = 0.07).ConclusionsWe found decreasing susceptibility of N. gonorrhoeae to ceftriaxone and azithromycin, as well as a high prevalence of resistance to azithromycin, among isolates in Hanoi, Vietnam from 2017 to 2019. The trends of decreasing susceptibility to first-line treatments are concerning and highlight the urgency of addressing antimicrobial resistance in N. gonorrhoeae. Expanded surveillance efforts within the Western Pacific Region are critical to monitoring trends and informing treatment guidelines.
Highlights
IntroductionSurveillance of Antimicrobial resistance (AMR) in N. gonorrhoeae in the Western Pacific Region is important, as resistant strains have typically emerged from this region
Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is an emerging global health threat
The most recent report by the World Health Organization (WHO) Gonococcal Antimicrobial Surveillance Programme (GASP), including isolates through 2016, found that many countries in the Western Pacific Region (WPR) exceeded the 5% resistance thresholds to ceftriaxone and azithromycin that were historically used by the WHO to guide treatment recommendations [11]
Summary
Surveillance of AMR in N. gonorrhoeae in the Western Pacific Region is important, as resistant strains have typically emerged from this region. Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is an emerging global health threat [1]. Strains with resistance to both ceftriaxone and azithromycin have been identified, likely originating from the Western Pacific Region (WPR) [10]. Surveillance of AMR in N. gonorrhoeae in the WPR is important, as resistant strains have typically emerged from this region [4]. The most recent report by the WHO Gonococcal Antimicrobial Surveillance Programme (GASP), including isolates through 2016, found that many countries in the WPR exceeded the 5% resistance thresholds to ceftriaxone and azithromycin that were historically used by the WHO to guide treatment recommendations [11]. We describe trends in antibiotic resistance in N. gonorrhoeae from 2017 to 2019 in Hanoi, Vietnam
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