Antimicrobial resistance and molecular epidemiological typing of Neisseria gonorrhoeae isolates from Kyrgyzstan in Central Asia, 2012 and 2017

Abstract

Background Gonorrhoea and antimicrobial resistance (AMR) in Neisseria gonorrhoeae are significant public health concerns globally. Nearly no gonococcal AMR data are available from Central Asia, and no data from Kyrgyzstan has been published. We examined, for the first time, AMR and molecular epidemiology of N. gonorrhoeae isolates cultured in Kyrgyzstan in 2012 and 2017, in order to inform refinements of the Kyrgyz national gonorrhoea management guidelines. Methods N. gonorrhoeae isolates cultured in 2012 (n = 84) and 2017 (n = 72) in Kyrgyzstan were examined. MICs of nine antimicrobials were determined using Etest and, where available, clinical breakpoints from the EUCAST were applied. N. gonorrhoeae multiantigen sequence typing (NG-MAST) was also performed. Results The overall resistance levels were high to ciprofloxacin (88.5%), tetracycline (56.9%), benzylpenicillin (39.1%), and kanamycin (4.7%). Resistance to cefixime (0.6%, n = 1 isolate), azithromycin (0.6%, n = 1), and gentamicin (0.6%, n = 1) was rare. No resistance to ceftriaxone or spectinomycin was found. However, the proportion of isolates with decreased susceptibility (MIC = 0.125 mg/L) to ceftriaxone and cefixime was 12.8 and 11.5%, respectively. Gonococcal isolates were assigned 69 sequence types, of which 52 (75.4%) were new. Conclusions The gonococcal population in Kyrgyzstan in 2012 and 2017 showed a high genetic diversity. Ceftriaxone, 500–1000 mg, in combination with azithromycin 2 g or doxycycline, particularly when chlamydial infection has not been excluded, should be recommended as empiric first-line treatment. Spectinomycin 2 g could be an alternative treatment, and given with azithromycin 2 g if pharyngeal gonorrhoea has not been excluded. Fluoroquinolones, aminoglycosides, benzylpenicillin, or tetracyclines should not be used for empiric treatment of gonorrhoea in Kyrgyzstan. Timely updating and high compliance to national gonorrhoea treatment guidelines based on quality-assured AMR data is imperative. Expanded and improved gonococcal AMR surveillance in Kyrgyzstan is crucial.

Genomic epidemiology of Neisseria gonorrhoeae in Shenzhen, China, during 2019–2020: increased spread of ceftriaxone-resistant isolates brings insights for strengthening public health responses

“…This alarming situation highlights the need to enhance AMR monitoring in other countries because the AMR transmission around the world could be connected through travel ( 6 ). These studies should be focused on countries where ceftriaxone remains sufficient for most settings, such as Kyrgyzstan in Central Asia, a country near China, attached a perfect rate (100%) of susceptibility to ceftriaxone ( 28 ). This information reinforces the importance of the “comprehensive and specific monitoring” strategy, which is aimed at those countries that cannot afford the resources required for comprehensive surveillance, to nevertheless aim to monitor high-risk regions.…”

The postal code as a “bar code” of antimicrobial resistance

“…Las tasas de resistencias a ciprofloxacino de nuestro estudio son levemente mayores que en otras series realizadas a nivel nacional, donde describen tasas de resistencia de ciprofloxacino en torno a un 50% [9][10][11]. Sin embargo, en otros estudios realizados a nivel mundial las tasas de resistencias son bastante más elevadas [12][13][14]. En cuanto a cefalosporinas, nuestra tasa de resistencia en las muestras analizadas se halla en torno a un 1,1%, lo que puede estar en consonancia con las series mencionadas previamente [15], pero claramente inferior a la serie de Fuertes Vega et al [16].…”

“…Esto podría hacernos concluir que de momento el uso de ceftriaxona como tratamiento de la infección por N. gonorrhoeae es el adecuado en nuestro medio. Cabe resaltar que en el estudio de las ITS la biología molecular y la utilización de técnicas de secuenciación para identificar cepas es cada vez más frecuente [ 12 , 17 ], especialmente en grandes ciudades y a nivel hospitalario, es decir, a gran escala. Además, hay que sumar a esto que el control de las ITS es sumamente complejo por múltiples factores, entre los que intervienen el estigma, desconocimiento, movilidad a otros centros sanitarios y la dificultad de realizar estudios de contacto óptimos.…”