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Blouin K, Lefebvre B, Trudelle A, Defay F, Perrault Sullivan G, Ezin Aloffan LND, Labbé AC. Correlates of Neisseria gonorrhoeae antimicrobial resistance: cross-sectional results from an open cohort sentinel surveillance network in Québec, Canada, 2016-2019. BMJ Open 2023; 13:e073849. [PMID: 37541749 PMCID: PMC10407373 DOI: 10.1136/bmjopen-2023-073849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/11/2023] [Indexed: 08/06/2023] Open
Abstract
OBJECTIVES To examine correlates of Neisseria gonorrhoeae antimicrobial resistance (AMR) to first-line antimicrobials (azithromycin, cefixime and ceftriaxone). DESIGN AND SETTING The sentinel surveillance network is an open cohort of gonococcal infection cases from Québec, Canada. Cross-sectional results are reported herein. PARTICIPANTS Between 1 January 2016 and 31 December 2019, data from 886 individuals accounting for 941 gonorrhoea cases were included. METHODS Epidemiological and clinical data were collected using an auto-administered questionnaire, direct case interviews and chart reviews. Antimicrobial susceptibility testing was performed using the agar dilution method. Generalised estimating equations were used for regression. RESULTS The prevalence of azithromycin resistance with a minimal inhibitory concentration (MIC) of ≥2 mg/L was 21.3%. In 2016, men who have sex with men were more likely to be infected with an azithromycin-resistant N. gonorrhoeae isolate (adjusted prevalence ratio (aPR)=4.73, 95% CI 1.48 to 15.19) or with an isolate with increased third-generation cephalosporin (3GC) MIC (aPR=5.32, 95% CI 1.17 to 24.11 for cefixime (MIC≥0.06 mg/L) and aPR=4.38, 95% CI 1.53 to 12.54 for ceftriaxone (MIC≥0.03 mg/L)). However, these associations were not maintained between 2017 and 2019, with increased MIC observed in men who have sex exclusively with women and women. Overall, azithromycin resistance was significantly more likely in cases who self-reported HIV infection (aPR=1.65, 95% CI 1.00 to 2.71). Cefixime increased MIC were more likely in individuals 25-34 years old (aPR=2.23, 95% CI 1.18 to 4.21). Cefixime and ceftriaxone increased MIC were both more likely in cases who reported ≥5 sexual partners (cefixime: aPR=2.10, 95% CI 1.34 to 3.27 and ceftriaxone: aPR=1.62, 95% CI 1.14 to 2.30). CONCLUSION Significant correlates of N. gonorrhoeae AMR to first-line antimicrobials were observed. Antimicrobial stewardship may be particularly important for 3GC. Active monitoring and interventions are critical for 3GC non-susceptible strains, especially considering the very low prevalence in Québec.
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Affiliation(s)
- Karine Blouin
- Direction des risques biologiques, Institut national de santé publique du Québec, Québec, Québec, Canada
- École de Santé Publique, Université de Montréal, Montréal, Québec, Canada
| | - Brigitte Lefebvre
- Laboratoire de santé publique du Québec, Sainte-Anne-de-Bellevue, Québec, Canada
| | - Annick Trudelle
- Direction des risques biologiques, Institut national de santé publique du Québec, Québec, Québec, Canada
| | - Fannie Defay
- Direction des risques biologiques, Institut national de santé publique du Québec, Québec, Québec, Canada
| | - Gentiane Perrault Sullivan
- Direction des risques biologiques, Institut national de santé publique du Québec, Québec, Québec, Canada
| | - Léni Nina Débora Ezin Aloffan
- Direction des risques biologiques, Institut national de santé publique du Québec, Québec, Québec, Canada
- École de Santé Publique, Université de Montréal, Montréal, Québec, Canada
| | - Annie-Claude Labbé
- Département de microbiologie, infectiologie et immunologie, Université de Montréal, Montréal, Québec, Canada
- Département de microbiologie et d'infectiologie, Hôpital Maisonneuve-Rosemont, CIUSSS de l'Est-de-l'île-de Montréal, Montréal, Québec, Canada
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King T, Schindler R, Chavda S, Conly J. Dimensions of poverty as risk factors for antimicrobial resistant organisms in Canada: a structured narrative review. Antimicrob Resist Infect Control 2022; 11:18. [PMID: 35074013 PMCID: PMC8785485 DOI: 10.1186/s13756-022-01059-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/10/2022] [Indexed: 11/24/2022] Open
Abstract
Background Few studies have assessed the relationship between poverty and the risk of infection with antimicrobial resistant organisms (AROs). We sought to identify, appraise, and synthesize the available published Canadian literature that analyzes living in poverty and risk of AROs. Methods A structured narrative review methodology was used, including a systematic search of three databases: MedLINE, EMBASE and Web of Science for articles pertaining to poverty, and infection with AROs in Canada between 1990 and 2020. Poverty was broadly defined to include economic measures and associated social determinants of health. Based on inclusion and exclusion criteria, there were 889 initial articles, and 43 included in the final review. The final articles were extracted using a standard format and appraised using the Joanna Briggs Institute Levels of Evidence framework. Results Of 43 studies, 15 (35%) related to methicillin-resistant Staphylococcus aureus (MRSA). One study found a 73% risk reduction (RR 0.27, 95%CI 0.19–0.39, p = < 0.0001) in community-acquired MRSA (CA-MRSA) infection for each $100,000 income increase. Results pertaining to homelessness and MRSA suggested transmission was related to patterns of frequent drug use, skin-to-skin contact and sexual contact more than shelter contact. Indigenous persons have high rates of CA-MRSA, with more rooms in the house being a significant protective factor (OR 0.86, p = 0.023). One study found household income over $60,000 (OR 0.83, p = 0.039) in univariate analysis and higher maternal education (OR 0.76, 95%CI 0.63–0.92, p = 0.005) in multivariate analysis were protective for otitis media due to an ARO among children. Twenty of 43 (46.5%) articles pertained to tuberculosis (TB). Foreign-born persons were four times more likely to have resistant TB compared to Canadian-born persons. None of the 20 studies used income in their analyses. Conclusions There is an association between higher income and protection from CA-MRSA. Mixed results exist regarding the impact of homelessness and MRSA, demonstrating a nuanced relationship with behavioural risk factors. Higher income and maternal education were associated with reduced ARO-associated acute otitis media in children in one study. We do not have a robust understanding of the social measures of marginalization related to being foreign-born that contribute to higher rates of resistant TB infection. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-022-01059-1.
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Ceccarelli M, Venanzi Rullo E, Berretta M, Cacopardo B, Pellicanò GF, Nunnari G, Guarneri C. New generation biologics for the treatment of psoriasis and psoriatic arthritis. State of the art and considerations about the risk of infection. Dermatol Ther 2020; 34:e14660. [PMID: 33301216 DOI: 10.1111/dth.14660] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 12/04/2020] [Indexed: 02/06/2023]
Abstract
Psoriasis is a chronic immune-mediated disease characterized by inflammation of skin (psoriasis) or joints (psoriatic arthritis) or both, resulting from a dysregulation in particular of the T helper (Th)17 functions. There is no available cure for psoriasis, and a life-long treatment is needed to control signs and symptoms. Research interest is high around the newest biological drugs approved for the treatment of moderate to severe psoriasis and psoriatic arthritis, and especially drugs blocking the IL-23/IL-17 axis. Our aim is to review the new biological drugs for the treatment of psoriasis and their adverse effects, focusing on the risk of infections.
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Affiliation(s)
- Manuela Ceccarelli
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Department of Biomedical and Dental Sciences and Morpho Functional Imaging, University of Messina, Messina, Italy
| | - Emmanuele Venanzi Rullo
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Massimiliano Berretta
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Bruno Cacopardo
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | | | - Giuseppe Nunnari
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Claudio Guarneri
- Department of Biomedical and Dental Sciences and Morpho Functional Imaging, University of Messina, Messina, Italy
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Rivillas-García JC, Sanchez SM, Rivera-Montero D. [Social inequalities related to antimicrobial resistance in N. gonorrhoeae in ColombiaDesigualdades sociais relacionadas à resistência antimicrobiana de N. gonorrhoeae na Colômbia]. Rev Panam Salud Publica 2020; 44:e49. [PMID: 32973901 PMCID: PMC7498285 DOI: 10.26633/rpsp.2020.49] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 03/12/2020] [Indexed: 11/29/2022] Open
Abstract
Objetivo. Medir desigualdades sociales en la resistencia antimicrobiana de la Neisseria gonorrhoeae en Colombia. Métodos. Estudio ecológico utilizando un multipanel de datos desagregado a nivel subnacional de los aislamientos en la N. gonorrhoeae como proxy de resistencia antimicrobiana (RAM) entre 2009 y 2018. Se llevó a cabo una caracterización sociodemográfica, un análisis de la sensibilidad antimicrobiana de aislamientos de N. gonorrhoeae, y una medición de desigualdades en la RAM para la N. gonorrhoeae mediante el índice de desigualdad de la pendiente, el índice de desigualdad relativo y el índice de concentración. Resultados. Los hallazgos indican resistencia antimicrobiana de aislamientos de N. gonorrhoeae a penicilina (50,7%) y tetraciclina (67,3%); y la existencia de desigualdades absolutas y relativas durante el período analizado. Las barreras de acceso a servicios de salud, no haber recibido información de prevención de las infecciones de transmisión sexual, necesidades básicas insatisfechas y analfabetismo explicaron las desigualdades en la RAM de la N. gonorrhoeae. Conclusiones. Seis recomendaciones emergen para contener en gran medida la RAM en la N. gonorrhoeae: i) aumentar conciencia sobre la salud sexual y reproductiva segura; ii) repensar cómo entregar mensajes claves con enfoque de equidad; iii) mejorar los sistemas de información, prescripción y cadena de medicamentos; iv) crear coaliciones para mejorar la respuesta y compartir objetivos con el sector privado; v) mejorar la disponibilidad y desagregación de los datos; y vi) apoyar investigaciones en desigualdades en RAM.
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Affiliation(s)
- Juan Carlos Rivillas-García
- Dirección de Investigaciones, Asociación Profamilia Bogotá D.C. Colombia Dirección de Investigaciones, Asociación Profamilia, Bogotá, D.C., Colombia
| | - Sandra Marcela Sanchez
- Dirección de Investigaciones, Asociación Profamilia Bogotá D.C. Colombia Dirección de Investigaciones, Asociación Profamilia, Bogotá, D.C., Colombia
| | - Danny Rivera-Montero
- Dirección de Investigaciones, Asociación Profamilia Bogotá D.C. Colombia Dirección de Investigaciones, Asociación Profamilia, Bogotá, D.C., Colombia
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Chen XS, Yin YP, Li XY. A ROADMAP Plan to Address Research Needs for Gonococcal Antimicrobial Resistance in China. Clin Infect Dis 2020; 68:505-510. [PMID: 29985996 DOI: 10.1093/cid/ciy566] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/08/2018] [Indexed: 12/30/2022] Open
Abstract
Gonococcal antimicrobial resistance (AMR) has become a global threat significantly hampering the control of gonorrhea. Many socioeconomic, biological, behavioral, and programmatic factors have played an important role in driving the emergence, transmission and spread of gonococcal AMR. However, research to address these scientific and programmatic questions is limited in China. Here we propose a ROADMAP (acronym for resistance surveillance, outcomes due to AMR, antibiotic stewardship and application, diagnostic tools, mechanisms of AMR, antimicrobial assessment, and population pharmacokinetics and pharmacodynamics) plan for expanding interdisciplinary collaborations to address the research needs in China.
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Affiliation(s)
- Xiang-Sheng Chen
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, China.,National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, China
| | - Yue-Ping Yin
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, China.,National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, China
| | - Xin-Yu Li
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, China
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Hofstraat SH, Götz HM, van Dam AP, van der Sande MA, van Benthem BH. Trends and determinants of antimicrobial susceptibility of Neisseria gonorrhoeae in the Netherlands, 2007 to 2015. ACTA ACUST UNITED AC 2019; 23. [PMID: 30205870 PMCID: PMC6134804 DOI: 10.2807/1560-7917.es.2018.23.36.1700565] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Sanne Hi Hofstraat
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, the Netherlands
| | - Hannelore M Götz
- Department of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, the Netherlands.,National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, the Netherlands
| | - Alje P van Dam
- Public Health Laboratory, Amsterdam Health Service, Amsterdam, the Netherlands
| | - Marianne Ab van der Sande
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, the Netherlands.,National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, the Netherlands
| | - Birgit Hb van Benthem
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, the Netherlands
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França ISXD, Coura AS, Sousa FSD, Aragão JDS, Silva AFR, Santos SRD. Acquiring of knowledge about sexual health by blind people: an action research. Rev Lat Am Enfermagem 2019; 27:e3163. [PMID: 31340347 PMCID: PMC6687357 DOI: 10.1590/1518-8345.3006.3163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/08/2019] [Indexed: 11/22/2022] Open
Abstract
Objective: to evaluate knowledge about sexual health, with blind people, before and
after educational intervention. Method: action research conducted with 58 blind people enrolled in a philanthropic
educational institution. A form with sociodemographic and knowledge
variables about Sexually Transmitted Infections was used. The Chi-square and
Fisher tests were performed. Results: men presented higher frequency of alcoholism (p <0.001) and illicit drugs
(p = 0.006). It was found that they used a male condom more frequently than
women using a female condom (p = 0.003), although they had more knowledge
about the prevention of Sexually Transmitted Infections (p = 0.006). Among
these infections, Trichomonas vaginalis (52.4%) was more frequent. Knowledge
gaps on risk factors and safe sex were identified. After the intervention,
an increase in the knowledge about sexual health was detected. Conclusion: the educational intervention, in the light of problematizing pedagogy, (re)
constructed the knowledge on sexual health, empowering the participants
regarding the prevention of Sexually Transmitted Infections. Therefore, it
is necessary that nurses carry out educational interventions with this
clientele, aiming to soften deficits of knowledge about the thematic in
screen.
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Affiliation(s)
| | | | | | - Jamilly da Silva Aragão
- Universidade Estadual da Paraíba, Campina Grande, PB, Brasil.,Universidade de Pernambuco, Recife, PE, Brasil.,Bolsista da Fundação de Amparo a Ciência e Tecnologia do Estado de Pernambuco (FACEPE), Brasil
| | - Arthur Felipe Rodrigues Silva
- Universidade Estadual da Paraíba, Campina Grande, PB, Brasil.,Universidade de Pernambuco, Recife, PE, Brasil.,Bolsista da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brasil
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George CRR, Enriquez RP, Gatus BJ, Whiley DM, Lo YR, Ishikawa N, Wi T, Lahra MM. Systematic review and survey of Neisseria gonorrhoeae ceftriaxone and azithromycin susceptibility data in the Asia Pacific, 2011 to 2016. PLoS One 2019; 14:e0213312. [PMID: 30943199 PMCID: PMC6447224 DOI: 10.1371/journal.pone.0213312] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 02/18/2019] [Indexed: 02/04/2023] Open
Abstract
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.
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Affiliation(s)
- C. R. Robert George
- WHO Collaborating Centre for Sexually Transmitted Infections and Antimicrobial Resistance, New South Wales Health Pathology, Microbiology, Prince of Wales Hospital, Randwick, New South Wales, Australia
- New South Wales Health Pathology, Microbiology, Prince of Wales Hospital, Randwick, New South Wales, Australia
- * E-mail:
| | - Rodney P. Enriquez
- WHO Collaborating Centre for Sexually Transmitted Infections and Antimicrobial Resistance, New South Wales Health Pathology, Microbiology, Prince of Wales Hospital, Randwick, New South Wales, Australia
- New South Wales Health Pathology, Microbiology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Barrie J. Gatus
- New South Wales Health Pathology, Microbiology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - David M. Whiley
- Faculty of Medicine, UQ Centre for Clinical Research, The University of Queensland, Herston, Queensland, Australia
- Pathology Queensland, Microbiology Department, Herston, Queensland, Australia
| | - Ying-Ru Lo
- World Health Organization, Office for Malaysia, Brunei Darussalam and Singapore, Kuala Lumpur, Malaysia
| | - Naoko Ishikawa
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Teodora Wi
- Department of Reproductive Health and Research, World Health Organization, Geneva Switzerland
| | - Monica M. Lahra
- WHO Collaborating Centre for Sexually Transmitted Infections and Antimicrobial Resistance, New South Wales Health Pathology, Microbiology, Prince of Wales Hospital, Randwick, New South Wales, Australia
- New South Wales Health Pathology, Microbiology, Prince of Wales Hospital, Randwick, New South Wales, Australia
- School of Medical Sciences, The University of New South Wales, Sydney, New South Wales, Australia
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Sood S, Mahajan N, Singh R, Agrawal SK, Shende T, Kapil A, Kar HK, Sharma VK. Typing of Neisseria gonorrhoeae isolates by phenotypic and genotypic techniques in New Delhi, India. J Lab Physicians 2019; 11:45-50. [PMID: 30983802 PMCID: PMC6437833 DOI: 10.4103/jlp.jlp_107_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/26/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The objective of this study is to investigate gonococcal isolates using phenotypic and genotypic methods. METHODOLOGY Sixty gonococcal isolates obtained were examined. Strains were divided into 9 resistant phenotypes: Chromosomally mediated penicillin-resistant Neisseria gonorrhoeae (CMRNGP), penicillinase-producing NG (PPNG), chromosomally mediated tetracycline-resistant NG (CMRNGT), TRNG, PPNG and TRNG, CMRNGPT, quinolone resistant NG (QRNG), Azithro R, and decreased susceptibility (DS) to ceftriaxone. These isolates were also subjected to auxotyping and NG-multi-antigen sequence typing (MAST). RESULTS Of 60 isolates, 32 (53.33%) PPNG and only one was CMRNGP; 16 (26.66%) were CMRNGT, while 18 (30%) were TRNG. Both PPNG and TRNG found in 13 (21.66%) and none were CMRNGPT. QRNG was seen in 93.33%, 5% Azithromycin R, and 6.66% were DS to ceftriaxone. Based on auxotyping, 24 (40%) nonrequiring, 16 (26.66%) were proline requiring, 13 (21.66%) arginine requiring while 7 (11.66%) belonged to others. The most common ST was 6058 (32.5%). The discriminatory indices of antibiogram, auxotyping and NG-MAST were 0.77, 0.72, and 0.95, respectively. CONCLUSIONS NG-MAST is the method of choice for epidemiological studies.
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Affiliation(s)
- Seema Sood
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Neeraj Mahajan
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajendra Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sonu Kumari Agrawal
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Trupti Shende
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Arti Kapil
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Hemanta K. Kar
- Department of Dermatology, STDs and Leprosy, PGIMER and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Vinod K. Sharma
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
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Sirivongrangson P, Girdthep N, Sukwicha W, Buasakul P, Tongtoyai J, Weston E, Papp J, Wi T, Cherdtrakulkiat T, Dunne EF. The first year of the global Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP) in Bangkok, Thailand, 2015-2016. PLoS One 2018; 13:e0206419. [PMID: 30412586 PMCID: PMC6226150 DOI: 10.1371/journal.pone.0206419] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 10/13/2018] [Indexed: 11/18/2022] Open
Abstract
Antimicrobial-resistant Neisseria gonorrhoeae (NG) infection is a global public health threat, and there is a critical need to monitor patterns of resistance and risk factors. In collaboration with the World Health Organization (WHO), the U.S. Centers for Disease Control and Prevention (CDC), and the Thailand Department of Disease Control (DDC), Ministry of Public Health (MoPH) implemented the first Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP) in November 2015. Men presenting with urethritis at two clinical settings in Bangkok, Thailand (Bangrak Hospital [BH] and Silom Community Clinic @TropMed [SCC @TropMed]) provided demographic and behavioral information and had a urethral swab for Gram's stain and NG culture collected. The NG isolates were evaluated for antimicrobial susceptibility by the Epsilometer test (Etest) to determine minimum inhibitory concentrations (MICs) for cefixime (CFM), ceftriaxone (CRO), azithromycin (AZI), gentamicin (GEN), and ciprofloxacin (CIP). From November 2015 -October 2016, 1,102 specimens were collected from 1,026 symptomatic men; 861 (78.1%) specimens were from BH and 241 (21.9%) specimens were from SCC @TropMed. Among the 1,102 specimens, 582 (52.8%) had intracellular Gram-negative diplococci and 591 (53.6%) had NG growth (i.e., NG infection); antimicrobial susceptibility testing (AST) was performed on 590 (99.8%) NG isolates. Among all symptomatic men, 293 (28.6%) had sex with men only, 430 (41.9%) were ages 18-29 years, 349 (34.0%) had antibiotic use in the last 2 weeks, and 564 (55.0%) had NG infection. Among 23 men with repeat NG infection during this first year of surveillance, 20 (87.0%) were infected twice, 2 (8.7%) were infected three times, and 1 (4.3%) was infected more than four times. All NG isolates were susceptible to CFM and CRO, and had MICs below 2 μg/mL for AZI and below 16 μg/mL for GEN. Overall, 545 (92.4%) isolates were resistant to CIP. This surveillance activity assessed individual patients, and included demographic and behavioral data linked to laboratory data. The inclusion of both individual and laboratory information in EGASP could help identify possible persistent infection and NG treatment failures. Expansion of EGASP to additional global settings is critical to assess trends and risk factors for NG, and to monitor for the emergence of resistance.
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Affiliation(s)
| | - Natnaree Girdthep
- Department of Disease Control, Thailand Ministry of Public Health, Nonthaburi, Thailand
| | - Wichuda Sukwicha
- Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Prisana Buasakul
- Department of Disease Control, Thailand Ministry of Public Health, Nonthaburi, Thailand.,Bangrak STIs Center, Bureau of AIDS, TB, and STIs, Bangkok, Thailand
| | - Jaray Tongtoyai
- Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Emily Weston
- Division of STD Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - John Papp
- Division of STD Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Teodora Wi
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Thitima Cherdtrakulkiat
- Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Eileen F Dunne
- Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.,Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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11
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Alividza V, Mariano V, Ahmad R, Charani E, Rawson TM, Holmes AH, Castro-Sánchez E. Investigating the impact of poverty on colonization and infection with drug-resistant organisms in humans: a systematic review. Infect Dis Poverty 2018; 7:76. [PMID: 30115132 PMCID: PMC6097281 DOI: 10.1186/s40249-018-0459-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 07/09/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Poverty increases the risk of contracting infectious diseases and therefore exposure to antibiotics. Yet there is lacking evidence on the relationship between income and non-income dimensions of poverty and antimicrobial resistance. Investigating such relationship would strengthen antimicrobial stewardship interventions. METHODS A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Ovid, MEDLINE, EMBASE, Scopus, CINAHL, PsychINFO, EBSCO, HMIC, and Web of Science databases were searched in October 2016. Prospective and retrospective studies reporting on income or non-income dimensions of poverty and their influence on colonisation or infection with antimicrobial-resistant organisms were retrieved. Study quality was assessed with the Integrated quality criteria for review of multiple study designs (ICROMS) tool. RESULTS Nineteen articles were reviewed. Crowding and homelessness were associated with antimicrobial resistance in community and hospital patients. In high-income countries, low income was associated with Streptococcus pneumoniae and Acinetobacter baumannii resistance and a seven-fold higher infection rate. In low-income countries the findings on this relation were contradictory. Lack of education was linked to resistant S. pneumoniae and Escherichia coli. Two papers explored the relation between water and sanitation and antimicrobial resistance in low-income settings. CONCLUSIONS Despite methodological limitations, the results suggest that addressing social determinants of poverty worldwide remains a crucial yet neglected step towards preventing antimicrobial resistance.
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Affiliation(s)
- Vivian Alividza
- NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK
| | - Victor Mariano
- NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK
| | - Raheelah Ahmad
- NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK
- Health Group, Management Department, Imperial College Business School, Exhibition Road, London, UK
| | - Esmita Charani
- NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK
| | - Timothy M. Rawson
- NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK
| | - Alison H. Holmes
- NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK
| | - Enrique Castro-Sánchez
- NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK
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12
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Sood S, Agarwal M, Bala M, Mahajan N, Singh R, Kapil A, Sreenivas V, Ram RJ, Kar HK, Sharma VK. Exploring quinolone resistance-determining region in Neisseria gonorrhoeae isolates from across India. Indian J Med Res 2018; 146:S64-S69. [PMID: 29205198 PMCID: PMC5735573 DOI: 10.4103/ijmr.ijmr_730_15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background & objectives: Antimicrobial resistance in Neisseria gonorrhoeae, the causative agent of gonorrhoea, is a subject of worldwide attention. The present study was undertaken to examine the rates of ciprofloxacin resistance, to correlate mutations in gyrA and parC genes with the level of resistance and to look for a variation in mutation pattern, if any, in isolates from across the country. Methods: A total of 113 isolates of N. gonorrhoeae collected from sexually transmitted infection patients in six centres during November 2010 to October 2013 were investigated. Minimum inhibitory concentration (MIC) determination was done by E-test and results interpreted as per Calibrated Dichotomous Sensitivity criteria. DNA sequence analysis of gyrA and parC genes was done. Results: Of the 113 isolates, only three (2.6%) were susceptible whereas eight (7.07%) were less susceptible, 32 [28.3%, 95% confidence interval (CI): 20.4-37.6%] resistant (MIC 1-3 µg/ml) and 70 (61.9%, 95% CI: 52.2-70.7%) exhibited high-level resistance (HLR) (MIC ≥4 µg/ml) to ciprofloxacin. A S91F substitution in gyrA gene was demonstrated in all ciprofloxacin non-susceptible isolates. All resistant and HLR isolates had a double mutation in gyrA gene. However, only 5.7 per cent of HLR isolates showed double mutations in parC gene. One isolate (MIC 32 µg/ml) had a previously undescribed G85D substitution in the parC gene. Interpretation & conclusions: A S91F substitution in gyrA gene was seen in all non-susceptible isolates of N. gonorrhoeae. It may be used as a marker for ciprofloxacin resistance for molecular surveillance approaches to complement the culture-based methods.
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Affiliation(s)
- Seema Sood
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Madhav Agarwal
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Manju Bala
- Apex Regional STD, Teaching, Training & Research Centre, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Neeraj Mahajan
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajendra Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Arti Kapil
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - R J Ram
- Department of Dermatology, Lal Bahadur Shastri Hospital, Delhi, India
| | - Hemanta Kumar Kar
- Department of Dermatology, STDs & Leprosy, Postgraduate Institute of Medical Education and Research & Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Vinod Kumar Sharma
- Department of Dermatology & Venereology, All India Institute of Medical Sciences, New Delhi, India
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13
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Abraha M, Egli-Gany D, Low N. Epidemiological, behavioural, and clinical factors associated with antimicrobial-resistant gonorrhoea: a review. F1000Res 2018; 7:400. [PMID: 29636908 PMCID: PMC5871945 DOI: 10.12688/f1000research.13600.1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2018] [Indexed: 01/03/2023] Open
Abstract
Antimicrobial-resistant
Neisseria gonorrhoeae is a global public health problem in the 21st century.
N. gonorrhoeae has developed resistance to all classes of antibiotics used for empirical treatment, and clinical treatment failure caused by extensively resistant strains has been reported. Identifying specific factors associated with an increased risk of antimicrobial-resistant
N. gonorrhoeae might help to develop strategies to improve antimicrobial stewardship. In this review, we describe the findings of 24 studies, published between 1989 and 2017, that examined epidemiological, behavioural, and clinical factors and their associations with a range of antimicrobial agents used to treat gonorrhoea. Antimicrobial-resistant
N. gonorrhoeae is more common in older than younger adults and in men who have sex with men compared with heterosexual men and women. Antimicrobial-resistant
N. gonorrhoeae is less common in some black minority and Aboriginal ethnic groups than in the majority white population in high-income countries. The factors associated with antimicrobial-resistant gonorrhoea are not necessarily those associated with a higher risk of gonorrhoea.
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Affiliation(s)
- Million Abraha
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland
| | - Dianne Egli-Gany
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland
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14
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Yin YP, Han Y, Dai XQ, Zheng HP, Chen SC, Zhu BY, Yong G, Zhong N, Hu LH, Cao WL, Zheng ZJ, Wang F, Zhi Q, Zhu XY, Chen XS. Susceptibility of Neisseria gonorrhoeae to azithromycin and ceftriaxone in China: A retrospective study of national surveillance data from 2013 to 2016. PLoS Med 2018; 15:e1002499. [PMID: 29408881 PMCID: PMC5800545 DOI: 10.1371/journal.pmed.1002499] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 01/02/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Gonorrhea remains one of the most common sexually transmitted diseases worldwide. Successful treatment has been hampered by emerging resistance to each of the antibiotics recommended as first-line therapies. We retrospectively analyzed the susceptibility of gonorrhea to azithromycin and ceftriaxone using data from the China Gonococcal Resistance Surveillance Programme (China-GRSP) in order to provide evidence for updating the treatment recommendations in China. METHODS AND FINDINGS In this study, we included 3,849 isolates collected from patients with a confirmed positive Neisseria gonorrhoeae (N. gonorrhoeae) culture at clinic visits during the period of 1 January 2013 through 31 December 2016 in 7 provinces. Antimicrobial susceptibility testing of gonorrhea isolates using agar dilution was conducted to determine minimum inhibitory concentration (MIC). Resistance to azithromycin (RTA) was defined as MIC ≥ 1.0 mg/l, and decreased susceptibility to ceftriaxone (DSC) was defined as MIC ≥ 0.125 mg/l. The prevalence of isolates with RTA was 18.6% (710/3,827; 95% CI 17.4%-19.8%). The percentage of patients with DSC fluctuated between 9.7% and 12.2% over this period. The overall prevalence of isolates with both RTA and DSC was 2.3% (87/3,827; 95% CI 1.9%-2.8%) and it increased from 1.9% in 2013 to 3.3% in 2016 (chi-squared test for trend, P = 0.03). Study limitations include the retrospective study design and potential biases in the sample, which may overrepresent men with symptomatic infection, coastal residents, and people reporting as heterosexual. CONCLUSIONS To our knowledge, this is the first national study on susceptibility of N. gonorrhoeae to azithromycin and ceftriaxone in China. Our findings indicate high rates of RTA and DSC from 2013 to 2016. Although dual therapy with azithromycin and ceftriaxone has been recommended by WHO and many countries to treat gonorrhea, reevaluation of this therapy is needed prior to its introduction in China.
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Affiliation(s)
- Yue-Ping Yin
- National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, China
- Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, China
| | - Yan Han
- National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, China
- Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, China
| | - Xiu-Qin Dai
- National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, China
- Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, China
| | - He-Ping Zheng
- Dermatology Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Dermatology Hospital, Guangzhou, China
| | - Shao-Chun Chen
- National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, China
- Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, China
| | - Bang-Yong Zhu
- Institute of Dermatology, Guangxi Autonomous Region, Nanning, China
| | - Gang Yong
- Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
| | - Na Zhong
- Hainan Provincial Center for STD/Skin Disease Control and Prevention, Haikou, China
| | - Li-Hua Hu
- Zhejiang Provincial Institute of Dermatology, Deqing, China
| | - Wen-Ling Cao
- Guangzhou Institute of Dermatology, Guangzhou, China
| | - Zhong-Jie Zheng
- Tianjin Center for Disease Control and Prevention, Tianjin, China
| | - Feng Wang
- Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Qi Zhi
- Xinjiang Center for Disease Control and Prevention, Urumqi, China
| | - Xiao-Yu Zhu
- National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, China
- Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, China
| | - Xiang-Sheng Chen
- National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, China
- Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, China
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15
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Wind CM, Bruisten SM, Schim van der Loeff MF, Dierdorp M, de Vries HJC, van Dam AP. A Case-Control Study of Molecular Epidemiology in Relation to Azithromycin Resistance in Neisseria gonorrhoeae Isolates Collected in Amsterdam, the Netherlands, between 2008 and 2015. Antimicrob Agents Chemother 2017; 61:e02374-16. [PMID: 28373191 PMCID: PMC5444120 DOI: 10.1128/aac.02374-16] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 03/24/2017] [Indexed: 12/30/2022] Open
Abstract
Neisseria gonorrhoeae resistance to ceftriaxone and azithromycin is increasing, which threatens the recommended dual therapy. We used molecular epidemiology to identify N. gonorrhoeae clusters and associations with azithromycin resistance in Amsterdam, the Netherlands. N. gonorrhoeae isolates (n = 143) were selected from patients visiting the Amsterdam STI Outpatient Clinic from January 2008 through September 2015. We included all 69 azithromycin-resistant isolates (MIC ≥ 2.0 mg/liter) and 74 frequency-matched susceptible controls (MIC ≤ 0.25 mg/liter). The methods used were 23S rRNA and mtrR sequencing, N. gonorrhoeae multiantigen sequence typing (NG-MAST), N. gonorrhoeae multilocus variable-number tandem-repeat analysis (NG-MLVA), and a specific PCR to detect mosaic penA genes. A hierarchical cluster analysis of NG-MLVA related to resistance and epidemiological characteristics was performed. Azithromycin-resistant isolates had C2611T mutations in 23S rRNA (n = 62, 89.9%, P < 0.001) and were NG-MAST genogroup G2992 (P < 0.001), G5108 (P < 0.001), or G359 (P = 0.02) significantly more often than susceptible isolates and were more often part of NG-MLVA clusters (P < 0.001). Two resistant isolates (2.9%) had A2059G mutations, and five (7.3%) had wild-type 23S rRNA. No association between mtrR mutations and azithromycin resistance was found. Twenty-four isolates, including 10 azithromycin-resistant isolates, showed reduced susceptibility to extended-spectrum cephalosporins. Of these, five contained a penA mosaic gene. Four of the five NG-MLVA clusters contained resistant and susceptible isolates. Two clusters consisting mainly of resistant isolates included strains from men who have sex with men and from heterosexual males and females. The co-occurrence of resistant and susceptible strains in NG-MLVA clusters and the frequent occurrence of resistant strains outside of clusters suggest that azithromycin resistance develops independently from the background genome.
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Affiliation(s)
- Carolien M Wind
- STI Outpatient Clinic, Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
- Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Sylvia M Bruisten
- Public Health Laboratory, Public Health Service Amsterdam, Amsterdam, the Netherlands
| | - Maarten F Schim van der Loeff
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
- Center for Infection and Immunity Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Mirjam Dierdorp
- Public Health Laboratory, Public Health Service Amsterdam, Amsterdam, the Netherlands
| | - Henry J C de Vries
- STI Outpatient Clinic, Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
- Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Center for Infection and Immunity Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Alje P van Dam
- Public Health Laboratory, Public Health Service Amsterdam, Amsterdam, the Netherlands
- Department of Medical Microbiology, OLVG General Hospital, Amsterdam, the Netherlands
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16
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Wind CM, Schim van der Loeff MF, van Dam AP, de Vries HJ, van der Helm JJ. Trends in antimicrobial susceptibility for azithromycin and ceftriaxone in Neisseria gonorrhoeae isolates in Amsterdam, the Netherlands, between 2012 and 2015. ACTA ACUST UNITED AC 2017; 22:30431. [PMID: 28079519 PMCID: PMC5388096 DOI: 10.2807/1560-7917.es.2017.22.1.30431] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 10/10/2016] [Indexed: 11/20/2022]
Abstract
Resistance of Neisseria gonorrhoeae to azithromycin and ceftriaxone has been increasing in the past years. This is of concern since the combination of these antimicrobials is recommended as the first-line treatment option in most guidelines. To analyse trends in antimicrobial resistance, we retrospectively selected all consultations with a positive N. gonorrhoeae culture at the sexually transmitted infection clinic, Amsterdam, the Netherlands, from January 2012 through September 2015. Minimum inhibitory concentrations (MICs) for azithromycin and ceftriaxone were analysed per year, and determinants associated with decreased susceptibility to azithromycin (MIC > 0.25 mg/L) or ceftriaxone (MIC > 0.032 mg/L) were assessed. Between 2012 and 2015 azithromycin resistance (MIC > 0.5 mg/L) was around 1.2%, the percentage of isolates with intermediate MICs (> 0.25 and ≤ 0.5 mg/L) increased from 3.7% in 2012, to 8.6% in 2015. Determinants associated with decreased azithromycin susceptibility were, for men who have sex with men (MSM), infections diagnosed in the year 2014, two infected sites, and HIV status (HIV; associated with less decreased susceptibility); for heterosexuals this was having ≥ 10 sex partners (in previous six months). Although no ceftriaxone resistance (MIC > 0.125 mg/L) was observed during the study period, the proportion of isolates with decreased ceftriaxone susceptibility increased from 3.6% in 2012, to 8.4% in 2015. Determinants associated with decreased ceftriaxone susceptibility were, for MSM, infections diagnosed in 2014, and pharyngeal infections; and for heterosexuals, infections diagnosed in 2014 or 2015, being of female sex, and having ≥ 10 sex partners. Continued decrease of azithromycin and ceftriaxone susceptibility will threaten future treatment of gonorrhoea. Therefore, new treatment strategies are warranted.
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Affiliation(s)
- Carolien M Wind
- STI Outpatient Clinic, Department of Infectious Diseases Public Health Service Amsterdam, Amsterdam, the Netherlands.,Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Maarten F Schim van der Loeff
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands.,Center for Infection and Immunity Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Alje P van Dam
- Public Health Laboratory, Public Health Service Amsterdam, Amsterdam, the Netherlands.,Department of Medical Microbiology, Onze Lieve Vrouwe Gasthuis General Hospital, Amsterdam, the Netherlands
| | - Henry Jc de Vries
- STI Outpatient Clinic, Department of Infectious Diseases Public Health Service Amsterdam, Amsterdam, the Netherlands.,Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Center for Infection and Immunity Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jannie J van der Helm
- STI Outpatient Clinic, Department of Infectious Diseases Public Health Service Amsterdam, Amsterdam, the Netherlands.,Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
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17
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Fuertes de Vega I, Baliu-Piqué C, Bosch Mestres J, Vergara Gómez A, Vallés X, Alsina Gibert M. Risk factors for antimicrobial-resistant Neisseria gonorrhoeae and characteristics of patients infected with gonorrhea. Enferm Infecc Microbiol Clin 2017; 36:165-168. [PMID: 28094065 DOI: 10.1016/j.eimc.2016.11.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 11/10/2016] [Accepted: 11/14/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND There are very few data available regarding risk factors associated with antibiotic resistant-Neisseria gonorrhoeae. METHODS A study was conducted on 110 samples from 101 patients with gonococcal infection, in order to describe their characteristics and compare them with the antimicrobial susceptibility profile of their samples. RESULTS An association was observed between resistant infections and heterosexual men, older age, concurrent sexually transmitted infection, and unsafe sexual behaviors. CONCLUSION There is a need for improved data on the risk factors associated with antibiotic resistant gonococcal infection in order to identify risk groups, and to propose public health strategies to control this infection.
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Affiliation(s)
- Irene Fuertes de Vega
- Department of Dermatology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
| | - Carola Baliu-Piqué
- Department of Dermatology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Jordi Bosch Mestres
- Department of Microbiology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Andrea Vergara Gómez
- Department of Microbiology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Xavier Vallés
- Institut Català d'Oncologia, Unitat de Biomarcadors i Susceptibilitat, Barcelona, Spain
| | - Mercè Alsina Gibert
- Department of Dermatology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
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18
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Comparison of Antimicrobial Susceptibility of Urogenital Neisseria gonorrhoeae Isolates Obtained From Women and Men. Sex Transm Dis 2016; 42:434-9. [PMID: 26165435 DOI: 10.1097/olq.0000000000000312] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The US system for gonococcal antimicrobial susceptibility surveillance monitors trends exclusively among men with urethral infection, the population from whom the yield of gonococcal culture is highest. Little is known about the susceptibility of female urogenital isolates, and it is unclear whether gonococcal susceptibility among men who report sex exclusively with women (MSW) is representative of susceptibility among women. METHODS Using isolates collected during a recent treatment trial in 5 US cities, we performed a secondary analysis to compare antimicrobial susceptibilities of Neisseria gonorrhoeae urogenital isolates obtained from women, MSW, and men who have sex with men (MSM). Pretreatment isolates were collected from trial participants; minimum inhibitory concentrations (MICs) were determined by agar dilution. Geometric mean MICs were adjusted for geographic location using general linear models. RESULTS Susceptibility data for urogenital isolates from 56 women, 252 MSW, and 170 MSM were studied. The adjusted geometric mean ceftriaxone MIC was similar among women (0.0067 μg/mL; 95% confidence interval [CI], 0.0049-0.0092 μg/mL) and MSW (0.0060 μg/mL; 95% CI, 0.0053-0.0066 μg/mL). In contrast, the adjusted geometric mean ceftriaxone MIC was higher among MSM (0.0098 μg/mL; 95% CI, 0.0082-0.0119 μg/mL) than among MSW. This same pattern was observed for other antimicrobials, including cefixime and azithromycin CONCLUSIONS Ceftriaxone, cefixime, and azithromycin MICs were higher among MSM than among MSW, but were similar among women and MSW. These findings suggest that gonococcal antimicrobial susceptibility surveillance based on urethral isolates from MSW may adequately represent susceptibility of urogenital N. gonorrhoeae in women.
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19
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Zheng H, Wu X, Huang J, Qin X, Xue Y, Zeng W, Lan Y, Ou J, Tang S, Fang M. The prevalence and epidemiology of plasmid-mediated penicillin and tetracycline resistance among Neisseria gonorrhoeae isolates in Guangzhou, China, 2002-2012. BMC Infect Dis 2015; 15:412. [PMID: 26453557 PMCID: PMC4600260 DOI: 10.1186/s12879-015-1148-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 09/24/2015] [Indexed: 11/23/2022] Open
Abstract
Background Gonococcal antimicrobial resistance is a global problem. Different resistance plasmids have emerged and spread among the isolates of Neisseria gonorrhoeae worldwide and in China. We conducted this study to monitor the plasmid-mediated penicillin and tetracycline resistance among N. gonorrhoeae isolates in Guangzhou from 2002 to 2012. Methods Consecutive isolates of N. gonorrhoeae were collected from outpatients with gonorrhea attending the STD clinic in Guangdong Provincial Centre for Skin Diseases and STIs Control and Prevention. Penicillinase-producing N. gonorrhoeae (PPNG) isolates were analyzed by the paper acidometric method. Plasmid-mediated resistance to tetracycline in N. gonorrhoeae (TRNG) isolates was screened by the agar plate dilution method. Plasmid types were determined for TRNG and PPNG isolates using polymerase chain reaction (PCR). Minimum inhibitory concentrations (MICs) to penicillin and tetracycline were detected by the agar plate dilution. Results Of 1378 consecutive N. gonorrhoeae isolates, 429 PPNG and 639 TRNG isolates were identified. The prevalence of PPNG, TRNG, and PPNG/TRNG increased from 18.3 to 47.1 % (χ2 = 31.57, p < 0.001), from 29.4 to 52.1 % (χ2 = 16.28, p < 0.001) and from 10.0 to 26.2 % (χ2 = 10.46, p < 0.001) between 2002 and 2012, respectively. Genotyping of plasmids among PPNGs showed that the majority (93.7 %) of the isolates were the Asian type plasmids, while the African type plasmid emerged in 2008 and rapidly increased to 14.0 % in 2012 (χ2 = 25.03, p < 0.001). For TRNGs, all 639 isolates carried the Dutch type plasmid. MICs of penicillin G and tetracycline persisted at high levels and the MIC90s were 32-fold higher than the resistant cutoff point over 11 years. The prevalence rates of penicillin- and tetracycline-resistant N. gonorrhoeae varied from 90.9 to 91.1 % and from 88.3 to 89.3 % during 2002 to 2012, respectively. Conclusions Resistance to penicillin and tetracycline among N. gonorrhoeae isolates remained at high levels in Guangzhou. The Asian type PPNG continued to spread and Dutch type TRNG was still the dominant strain. The African type PPNG has emerged and is spreading rapidly.
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Affiliation(s)
- Heping Zheng
- Guangdong Provincial Centre for Skin Diseases and STIs Control and Prevention, Guangzhou, 510091, China.
| | - Xingzhong Wu
- Guangdong Provincial Centre for Skin Diseases and STIs Control and Prevention, Guangzhou, 510091, China.
| | - Jinmei Huang
- Guangdong Provincial Centre for Skin Diseases and STIs Control and Prevention, Guangzhou, 510091, China.
| | - Xiaolin Qin
- Guangdong Provincial Centre for Skin Diseases and STIs Control and Prevention, Guangzhou, 510091, China.
| | - Yaohua Xue
- Guangdong Provincial Centre for Skin Diseases and STIs Control and Prevention, Guangzhou, 510091, China.
| | - Weiying Zeng
- Guangdong Provincial Centre for Skin Diseases and STIs Control and Prevention, Guangzhou, 510091, China.
| | - Yinyuan Lan
- Guangdong Provincial Centre for Skin Diseases and STIs Control and Prevention, Guangzhou, 510091, China.
| | - Jiangli Ou
- Guangdong Provincial Centre for Skin Diseases and STIs Control and Prevention, Guangzhou, 510091, China.
| | - Sanmei Tang
- Guangdong Provincial Centre for Skin Diseases and STIs Control and Prevention, Guangzhou, 510091, China.
| | - Mingheng Fang
- Guangdong Provincial Centre for Skin Diseases and STIs Control and Prevention, Guangzhou, 510091, China.
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Abstract
BACKGROUND The European Gonococcal Antimicrobial Surveillance Programme performs antimicrobial resistance surveillance and is coordinated by the European Centre for Disease Prevention and Control. This study used epidemiological and behavioral data combined with the gonococcal susceptibility profiles to determine risk factors associated with harboring resistant gonococci in Europe. METHODS From 2009 to 2011, gonococcal isolates from 21 countries were submitted to the European Gonococcal Antimicrobial Surveillance Programme for antimicrobial susceptibility testing. Patient variables associated with resistance to azithromycin, cefixime, and ciprofloxacin were identified using univariate and multivariable logistic regression analyses of odds ratios. Geometric means for ceftriaxone and cefixime minimum inhibitory concentrations (MICs) were compared for patients of different sexual orientation and sex. RESULTS A total of 5034 gonococcal isolates were tested from 2009 to 2011. Isolates exhibiting resistance to cefixime (MIC > 0.125 mg/L) and ciprofloxacin (MIC > 0.5 mg/L) were significantly associated with infection in heterosexuals (males only for ciprofloxacin), older patients (>25 years of age), or those without a concurrent chlamydial infection in the multivariable analysis. The geometric mean of cefixime and ceftriaxone MICs decreased from 2009 to 2011, most significantly for men who have sex with men, and isolates from male heterosexuals exhibited the highest MICs in 2011. CONCLUSIONS The linking of epidemiological and behavioral data to the susceptibility profiles of the gonococcal isolates has allowed those at higher risk for acquiring antimicrobial resistant Neisseria gonorrhoeae to be identified. Improved data numbers and representativeness are required before evidence-based risk groups can be identified, and subsequent focused treatments or public health intervention strategies can be initiated with confidence.
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Identification of demographic and behavioral risk factors for antibiotic resistant gonorrhea infections to combat the emergence of potentially untreatable infections. Sex Transm Dis 2015; 41:730-1. [PMID: 25581809 DOI: 10.1097/olq.0000000000000214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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