Background: Gonorrhea is on the rise in Canada. Treatment has been complicated by the fact that Neisseria gonorrhoeae has acquired resistance to many antibiotics, including penicillin, tetracycline, erythromycin and ciprofloxacin. The emergence of isolates with decreased susceptibilities to the third generation cephalosporins and reports of treatment failures in Canada and around the world are cause for concern.Objective: To assess the resistance levels of common antibiotics to N. gonorrhoeae and to observe trends in resistance and/or decreased susceptibility to ciprofloxacin, third generation cephalosporins and azithromycin.Methods: Laboratory surveillance data for N. gonorrhoeae isolates submitted by provincial microbiology laboratories to the National Microbiology Laboratory (NML) from 2009-2013 were compared. Results:Since 2009, there has been an overall rise in antibiotic-resistant N. gonorrhoeae. In 2013, 24.3% of the isolates were resistant to erythromycin, 18.9% were resistant to penicillin, 33.0% were resistant to tetracycline, and 29.3% were resistant to ciprofloxacin. The percentage of isolates with decreased susceptibility to ceftriaxone (≥0.125 mg/L) and/or cefixime (≥0.25 mg/L) was 3.9% in 2013. This number represents a decrease from 5.9% in 2012 and 7.6% in 2011. The proportion of azithromycin resistant (MIC ≥2 mg/L) N. gonorrhoeae isolates increased from 0.4% in 2009 to 1.2% in 2013. Conclusion:Resistance to erythromycin, penicillin, tetracycline and ciprofloxacin is common. Decreased susceptibility to ceftriaxone and/or cefixime is now almost 4% and azithromycin resistance is emerging but remains low at 1.2%. These results have informed the gonococcal infection treatment recommendations in the Canadian Guidelines on Sexually Transmitted Infections. Pen MIC ≥ 2.0 mg/L, Tet MIC ≥ 2.0 mg/L but ≤ 8.0 mg/L and Ery MIC ≥ 2.0 mg/L Probable CMRNG Probable Chromosomal Mediated Resistant N. gonorrhoeae One of the MIC values of Pen, Tet, Ery = 1 mg/L, the other two ≥ 2.0 mg/L TetR Tetracycline Resistant N. gonorrhoeae (chromosomal mediated) Tet MIC ≥ 2.0 mg/L but ≤ 8.0 mg/L CipR Ciprofloxacin Resistant N. gonorrhoeae Cip MIC ≥ 1.0 mg/L AzR Azithromycin Resistant N. gonorrhoeae Az MIC ≥ 2.0 mg/L SpecR Spectinomycin Resistant N. gonorrhoeae Spec R ≥ 128 mg/L CxDS N. gonorrhoeae with decreased susceptibility to Ceftriaxone Cx MIC ≥ 0.125 mg/L CeDS N. gonorrhoeae with decreased susceptibility to Cefixime Ce MIC ≥ 0.25 mg/L
Background GC constitutes the second most commonly reportable disease in the United States with over 320,000 cases annually. With the emergence of drug-resistant GC in the past 40 years, treatment options have become very limited. Hence, the U.S. Department of Defense has launched a GC resistance surveillance network in 8 countries; preliminary results are reported from the United States, Djibouti, Ghana, Kenya, and Peru. Methods Patients with urethritis, cervicitis or vaginitis symptoms were recruited at participating clinics serving military personnel and beneficiaries, civilians, and at-risk groups of men who have sex with men and female commercial sex workers. Urethral swabs were collected from men; urethral or vaginal swabs from women; diagnosis was done using culture identification, nucleic acid amplification testing, and real-time PCR. Antimicrobial susceptibility testing (AST) was conducted on GC positive isolates using real-time PCR, disc diffusion, and E-test strip methods. Results Overall, 108 (6%) of 1,694 enrolled subjects tested positive for GC. Prevalence was found to be highest in Kenya where 33 (38%) of 86 patients were positive and was lowest in Peru where only 30 (2%) of 1,296 patients were positive. AST results were available on 66 GC positives; resistance to at least three antibiotics was observed across all overseas sites. Greatest variability in resistance was noted in Djibouti as follows: penicillin (100%), tetracycline (88%), ciprofloxacin (38%), levofloxacin (17%), cefepime (13%), and ceftriaxone (13%). High-level resistance (100%) was also noted in Ghana to ciprofloxacin, penicillin, and tetracycline. Conclusion These findings provide evidence of emerging drugresistant GC in several regions of the world; the resistance found against third-generation cephalosporin in Djibouti is especially noteworthy. With continuing global vigilance, GC drug resistance information will provide an important basis for the development of effective control measures, particularly among deployable forces and at-risk populations in geographical regions of military relevance. (14) were collected from urethral swabs of men, 8 strains were isolated from female cervical swabs, gender was unknown for 2 cases (anonymous). AMR detected in 4 isolates; 2 were strains isolated after treatment failure: one -resistant to Pen, Tetra, Cipro and susceptible to Ceftriaxone; second -resistant to Pen, Tetra, Cipro and had decreased susceptibility (resistance) to Ceftriaxone (MIC 0.25mg/L). In addition in 2 isolates MICs to Ceftriaxone were 0.38mg/L and 0.50 mg/L. AMR were detected to penicillin (12.5%), to ciprofloxacin (8.4%) and to tetracycline (8.4%). Control, Vancouver, BC, Canada; 6 Saskatchewan Disease Control Laboratory, Regina, SK, Canada; 7 Public Health Agency of Canada, Ottawa, ON, Canada Background Neisseria gonorrhoeae have developed resistance to many antibiotics and current Canadian STI guidelines recommend azithromycin as part of a combination therapy for gonorrhoea. Methods Between 2010 and 2011, N....
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