Antimicrobial Susceptibility of Neisseria gonorrhoeae in Bangladesh (2014 Update)

Global status of Azithromycin and Erythromycin Resistance Rates in Neisseria gonorrhoeae: A Systematic Review and Meta-analysis

Background: The widespread development of antibiotic resistance or decreased susceptibility in Neisseria gonorrhoeae (NG) infection is a global and significant human public health issue. Objectives: Therefore, this meta-analysis aimed to estimate worldwide resistance rates of NG to the azithromycin and erythromycin according to years, regions, and antimicrobial susceptibility testing (AST). Methods: We systematically searched the published studies in PubMed, Scopus, and Embase from 1988 to 2021. All analyses were conducted using Stata software. Results: The 134 reports included in the meta-analysis were performed in 51 countries and examined 165,172 NG isolates. Most of the included studies were from Asia (50 studies) and Europe (46 studies). In the metadata, the global prevalence over the past 30 years were 6% for azithromycin and 48% for erythromycin. There was substantial change in the prevalence of macrolides NG resistance over time (P <0.01). In this metadata, among 58 countries reporting resistance data for azithromycin, 17 (29.3%) countries reported that >5% of specimens had azithromycin resistance. Conclusions: The implications of this study emphasize the rigorous or improved antimicrobial stewardship, early diagnosis, contact tracing, and enhanced intensive global surveillance system are crucial for control of further spreading of gonococcal emergence of antimicrobial resistance (AMR).

Systematic review and survey of Neisseria gonorrhoeae ceftriaxone and azithromycin susceptibility data in the Asia Pacific, 2011 to 2016

BACKGROUND

Antimicrobial resistance in Neisseria gonorrhoeae is a global concern, with the ongoing emergence of ceftriaxone and azithromycin resistance threatening current treatment paradigms. To monitor the emergence of antimicrobial resistance in N. gonorrhoeae, the World Health Organization (WHO) Gonococcal Antimicrobial Surveillance Programme (GASP) has operated in the Western Pacific and South East Asian regions since 1992. The true burden of antimicrobial resistance remains unknown. In response, the objective of this study was to survey ceftriaxone and azithromycin susceptibility in N. gonorrhoeae across the western Pacific and south-east Asia, and interlink this data with systematically reviewed reports of ceftriaxone and azithromycin resistance.

METHODS AND FINDINGS

The WHO Collaborating Centre for Sexually Transmitted Infections and Antimicrobial Resistance, Sydney, coordinated annual surveys of gonococcal susceptibilities with participating laboratories, and additionally undertook a systematic review of reports detailing gonococcal ceftriaxone and azithromycin susceptibility data for locations geographically in the Asia Pacific from 2011 to 2016. It was found that surveillance of gonococcal antimicrobial resistance remains limited in the Asia Pacific, with weaker surveillance of azithromycin versus ceftriaxone. Ninety-three published reports were identified (including national reports) which documented susceptibility data for ceftriaxone and azithromycin. GASP survey data was available for 21 countries, territories or areas, and suggested MICs are increasing for ceftriaxone and azithromycin. Between 2011 and 2016, the percentage of locations reporting >5% of gonococcal isolates with MICs to ceftriaxone meeting WHO's definition of decreased susceptibility (MIC ≥ 0.125 mg/L) increased from 14.3% to 35.3% and the percentage of locations reporting >5% of gonococcal isolates with azithromycin resistance (MIC ≥ 1 mg/L) increased from 14.3% to 38.9%. Published reports were available for several countries that did not provide GASP surveillance responses for ceftriaxone (n = 5) and azithromycin (n = 3) respectively. Over the study period, there was a 183% increase in the number of countries providing surveillance data for GASP for both ceftriaxone and azithromycin, and a 30.6% increase in ceftriaxone MIC testing across the Asia Pacific facilitated by this project.

CONCLUSION

This study provides the first comprehensive illustration of increasing MICs to ceftriaxone in the Asia Pacific. The survey and literature review additionally detail increasing resistance to azithromycin. Further surveillance system strengthening is required to monitor these trends in order to address and curb gonococcal AMR in the region.

Sexually Transmitted Infections and Associated Risk Factors Among Street-Based and Residence-Based Female Sex Workers in Dhaka, Bangladesh

BACKGROUND

Female sex workers (FSWs) in Bangladesh remain at elevated risk of sexually transmitted infections (STIs) although the human immunodeficiency virus (HIV) prevalence among them is low. Recent information on the burden and etiological diagnosis of STIs among them has been lacking. This study examines prevalence and risk behaviors of selected STIs among FSWs in Dhaka in 2014.

METHODS

Between August and October 2014, a cross-sectional study was conducted among street-based and residence-based FSWs receiving HIV prevention services at 24 drop in centers in Dhaka. Participants underwent behavioral interview, clinical examination, and laboratory testing for selected STIs using cervical swabs and blood.

RESULTS

The sample consisted of 371 streets and 329 residence FSWs. Prevalence of gonorrhea, chlamydia, and active syphilis were 5.1%, 4.6%, 1.3% in street FSWs and were 5.8%, 8.2%, and 0.6% for residence FSWs which are lower compared with the previously reported rates. The following factors were associated with having any STI: being ≤5 years in sex trade (odds ratio, 2.2; 95% confidence interval, 1.2-3.9; P < 0.01), and having a cervical discharge (odds ratio, 2.6, 95% confidence interval, 1.5-4.6; P < 0.01). Resistance to cefixime and azithromycin was observed for 1 and 3 Neisseria gonorrhoeae strains, respectively.

CONCLUSIONS

Despite receiving HIV/STI prevention services, bacterial STIs remain prevalent among FSWs suggesting the need for more effective management of STIs. The guidelines for management of STIs need revision in view of the emerging resistance.

Antimicrobial susceptibility of Neisseria gonorrhoeae isolates in Vientiane, Lao PDR

OBJECTIVES

The aim of this study was to determine the antimicrobial susceptibility of Neisseria gonorrhoeae isolates in the Lao People's Democratic Republic (Laos).

METHODS

A total of 165 gonococcal isolates (1.3%) were obtained from 12 281 genital samples routinely submitted to a diagnostic laboratory in Vientiane, Laos, between 2011 and 2015. Susceptibility to five antibiotics was determined by the standard disk diffusion method for 158 of the isolates.

RESULTS

Rates of resistance to penicillin (by β-lactamase production), tetracycline and ciprofloxacin were 89.9%, 99.4% and 84.8%, respectively. All isolates were susceptible to ceftriaxone and spectinomycin.

CONCLUSIONS

The situation in Laos is similar to that in neighbouring countries; this fortunately means that the latest Lao national guidelines for treating gonorrhoea should still be effective.