Antimicrobial Susceptibility of Neisseria gonorrhoeae in Japan from 2000 to 2015

Abstract

Background Gonococcal infections are difficult to treat because of their multidrug antimicrobial resistance. The outbreak of antimicrobial-resistant Neisseria gonorrhoeae has begun in Asia and particularly in Japan. Therefore, it is very important that we understand the trend of antimicrobial resistance of N. gonorrhoeae in Asia including Japan. Our surveillance of the antimicrobial susceptibility of N. gonorrhoeae began in 2000 under the guidance of the Department of Urology, Gifu University. We report our surveillance data from 2000 to 2015. Methods We collected N. gonorrhoeae strains isolated from patients with gonococcal infections who visited our cooperating medical institutions in Japan from 2000 to 2015. MICs of penicillin G, cefixime, ceftriaxone, tetracycline, spectinomycin, azithromycin, and levofloxacin were determined by the agar dilution method approved by the Clinical and Laboratory Standards Institute. Results From 2000 to 2015, 2471 isolates of N. gonorrhoeae were collected in Japan. High rates of nonsusceptibility to penicillin, tetracycline, levofloxacin, cefixime, and azithromycin were shown. Around 5% to 10% of the strains isolated had a 0.25-mg/L MIC of ceftriaxone in each year, and 6 strains (0.24%) with a 0.5-mg/L MIC of ceftriaxone were isolated throughout the study period. Approximately 5% to 10% of the strains were resistant to each of ceftriaxone, azithromycin, and levofloxacin according to European Committee on Antimicrobial Susceptibility Testing breakpoints, and the rate has not increased significantly. Conclusions From this study and previous pharmacodynamic analyses, a single 1-g dose of ceftriaxone is recommended to treat gonorrhea. As strains with high-level ceftriaxone resistance continue to spread, higher doses of ceftriaxone in monotherapy or multiple doses of ceftriaxone should be considered.

Azithromycin susceptibility of Neisseria gonorrhoeae in the USA in 2017: a genomic analysis of surveillance data

“…7 Reduced susceptibility of gonococci to azithromycin was reported in the 1990s, and although azithromycin has not been recommended as a monotherapy, growing reports of decreased azithromycin susceptibility are being monitored worldwide. [8][9][10][11][12][13] Azithromycin was recommended to be used in dual therapy with ceftriaxone in 2015, 6 to function as a shield to potentially delay the emergence of resistance to ceftriaxone, the last remaining antimicrobial option. This recommendation was modelled after combination antimicrobial therapy for prevention of resistance used for other infectious diseases such as tuberculosis.…”

“…1 The predominant reason for this increase is the growth (from 2013 to 2017) in the proportion of isolates with low-level decreased susceptibility to azithromycin (MIC 2-4 µg/mL). 1 WHO 9 and other international organisations [10][11][12] reported an increase in the percentage of isolates with reduced susceptibility to azithromycin across multiple countries, approaching the level at which WHO recommends the review, modification, or discontinuation of an antimicrobial in empirical treatment. 9 Several cases of decreased susceptibility to both azithromycin and ceftriaxone have been recorded internationally.…”

Surveillance systems to monitor antimicrobial resistance in Neisseria gonorrhoeae: a global, systematic review, 1 January 2012 to 27 September 2020

“…Of 27 individual countries with included surveillance systems, five were in the WHO African Region (n = 54 countries) [24][25][26][27][28][29], four in WHO Region of the Americas (n = 41 countries) [30][31][32][33][34][35][36][37][38][39]; one in the WHO Eastern Mediterranean Region (n = 22 countries) [40], nine in the WHO European Region (n = 53 countries) [41][42][43][44][45][46][47][48][49][50][51][52][53][54], three in the WHO South-East Asia Region (n = 11 countries) [55][56][57], and five in the WHO Western Pacific Region (n = 27 countries) [58][59][60][61][62][63][64]. See Table 1 and Supplementary Table S2a and Table S2b, which provide an overview of surveillance systems.…”

The antimicrobial resistance travel tool, an interactive evidence-based educational tool to limit antimicrobial resistance spread

“…Data were extracted from: the COMBACTE-MAGNET EPI-Net and CDDEP repositories, which include several surveillance systems and sources; four international surveillance systems, namely GLASS, EARS-Net, FWD-Net and Euro-GASP; seven national surveillance systems, namely AGAR-AURA (Australia), ANRESIS (Switzerland), CARA (Canada), CARSS (Canada), ICMR (India), Ministry of Health New Zealand (New Zealand) and SWEDRES (Sweden); and eight surveillance studies. 7–14 Out of 436 papers screened, eight studies met inclusion criteria. Overall, data for a total of 2.018.241 isolates from 86 countries were extracted.…”