Antimicrobial resistance in Neisseria gonorrhoeae in Finland, 1976 to 1995. The Finnish Study Group For Antimicrobial Resistance

Dynamics of the sensitivity of N. gonorrhoeae strains found in the territory of the Russian Federation in 2010-2013 to antimicrobial drugs used for the treatment of gonococcal infection

Goal of the study. To study the sensitivity of N. gonorrhoeae strains found in the territory of the Russian Federation in 2010- 2013 to antimicrobial drugs. Materials and methods. During the monitoring of antibiotic resistance of N. gonorrhoeae in 2010-2013, phenotypic properties of N. gonorrhoeae strains to antimicrobial drugs (penicillin, tetracycline, ciprofloxacin, spectinomycin, azithromycin and ceftriaxone) were examined by the agar serial dilution technique. As many as 1,305 viable N. gonorrhoeae strains from different regions of the russian Federation were examined. The results were evaluated according to the criteria such as CLSI (Clinical and Laboratory Standards Institution) and EUCAST (European Committee for Antimicrobial Susceptibility Testing). The results were processed by using the WHONET software, version 5.4. Results. According to the results of a study of N. gonorrhoeae antibiotic resistance, N. gonorrhoeae is highly resistant to penicillin (in 2010 - 72.4%, in 2011 - 50.6%, in 2012 - 51.2%, in 2013 - 49.3%), to tetracycline (in 2010 - 68.5%, in 2011 - 55%, in 2012 - 61.9%, in 2013 - 49.3%) and ciprofloxacin (in 2010 - 56.2%, in 2011 - 37.1%, in 2012 - 35%, in 2013 - 24.6%) for the entire observation period without any substantial trend towards its reduction. During studies of the resistance of the gonococcal infection pathogen to spectinomycin, the share of non-sensitive strains to the antibiotic reduced from 16.7% in 2010 to 0.7% in 2013. A slight reduction in the share of non-sensitive N. gonorrhoeae strains to azithromycin was also observed (in 2010 - 15.3%, in 2011 - 25.3%, in 2012 - 17.5%, in 2013 - 9.9%) yet these data substantially exceed the level recommended by the WHO for prescribing an antimicrobial therapy. A high level of N. gonorrhoeae sensitivity to ceftriaxone (100%) was revealed in 2010-2013. Conclusions. According to the analysis of resistance of N. gonorrhoeae strains to antimicrobial drugs found in the territory of the russian Federation in 2010-2013, there is a trend towards the reduction in the number of non-sensitive N. gonorrhoeae strains to penicillin, tetracycline, ciprofloxacin, spectinomycin and azithromycin, which can confirm the efficacy of the Neisseria gonorrhoeae antibiotic resistance monitoring measures taken by State research Center of Dermatovenereology and Cosmetology since 2002.

Worldwide susceptibility rates of Neisseria gonorrhoeae isolates to cefixime and cefpodoxime: a systematic review and meta-analysis

BACKGROUND

Neisseria gonorrhoeae (NG) infection is a serious public health problem. The third-generation extended-spectrum cephalosporins (ESCs) have been used as the first-line treatment for NG infection for almost three decades. However, in recent years, treatment failures with the oral third-generation ESCs have been reported worldwide. This study aimed to estimate worldwide susceptibility rates of NG to cefixime and cefpodoxime by analyzing data from all relevant published studies.

METHODOLOGY/PRINCIPAL FINDINGS

Two researchers independently searched five databases to identify studies on susceptibilities of NG to cefixime and cefpodoxime published between January 1, 1984 and October 15, 2012. A fixed-effect model was used to perform group analysis, and a χ2 test was employed to make subgroup comparison. Publication bias was assessed with the Begg rank correlation test. The pooled susceptibility rate of NG isolates to cefixime was 99.8% (95% CI: 99.7%-99.8%). The cefixime susceptibility rate of NG isolates from men was significantly lower than that from patients without information of gender or from men and women; the susceptibility rate of NG isolates from Asia was significantly lower than that from other continents; and the susceptibility rate of NG isolates collected before or during 2003 was significantly higher than that after 2003. The pooled susceptibility rate of NG isolates to cefpodoxime was 92.8% (95% CI: 89.0%-95.3%), which was lower than that to cefixime (92.8% vs. 99.8%, χ2 = 951.809, P<0.01).

CONCLUSIONS

The susceptibility rate of NG isolates to cefixime varied with the gender of patients and geographical location from which NG isolates were collected, and declined with time. The reported lower susceptibility rate of NG isolates to cefixime and associated treatment failures, as well as the emergence of NG strains with cephalosporin resistance call for the more effective control of NG infection and the development of new antibiotics.

Selection of drugs for treatment of gonococcal infection based on the results ofthe monitoring of N. gonorrhoeae antibiotic resistance

The article presents recommendations for selecting drugs for treatment of gonococcal infection based on the results of the monitoring of N. gonorrhoeae antibiotic resistance in 2009 and 2005-2009. It was shown that it is not recommended to use penicillin, tetracycline and ciprofloxacin in the territory of the Russian Federation because of the high level of N. gonorrhoeae resistance to these drugs. The drug of choice for gonorrhea treatment in the Russian Federation is Ceftriaxon because of the high level of N. gonorrhoeae sensitivity (100%). It is recommended to use spectinomycin for gonorrhea treatment only in the Ural and Far Eastern Districts; azithromycin - only in the Ural and Central Districts characterized by the high level of N. gonorrhoeae sensitivity to these antimicrobial drugs, and it is necessary to use spectinomycin and azithromycin in other federal districts of Russia only under control of determination of N. gonorrhoeae sensitivity.

Surveillance systems for STIs in the European Union: facing a changing epidemiology

OBJECTIVES

To characterise the nature, content, and performance characteristics of existing national STI surveillance systems in the European Union (EU) and Norway, to facilitate collection of comparable surveillance data.

METHODS

Cross sectional survey using a structured questionnaire.

RESULTS

Case reporting from clinicians and/or laboratories is the mainstay of EU surveillance systems for bacterial STIs. Coverage of case reporting varies from less than 10% to over 75%, and lack of and/or heterogeneity in case definitions affect the relative specificity and sensitivity of reporting systems. Considerable variations also exist in STI care sites; the populations who use these services; and in partner notification practices, STI screening practices, and STI laboratory diagnostic tests employed, affecting the representativeness of reported data and the sensitivity of surveillance systems for detecting the true number of STI cases.

CONCLUSIONS

The heterogeneity of current surveillance systems complicates direct comparison of STI incidence rates across Europe. Introduction of standardised case definitions for reporting, and increased coverage of mandatory reporting systems where necessary, are needed. Definition of standardised minimum datasets and use of sentinel and enhanced surveillance systems to supplement universal case/laboratory notification data, could improve our understanding of the distribution and determinants of STIs across Europe, and aid in the design of effective public health responses. In the context of the changing epidemiology of STIs, systems for detection and monitoring of localised outbreaks of acute bacterial STIs (syphilis and antimicrobial resistant gonorrhoea), as well as prevalence monitoring systems for frequently asymptomatic STIs (chlamydial infection and viral STIs), are also necessary.

The use of fluoroquinolones in gonorrhoea: the increasing problem of resistance

The recent re-emergence of gonorrhoea in developed countries has been accompanied by the rise and spread of gonococcal resistance to the fluoroquinolones. In the 1980s fluoroquinolones were considered an important addition to the arsenal of agents used to treat gonorrhoea. They proved to be excellent drugs for this indication, including infections caused by penicillinase-producing and tetracycline-resistant strains of Neisseria gonorrhoeae. However, as gonococci have a well-recognised potential to develop resistance to antibiotics, the first reports of reduced susceptibility to fluoroquinolones appeared a few years after their introduction. Gonococcal resistance to fluoroquinolones is now well-established in the Far East, from where it has spread to Australia, Hawaii, California and Europe. In Africa and Latin America, gonococci continue to be susceptible to fluoroquinolones.

A Comparison of the Microbiological Characteristics of <i>Neisseria gonorrhoeae</i> Isolated from Male and Female Patients with Gonorrhea

<i>Background:</i> A trend towards a decrease in gonorrhea in Japan was observed until the mid-1990s, but soon after that period, an increased incidence of gonorrhea was reported. <i>Methods:</i> Antimicrobial susceptibility, auxotype and the type of <i>gyrA</i> and <i>parC</i> mutations were compared between 200 and 132 <i>Neisseria gonorrhoeae</i> isolates from male and female patients with gonorrhea, respectively. <i>Results and Conclusion:</i> The isolation frequency of ciprofloxacin-resistant isolates from male patients was higher than that from female patients (19.5 and 13.6%, respectively). All ciprofloxacin-resistant isolates had single to triple mutations in <i>gyrA</i> and/or <i>parC</i> genes. <i>N. gonorrhoeae </i>isolates showed a predominance of Pro-requiring auxotypes (46.5 and 46.2% of the isolates from male and female patients, respectively). Of the Pro-requiring isolates, the incidence of ciprofloxacin-resistant isolates was higher in the isolates from male patients than in the isolates from female patients.

Increasing antimicrobial resistance in STDs and the need for surveillance: Neisseria gonorrhoeae as a model

Neisseria gonorrhoeae has a rising trend of resistance against antimicrobials. Today, third generation cephalosporins are the only antibiotics for treatment of gonorrhea against which there is no resistance in gonococci. On the other hand, decreased susceptibility against this group, including ceftriaxone, has already been observed. This historically famous pathogen deserves current attention and is reviewed here with respect to its resistance mechanisms and patterns, and the problems concerning standardization of its susceptibility testing are discussed.

The epidemiology of Neisseria gonorrhoeae in Europe

This review addresses the occurrence, the trends, and the risk groups of Neisseria gonorrhoeae in Europe over the past decade. A decline has been observed in most of Europe since the 1980s, except for an increase in the Baltic countries (early 1990s) and an increase among men who have sex with men (between 1989 and 1991), and heterosexuals in some countries (between 1995 and 1997). Despite the overall fall in the incidence of gonorrhoea, plasmid-mediated resistance to penicillin and tetracycline increased in Europe. More recently, resistance to fluoroquinolones has been documented, mainly imported from Southeast Asia. Until now, no resistance to third-generation cephalosporins has been observed.

Antimicrobial susceptibilities and plasmid contents of Neisseria gonorrhoeae isolates from commercial sex workers in Dhaka, Bangladesh: emergence of high-level resistance to ciprofloxacin

Commercial sex workers (CSWs) serve as the most important reservoir of sexually transmitted diseases (STD), including gonorrhea. Periodic monitoring of the antimicrobial susceptibility profile of Neisseria gonorrhoeae in a high-risk population provides essential clues regarding the rapidly changing pattern of antimicrobial susceptibilities. A study concerning the prevalence of gonococcal infection among CSWs was conducted in Bangladesh. The isolates were examined with regards to their antimicrobial susceptibility to, and the MICs of, penicillin, tetracycline, ciprofloxacin, cefuroxime, ceftriaxone, and spectinomycin by disk diffusion and agar dilution methods. The total plasmid profile of the isolates was also analyzed. Of the 224 CSWs, 94 (42%) were culture positive for N. gonorrhoeae. There was a good correlation between the results of the disk diffusion and agar dilution methods. Some 66% of the isolates were resistant to penicillin, and 34% were moderately susceptible to penicillin. Among the resistant isolates, 23.4% were penicillinase-producing N. gonorrhoeae (PPNG). 60.6% of the isolates were resistant and 38.3% were moderately susceptible to tetracycline, 17.5% were tetracycline-resistant N. gonorrhoeae, 11.7% were resistant and 26.6% had reduced susceptibility to ciprofloxacin, 2.1% were resistant and 11.7% had reduced susceptibility to cefuroxime, and 1% were resistant to ceftriaxone. All PPNG isolates contained a 3.2-MDa African type of plasmid, and a 24.2-MDa conjugative plasmid was present in 34.1% of the isolates. Since quinolones such as ciprofloxacin are recommended as the first line of therapy for gonorrhea, the emergence of significant resistance to ciprofloxacin will limit the usefulness of this drug for treatment of gonorrhea in Bangladesh.

An essential saccharide binding domain for the mAb 2C7 established for Neisseria gonorrhoeae LOS by ES-MS and MSn

A study of bacterial surface oligosaccharides were investigated among different strains of Neisseria gonorrhoeae to correlate structural features essential for binding to the MAb 2C7. This epitope is widely expressed and conserved in gonococcal isolates, characteristics essential to an effective candidate vaccine antigen. Sample lipooligosaccharides (LOS), was prepared by a modification of the hot phenol-water method from which de-O-acetylated LOS and oligosaccharide (OS) components were analyzed by ES-MS-CID-MS and ES-MSnin a triple quadrupole and an ion trap mass spectrometer, respectively. Previously documented natural heterogeneity was apparent from both LOS and OS preparations which was admixed with fragments induced by hydrazine and mild acid treatment. Natural heterogeneity was limited to phosphorylation and antenni extensions to the alpha-chain. Mild acid hydrolysis to release OS also hydrolyzed the beta(1-->6) glycosidic linkage of lipid A. OS structures were determined by collisional and resonance excitation combined with MS and multistep MSn which provided sequence information from both neutral loss, and nonreducing terminal fragments. A comparison of OS structures, with earlier knowledge of MAb binding, enzyme treatment, and partial acid hydrolysis indicates a generic overlapping domain for 2C7 binding. Reoccurring structural features include a Hepalpha(1-->3)Hepbeta(1-->5)KDO trisaccharide core branched on the nonreducing terminus (Hep-2) with an alpha(1-->2) linked GlcNAc (gamma-chain), and an alpha-linked lactose (beta-chain) residue. From the central heptose (Hep-1), a beta(1-->4) linked lactose (alpha-chain), moiety is required although extensions to this residue appear unnecessary.

Antimicrobial resistance in Neisseria gonorrhoeae

Despite a declining incidence of gonorrhea in much of the industrialized world, antimicrobial resistance continues to present a challenge to the treatment of gonococcal infections. Although no clinically significant resistance to the broad-spectrum cephalosporins has been identified, fluoroquinolone-resistant gonococcal strains are now prevalent in Australia and much of the Far East. Ongoing surveillance for antimicrobial resistance is crucial to obtain the information needed to choose effective empiric therapies for gonorrhea.