First nationwide antimicrobial susceptibility surveillance for Neisseria gonorrhoeae in Brazil, 2015–16

Bazzo, Maria Luiza; Golfetto, Lisléia; Gaspar, Pâmela Cristina; Pires, Ana Flávia; Ramos, Maria Eliza Barbosa; Franchini, Matías; Ferreira, William Antunes; Unemo, Magnus; Benzaken, Adèle Schwartz

doi:10.1093/jac/dky090

Cited by 41 publications

(57 citation statements)

References 37 publications

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“…cdc.gov/std/gisp/default.htm, accessed 28 June 2019). All isolates in Brazil, 62 Chile and Paraguay (and Peru in 2015) were susceptible to cefixime (Fig. 2).…”

Section: Ceftriaxone and Cefiximementioning

confidence: 96%

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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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“…cdc.gov/std/gisp/default.htm, accessed 28 June 2019). All isolates in Brazil, 62 Chile and Paraguay (and Peru in 2015) were susceptible to cefixime (Fig. 2).…”

Section: Ceftriaxone and Cefiximementioning

confidence: 96%

“…In the WHO Region of Americas, azithromycin resistance was identified in all eight countries reporting in 2016. Five (62.5%) countries (Brazil, 62 Canada, Columbia, Cuba and Peru) reported !5% resistance, whereas three (37.5%) reported <5% resistance (Argentina, Chile and the US; 3.6% vs 2.5% in 2014; 6 Fig. 3).…”

Section: Azithromycinmentioning

confidence: 99%

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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“…The levels of resistance to the other previously recommended antimicrobials penicillin and tetracycline were low at 22.4% and 10.5%, respectively. However, the rates of intermediate resistance to these two antimicrobials was high, which has also been recently reported in the first nationwide antimicrobial susceptibility surveillance for NG in Brazil [ 26 ].…”

Section: Discussionmentioning

confidence: 60%

Antimicrobial Susceptibility of Neisseria gonorrhoeae Isolates in Baltimore, Maryland, 2016: The Importance of Sentinel Surveillance in the Era of Multi-Drug-Resistant Gonorrhea

et al. 2018

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The increasing rates of gonorrhea infections and the global emergence and spread of multi-drug-resistant Neisseria gonorrhoeae (NG) threaten the successful management of gonorrhea. In the era of nucleic acid amplification tests (NAATs), surveillance projects are urgently needed to monitor prevalence and trends in the antimicrobial susceptibility of NG. In this study, we retrospectively determined the susceptibility profile of NG isolates to previously and currently prescribed antimicrobials. NG isolates collected in Baltimore, Maryland between January and October 2016 were evaluated by the E-test method and/or molecular methods for susceptibility to ceftriaxone, azithromycin, ciprofloxacin, tetracycline, gentamicin, and penicillin. One-hundred and forty-three NG isolates from African-American males (98.6%), primarily heterosexual (88.8%), ranging in age from 15 to 69 years of age were included in the study. Ciprofloxacin resistance was observed in 44.1% of isolates. Plasmid-mediated resistance to penicillin and tetracycline resistance was detected in 22.4% and 10.1% of isolates, respectively. Three isolates (2.1%) displayed high-level resistance to azithromycin (minimum inhibitory concentration (MIC) > 256 μg/mL). Forty-three percent of isolates were resistant or had decreased susceptibility to three antimicrobials (ciprofloxacin, tetracycline, and penicillin). All isolates were susceptible to ceftriaxone and gentamicin. Overall, the epidemiology of antimicrobial resistant NG in Baltimore continues to evolve, and the emergence of azithromycin resistance in this population emphasizes the need for continued sentinel surveillance programs to monitor susceptibility trends and aid in treatment recommendations.

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“…, through epistatic interactions with other genetic variants) within and/or across different antibiotics when screening for a novel resistance variant. For example, as ciprofloxacin was the recommended first-line therapy for uncomplicated gonorrhea through 2005 in the United Kingdom ( Whittles et al, 2018 ), 2007 in the United States ( Centers for Disease Control and Prevention (CDC), 2007 ), and more recent years in other countries ( Hemarajata et al, 2016 ; Unemo and Dillon, 2014 ; Bazzo et al, 2018 ), we investigated whether resistance to ESCs is significantly more likely to occur in the background of genotypic ciprofloxacin resistance (i.e., in strains with the GyrA S91F mutation). Similarly, as mutations at positions 120 and/or 121 in PorB, the major outer membrane protein in gonococci, have been associated with resistance to a range of drugs from multiple classes ( Mortimer and Grad, 2019 ), we investigated whether resistance to ESCs is significantly more likely to occur in strains with PorB 120 and/or 121 mutations.…”

Section: Resultsmentioning

confidence: 99%

Targeted surveillance strategies for efficient detection of novel antibiotic resistance variants

Hicks

Kissler

Mortimer

et al. 2020

eLife

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Genotype-based diagnostics for antibiotic resistance represent a promising alternative to empiric therapy, reducing inappropriate antibiotic use. However, because such assays infer resistance based on known genetic markers, their utility will wane with the emergence of novel resistance. Maintenance of these diagnostics will therefore require surveillance to ensure early detection of novel resistance variants, but efficient strategies to do so remain undefined. We evaluate the efficiency of targeted sampling approaches informed by patient and pathogen characteristics in detecting antibiotic resistance and diagnostic escape variants in Neisseria gonorrhoeae, a pathogen associated with a high burden of disease and antibiotic resistance and the development of genotype-based diagnostics. We show that patient characteristic-informed sampling is not a reliable strategy for efficient variant detection. In contrast, sampling informed by pathogen characteristics, such as genomic diversity and genomic background, is significantly more efficient than random sampling in identifying genetic variants associated with resistance and diagnostic escape.

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First nationwide antimicrobial susceptibility surveillance for Neisseria gonorrhoeae in Brazil, 2015–16

Cited by 41 publications

References 37 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

Antimicrobial Susceptibility of Neisseria gonorrhoeae Isolates in Baltimore, Maryland, 2016: The Importance of Sentinel Surveillance in the Era of Multi-Drug-Resistant Gonorrhea

Targeted surveillance strategies for efficient detection of novel antibiotic resistance variants

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