Antimicrobial resistance in Neisseria gonorrhoeae: Global surveillance and a call for international collaborative action

Wi, Teodora; Lahra, Monica M; Ndowa, Francis; Bala, Manju; Dillon, Jo-Anne R.; Ramón-Pardo, Pilar; Eremin, Sergey; Bolan, Gail; Unemo, Magnus

doi:10.1371/journal.pmed.1002344

Cited by 512 publications

(528 citation statements)

References 61 publications

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“…Integrating a reliable and more rapid assay for the accurate diagnosis of C trachomatis and N gonorrhoeae in the ED could facilitate appropriate use of antibiotics and prevent the overuse of inappropriate antibiotic therapy for patients who are not infected, thus affecting both the patient and antibiotic stewardship. 9–11 …”

Section: Importancementioning

confidence: 99%

Use of a Rapid Diagnostic for Chlamydia trachomatis and Neisseria gonorrhoeae for Women in the Emergency Department Can Improve Clinical Management: Report of a Randomized Clinical Trial

Gaydos

Ako

Lewis

et al. 2019

Annals of Emergency Medicine

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Study objective: In emergency departments (EDs), diagnosis and treatment of Chlamydia trachomatis and Neisseria gonorrhoeae are challenging. We conducted a randomized clinical trial to assess rapid C trachomatis and N gonorrhoeae testing on overtreatment and undertreatment of women evaluated for C trachomatis and N gonorrhoeae. Methods: Women undergoing pelvic examinations and C trachomatis and N gonorrhoeae testing (n=254) were randomized to control or rapid test groups. The control group received standard-of-care C trachomatis and N gonorrhoeae nucleic acid amplification tests of endocervical specimens, with 2- to 3-day turnaround times. For the rapid test group, clinicians collected an extra endocervical swab for GeneXpert C trachomatis and N gonorrhoeae rapid testing, in addition to the standard-of-care nucleic acid amplification test swab. Rapid results were immediately provided, and all patients were treated according to providers’ clinical judgment. Results: In the rapid test group, 7.9% of patients had positive test results for C trachomatis; 3.9% had positive test results for N gonorrhoeae. In the control standard-of-care group, 10.2% of patients had positive nucleic acid amplification test results for C trachomatis; 5.5% had positive results for N gonorrhoeae. Undertreatment for both C trachomatis and N gonorrhoeae in the ED was 0% for the rapid test group and 43.8% for the control standard-of-care group. Clinicians overtreated 46.5% of uninfected standard-of-care control patients for C trachomatis compared with 23.1% of uninfected rapid test patients. For patients uninfected with N gonorrhoeae, clinicians overtreated 46.7% of standard-of-care control patients compared with 25.4% of rapid test patients. The length of stay did not differ significantly between groups. Conclusion: Rapid C trachomatis and N gonorrhoeae testing in the ED led to a significant reduction in overtreatment for women without infections compared with the standard-of-care control group. Additionally, in the rapid test group there was significant improvement in appropriate treatment for patients with infections.

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Section: Importancementioning

confidence: 99%

Use of a Rapid Diagnostic for Chlamydia trachomatis and Neisseria gonorrhoeae for Women in the Emergency Department Can Improve Clinical Management: Report of a Randomized Clinical Trial

Gaydos

Ako

Lewis

et al. 2019

Annals of Emergency Medicine

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“…The emergence of ceftriaxone resistance in Neisseria gonorrhoeae (NG) has caused public health concern worldwide [1][2][3] and it is a grave concern that the first global failure to treat pharyngeal gonorrhoea with dual antimicrobial therapy was reported in 2016 in the United Kingdom (UK) [4].…”

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Multidrug-resistant Neisseria gonorrhoeae failing treatment with ceftriaxone and doxycycline in France, November 2017

et al. 2018

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We report a multidrug-resistant Neisseria gonorrhoeae urogenital and pharyngeal infection with ceftriaxone resistance and intermediate resistance to azithromycin in a heterosexual woman in her 20s in France. Treatment with ceftriaxone plus doxycycline failed for the pharyngeal localisation. Whole-genome sequencing of isolate F90 identified MLST1903, NG-MAST ST3435, NG-STAR233, and relevant resistance determinants. F90 showed phenotypic and genotypic similarities to an internationally spreading multidrug-resistant and ceftriaxone-resistant clone detected in Japan and subsequently in Australia, Canada and Denmark.

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“…However, N. gonorrhoeae has developed resistance to all antimicrobials introduced for empirical treatment 3,4 . Thus, enhanced antimicrobial resistance surveillance, rapid point-of-care diagnostic tests that ideally simultaneously predict resistance, and new antimicrobials are crucial for maintaining treatability of gonorrhoea 2–4 .…”

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confidence: 99%

Proof of principle for effectiveness of a gonorrhoea vaccine

Unemo

Sikora

2017

Nat Rev Urol

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Antimicrobial resistance in Neisseria gonorrhoeae: Global surveillance and a call for international collaborative action

Abstract: In a Policy Forum, Teodora Wi and colleagues discuss the challenges of antimicrobial resistance in gonococci.

Cited by 512 publications

References 61 publications

Use of a Rapid Diagnostic for Chlamydia trachomatis and Neisseria gonorrhoeae for Women in the Emergency Department Can Improve Clinical Management: Report of a Randomized Clinical Trial

Use of a Rapid Diagnostic for Chlamydia trachomatis and Neisseria gonorrhoeae for Women in the Emergency Department Can Improve Clinical Management: Report of a Randomized Clinical Trial

Multidrug-resistant Neisseria gonorrhoeae failing treatment with ceftriaxone and doxycycline in France, November 2017

Proof of principle for effectiveness of a gonorrhoea vaccine

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