Antimicrobial susceptibility in <i>Neisseria gonorrhoeae</i> isolates from five sentinel surveillance sites in Zimbabwe, 2015–2016

Latif, Ahmed S.; Gwanzura, Lovemore; Machiha, Anna; Ndowa, Francis; Tarupiwa, Andrew; Gudza-Mugabe, Muchaneta; Shukusho, Fungai D; Musanhu, Christine Chakanyuka; Wi, Teodora; Unemo, Magnus

doi:10.1136/sextrans-2016-053090

Cited by 20 publications

(20 citation statements)

References 24 publications

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“…4,67 To develop evidence-based treatment guidelines based on validated surveillance information, it is crucial to strengthen the WHO GASP and other GASPs (both more countries and more representative isolates), including the use of only MIC determination (agar dilution or MIC gradient strip tests) instead of different disc diffusion methods, and to monitor treatment failures. Strengthened AMR surveillance is especially urgent in the WHO AFR, where some progress has been made recently, 63,64,89 and in the EMR. In the SEAR and WPR, there has been a substantial increase in the number of countries providing surveillance data for both ceftriaxone and azithromycin, and in ceftriaxone MIC testing across the Asia-Pacific; 59 however, much more needs to be done in these regions because many ceftriaxone-resistant strains have originated from this region.…”

Section: Discussionmentioning

confidence: 99%

“…6 In 2016, only four of 47 WHO AFR countries (8.5%) provided ceftriaxone susceptibility data for 496 isolates and no DS/R was reported from Cote d'Ivoire, 63 South Africa or Zimbabwe. 64 However, one of 35 isolates (3.0%) from Madagascar showed DS/R to ceftriaxone, but this single isolate was not confirmed using MIC determination (Fig. 1).…”

Section: Ceftriaxone and Cefiximementioning

confidence: 91%

“…2). 64 In the WHO EMR, only Pakistan (4.5%; 1/22) provided ceftriaxone and cefixime susceptibility data for 64 isolates in 2016 and no DS/R to these ESCs was found (Figs 1, 2).…”

Section: Ceftriaxone and Cefiximementioning

confidence: 99%

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World Health Organization Global Gonococcal Antimicrobial Surveillance Program (WHO GASP): review of new data and evidence to inform international collaborative actions and research efforts

et al. 2019

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Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a serious public health problem, compromising the management and control of gonorrhoea globally. Resistance in N. gonorrhoeae to ceftriaxone, the last option for first-line empirical monotherapy of gonorrhoea, has been reported from many countries globally, and sporadic failures to cure especially pharyngeal gonorrhoea with ceftriaxone monotherapy and dual antimicrobial therapies (ceftriaxone plus azithromycin or doxycycline) have been confirmed in several countries. In 2018, the first gonococcal isolates with ceftriaxone resistance plus high-level azithromycin resistance were identified in England and Australia. The World Health Organization (WHO) Global Gonococcal Antimicrobial Surveillance Program (GASP) is essential to monitor AMR trends, identify emerging AMR and provide evidence for refinements of treatment guidelines and public health policy globally. Herein we describe the WHO GASP data from 67 countries in 2015–16, confirmed gonorrhoea treatment failures with ceftriaxone with or without azithromycin or doxycycline, and international collaborative actions and research efforts essential for the effective management and control of gonorrhoea. In most countries, resistance to ciprofloxacin is exceedingly high, azithromycin resistance is present and decreased susceptibility or resistance to ceftriaxone has emerged. Enhanced global collaborative actions are crucial for the control of gonorrhoea, including improved prevention, early diagnosis, treatment of index patient and partner (including test-of-cure), improved and expanded AMR surveillance (including surveillance of antimicrobial use and treatment failures), increased knowledge of correct antimicrobial use and the pharmacokinetics and pharmacodynamics of antimicrobials and effective drug regulations and prescription policies (including antimicrobial stewardship). Ultimately, rapid, accurate and affordable point-of-care diagnostic tests (ideally also predicting AMR and/or susceptibility), new therapeutic antimicrobials and, the only sustainable solution, gonococcal vaccine(s) are imperative.

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Section: Discussionmentioning

confidence: 99%

Section: Ceftriaxone and Cefiximementioning

confidence: 91%

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World Health Organization Global Gonococcal Antimicrobial Surveillance Program (WHO GASP): review of new data and evidence to inform international collaborative actions and research efforts

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“…Standardized monitoring of the antimicrobial susceptibility profile has been restricted to some nations in the developed world; such as the Gonococcal Isolate Surveillance Project (GISP) in the US and Gonococcal Resistance to Antimicrobials Surveillance Program (GRASP) in England and Wales [7] although some fragmented reports are available in Africa [31,32]. A recent review by Tilahun et al, (2017) showed that antimicrobial resistance (AMR) data is not at all available for > 40% of the African countries.…”

Section: Introductionmentioning

confidence: 99%

Azithromycin resistant gonococci: a literature review

Derbie

Mekonnen

Woldeamanuel

et al. 2020

Antimicrob Resist Infect Control

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Objective Gonorrhea is the second most common sexually transmitted bacterial infection (STI) next to Chlamydia. Untreated cases could results in major complications like pelvic inflammatory disease (PID), ectopic pregnancy, infertility, miscarriage, fetal death and congenital infections. Gonorrhea has been treated with antibiotics for more than eight decades. However, the emergence and spread of antimicrobial resistance (AMR) in gonococcus seriously compromises the management of the disease. The aim of this review was to describe the current developments in the field of azithromycin resistant gonococci. Methods Literatures published in English in the last 10 years were retrieved from PubMed, SCOPUS, Google scholar, Cochrane library and the Google databases using relevant searching terms. Results Gonococcus is capable of using a number of strategies to confer resistance as the bacterium has an extraordinary capacity to alter its genome. So far the accumulated data on the field showed that the world is heading towards a pandemic of extensively drug-resistant (XDR) gonococcus which is now seems to be evolving into a true “superbug”. Hence, in the near future gonorrhea may become untreatable on the international basis unless new drugs become available. An antibiotic resistance in gonococcus has been noted beginning in 1940s against sulfonamides. Since then, resistance has rapidly emerged to penicillins, tetracyclines, macrolides, fluoroquinolones, and cephalosporins. Currently, in most nations, the injectable extended-spectrum cephalosporin (ESC), i.e. ceftriaxone based therapy is the only remaining option for gonorrhea. Based on the WHO and the US-CDC recommendations, countries are increasingly using a combination of cephalosporin and azithromycin for the treatment of gonorrhoea. Azithromycin revolutionized gonoccocal therapy as it shortened treatment time by more than half from 7 to 14 days and improved patient compliance due to high tissue levels and long half-life. However, constantly emerging reports from different parts of the globe showed that N. gonorrhoeae is developing significant level of resistance against azithromycin, and so far more than 33% level of resistance was reported. Two strategies have been commonly implicated in gonococcal resistance against azithromycin: over expression of an efflux pump (due to mutations at mtrR coding region) and decreased antimicrobial affinity (due to mutations in genes encoding the 23S ribosomal subunit). Conclusions With no alternative antimicrobial treatment options for gonorrhoea and only a few new drugs in the development pipeline, it is necessary to monitor drug resistance and optimize treatment regimens regularly. Moreover, investigations for novel drugs should be wired.

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“…This is a real concern. On the topic of AMR, we also have a report on N. gonorrhoeae from surveillance sites in Zimbabwe, by Latif et al 8 and a letter from Affolabi and colleagues in Benin 9…”

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Sex Transm Infect

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Antimicrobial susceptibility in Neisseria gonorrhoeae isolates from five sentinel surveillance sites in Zimbabwe, 2015–2016

Cited by 20 publications

References 24 publications

World Health Organization Global Gonococcal Antimicrobial Surveillance Program (WHO GASP): review of new data and evidence to inform international collaborative actions and research efforts

World Health Organization Global Gonococcal Antimicrobial Surveillance Program (WHO GASP): review of new data and evidence to inform international collaborative actions and research efforts

Azithromycin resistant gonococci: a literature review

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