Antibiotic susceptibility of Neisseriagonorrhoeae in Arkhangelsk, Russia

Abstract

Objectives: To characterise comprehensively the antibiotic susceptibility of Neisseria gonorrhoeae in Arkhangelsk, Russia, and to investigate whether the recommended treatment guidelines are updated and effective. Methods: The susceptibility of N gonorrhoeae isolates, cultured during June-November 2004 mainly from consecutive patients with gonorrhoea (n = 76) in Arkhangelsk, to penicillin G, ampicillin, cefixime, ceftriaxone, ciprofloxacin, erythromycin, azithromycin, kanamycin, spectinomycin and tetracycline was analysed using Etest. Nitrocefin discs were used for b-lactamase detection. Results: The levels of intermediate susceptibility and resistance to the different antibiotics were as follows: penicillin G 76%, ampicillin 71%, cefixime 0%, ceftriaxone 3%, ciprofloxacin 17%, erythromycin 54%, azithromycin 14%, kanamycin 49%, spectinomycin 0% and tetracycline 92%. Of the isolates 55 (72%) were determined as multiresistant-that is, they showed intermediate susceptibility or resistance to three or more classes of antibiotics. However, none of the isolates were b-lactamase producing. Conclusions: In Arkhangelsk, and presumably in many other areas of Russia, penicillins, ciprofloxacin, erythromycin, azithromycin, kanamycin and tetracycline should not be used in the treatment of gonorrhoea if the results of antibiotic susceptibility testing are not available. In Russia, optimised, standardised and qualityassured antibiotic susceptibility testing needs to be established in many laboratories. Subsequently, continuous local, regional and national surveillance of antibiotic susceptibility is crucial to detect the emergence of new resistance, monitor changing patterns of susceptibility and be able to update treatment recommendations on a regular basis.A s a result of the break-up of the Soviet Union, during the past decade, Russia and the other newly independent states have gone through major changes, which have considerably influenced the healthcare system too. Regarding the incidence of gonorrhoea, reliable figures are still lacking mainly because of suboptimal diagnostics, incomplete epidemiological surveillance and reporting of new cases, as well as self-medication.1 Furthermore, the prevalence of antibiotic resistance of Neisseria gonorrhoeae is unknown in most Russian areas, and this knowledge is crucial for empirical treatment. Owing to the worldwide rapid increase of antibiotic resistance, empirical treatment strategies need constant re-evaluation, 2 and antibiotic susceptibility testing is the main tool for updating them.3 Consequently, it is also essential to monitor the level of antibiotic resistance of N gonorrhoeae in Russia.1 4 As in most of the east European countries, it is crucial to establish local, regional and national antibiotic resistance networks and, in addition, monitor antibiotic consumption in Russia.5 During the 1990s, controlled, centralised provision of antibiotics and/or antibiotic resistant surveillance ended and the consumption of antibiotics increased markedly in Russia. 6The Arkhangels...

National surveillance of antimicrobial susceptibility in Neisseria gonorrhoeae in 2005-2006 and recommendations of first-line antimicrobial drugs for gonorrhoea treatment in Russia

“…Previously, thorough knowledge regarding these issues has been entirely lacking and very limited studies have been performed 15 – 18. This has been mainly the result of suboptimal diagnostics, including the rare use of culture and a lack of antimicrobial susceptibility testing for N gonorrhoeae 17 22 – 24. The present national surveillance programme has, however, recently implemented appropriate, standardised and quality assured culture diagnostics, as well as effective and quality assured antimicrobial susceptibility testing, in accordance with international recommendations21 25 – 29 in Russia.…”

Antimicrobial susceptibility and biochemical patterns of Neisseria gonorrhoeae strains in Vejle area, Denmark

“…However, since 1995, the proportion of resistant Neisseria gonorrhoeae strains has risen, 4 making effective treatment difficult and posing a challenge for successful case management. Antibiotic susceptibility testing is the main tool for updating empirical treatment strategies 5 . Therefore, we conducted a retrospective study to assess antimicrobial susceptibility of N. gonorrhoeae isolates in the Vejle community area, Denmark.…”

Relation between Genetic Markers of Drug Resistance and Susceptibility Profile of Clinical Neisseria gonorrhoeae Strains

“…Although the incidence of gonorrhea decreased slightly during recent years, the situation remains alarming due to the spread of multiresistant strains which are resistant to at least penicillin, tetracycline, and fluoroquinolones (31). However, replacement in routine practice of culture and susceptibility testing by nucleic acid amplification techniques reduces the amount of information on antimicrobial susceptibility patterns and highlights the need for the development of molecular tools for the detection of antibacterial resistance in Neisseria gonorrhoeae.…”