Worldwide Susceptibility Rates of Neisseria gonorrhoeae Isolates to Cefixime and Cefpodoxime: A Systematic Review and Meta-Analysis

Abstract

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 findingsTwo 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).ConclusionsThe 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.

Global travel and HIV/STI epidemics among MSM: what does the future hold?

“…In their global systematic review and meta-analysis, Yu et al compared cefixime susceptibility rates of NG isolates across 21 studies and found that NG isolates from men had a lower cefixime susceptibility rate than isolates from the mixed group of men and women and the group where biological sex was not provided. 40 Among MSM specifically, gonococcal surveillance in the US from 2005 to 2010 and from 2006 to 2012 showed that MSM exhibited higher prevalence of microbial resistance compared with men who have sex exclusively with women. 41,42 Kirkcaldy et al hypothesised this higher level of resistance could be attributed to exposure to sexual partnerships during international travel or at group events where participants travelled from various geographic locations.…”

Modern aspects of epidemiological surveillance of gonococcal infection spread

“…В метаанализе [65], посвященном обзору публи-каций на тему распространения штаммов N. gonorrhoeae с пониженной чувствительностью к цефиксиму и цефродоксину, цефалоспоринам III поколения, принимаемым перорально, показано, что чувствительность N. gonorrhoeae к данным пре-паратам зависит от пола пациентов и географиче-ского региона, в котором производился сбор штам-мов возбудителя. Отмечено, что среди мужчин про-цент штаммов со сниженными показателями чув-ствительности к цефиксиму и цефродоксину выше, чем в популяциях с необозначенной гендерной при-надлежностью или у женщин [39,[66][67][68][69][70].…”

“…Выявлено, что в странах Азии (в особенности в Японии) штаммы N. gonorrhoeae со сниженной чув-ствительностью к пероральным цефалоспоринам III поколения встречаются чаще, чем в Европе и Север-ной Америке [65]. Наибольшее число изолятов N. gonorrhoeae со сниженной чувствительностью к пероральным цефалоспоринам III поколения -це-фиксиму и цефродоксину -получено в США [65].…”

“…Наибольшее число изолятов N. gonorrhoeae со сниженной чувствительностью к пероральным цефалоспоринам III поколения -це-фиксиму и цефродоксину -получено в США [65].…”

“…На основании проведенных исследований пре-парат цефалоспоринового ряда цефиксим был ис-ключен из терапии гонококковой инфекции как пре-парат выбора для лечения гонококковой инфекции в Японии, Австралии, странах Европы и США [65].…”