Antimicrobial susceptibility/resistance and molecular epidemiological characteristics of Neisseria gonorrhoeae in 2009 in Belarus

Glazkova, Slavyana; Golparian, Daniel; Titov, Leonid; Pankratova, N. D.; Suhabokava, Nataliya; Shimanskaya, Irina; Domeika, Marius; Unemo, Magnus

doi:10.1111/j.1600-0463.2011.02770.x

Cited by 10 publications

(17 citation statements)

References 17 publications

(26 reference statements)

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“…Exceedingly high prevalence of resistance was observed for previous first-line antimicrobials such as ciprofloxacin (98%), tetracycline (82%) and penicillin G (48%), but also relatively high for azithromycin (11%) (Table 1). This is in accordance with previous studies from other countries in WHO WPR such as Japan, The Philippines, China, Hong Kong, Korea and Taiwan [4,46-51], South Asia, e.g., India, Pakistan, Thailand, Sri Lanka and Bhutan [47,52,53], and many other regions globally [3-6,18,19,54-58]. None of these antimicrobials can be recommended for first-line empiric therapy of gonorrhoea in Vietnam as well as in most parts of the world.…”

Section: Discussionsupporting

confidence: 92%

Antimicrobial susceptibility and genetic characteristics of Neisseria gonorrhoeae isolates from Vietnam, 2011

et al. 2013

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BackgroundAntimicrobial resistance (AMR) in Neisseria gonorrhoeae is a major public health concern worldwide. In Vietnam, knowledge regarding N. gonorrhoeae prevalence and AMR is limited, and data concerning genetic characteristics of N. gonorrhoeae is totally lacking. Herein, we investigated the phenotypic AMR (previous, current and possible future treatment options), genetic resistance determinants for extended-spectrum cephalosporins (ESCs), and genotypic distribution of N. gonorrhoeae isolated in 2011 in Hanoi, Vietnam.MethodsN. gonorrhoeae isolates from Hanoi, Vietnam isolated in 2011 (n = 108) were examined using antibiograms (Etest for 10 antimicrobials), Neisseria gonorrhoeae multi-antigen sequence typing (NG-MAST), and sequencing of ESC resistance determinants (penA, mtrR and penB).ResultsThe levels of in vitro resistance were as follows: ciprofloxacin 98%, tetracycline 82%, penicillin G 48%, azithromycin 11%, ceftriaxone 5%, cefixime 1%, and spectinomycin 0%. The MICs of gentamicin (0.023-6 mg/L), ertapenem (0.002-0.125 mg/L) and solithromycin (<0.016-0.25 mg/L) were relatively low. No penA mosaic alleles were found, however, 78% of the isolates contained an alteration of amino acid A501 (A501V (44%) and A501T (34%)) in the encoded penicillin-binding protein 2. A single nucleotide (A) deletion in the inverted repeat of the promoter region of the mtrR gene and amino acid alterations in MtrR was observed in 91% and 94% of the isolates, respectively. penB resistance determinants were detected in 87% of the isolates. Seventy-five different NG-MAST STs were identified, of which 59 STs have not been previously described.ConclusionsIn Vietnam, the highly diversified gonococcal population displayed high in vitro resistance to antimicrobials previously recommended for gonorrhoea treatment (with exception of spectinomycin), but resistance also to the currently recommended ESCs were found. Nevertheless, the MICs of three potential future treatment options were low. It is essential to strengthen the diagnostics, case reporting, and epidemiologic surveillance of gonorrhoea in Vietnam. Furthermore, the surveillance of gonococcal AMR and gonorrhoea treatment failures is imperative to reinforce. Research regarding novel antimicrobial treatment strategies (e.g., combination therapy) and new antimicrobials is crucial for future treatment of gonorrhoea.

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Section: Discussionsupporting

confidence: 92%

Antimicrobial susceptibility and genetic characteristics of Neisseria gonorrhoeae isolates from Vietnam, 2011

et al. 2013

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“…Nevertheless, interestingly β-lactamase producing N. gonorrhoeae strains have remained rare in Russia [24,25,29] as well as in other independent countries of the former Soviet Union, e.g. Belarus [36]. This may indicate that penicillins have not been widely used for treatment of gonorrhoea in many years and/or that no imported β-lactamase producing gonococcal strains have been established and resulted in an endemic spread in Russia during several years.…”

Section: Discussionmentioning

confidence: 99%

Russian gonococcal antimicrobial susceptibility programme (RU-GASP) – resistance in Neisseria gonorrhoeae during 2009–2012 and NG-MAST genotypes in 2011 and 2012

et al. 2014

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BackgroundAntimicrobial resistance (AMR) in Neisseria gonorrhoeae is a major concern worldwide and gonococcal AMR surveillance globally is imperative for public health purposes. In Eastern Europe, gonococcal AMR surveillance is exceedingly rare. However, in 2004 the Russian gonococcal antimicrobial susceptibility programme (RU-GASP) was initiated. The aims of this study were to describe the prevalence and trends of gonococcal AMR from 2009 to 2012, and molecular epidemiological genotypes in 2011 and 2012 in Russia.MethodsGonococcal isolates from 12–46 surveillance sites distributed across Russia, obtained in 2009 (n = 1200), 2010 (n = 407), 2011 (n = 423), and 2012 (n = 106), were examined for antimicrobial susceptibility using agar dilution method. Gonococcal isolates from 2011 and 2012 were investigated with N. gonorrhoeae multi-antigen sequence typing (NG-MAST).ResultsDuring 2009–2012, the proportions of gonococcal isolates resistant to ciprofloxacin, penicillin G, azithromycin and spectinomycin ranged from 25.5% to 44.4%, 9.6% to 13.2%, 2.3% to 17.0% and 0.9% to 11.6%, respectively. Overall, the resistance level to penicillin G was stable, the resistance level to ciprofloxacin was decreasing, however, the level of resistance to azithromycin increased. All isolates were susceptible to ceftriaxone using the US CLSI breakpoints. However, using the European breakpoints 58 (2.7%) of the isolates were resistant to ceftriaxone. Interestingly, this proportion was decreasing, i.e. from 4.8% in 2009 to 0% in 2012.ConclusionsIn Russia, the diversified gonococcal population showed a high resistance to ciprofloxacin, penicillin G and azithromycin. In general, the MICs of ceftriaxone were relatively high, however, they were decreasing from 2009 to 2012. Ceftriaxone should be the first-line for empiric antimicrobial monotherapy of gonorrhoea in Russia. It is essential to further strengthen the surveillance of gonococcal AMR (ideally also gonorrhoea treatment failures) in Russia.

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“…At the WHO Collaborating Centre for Gonorrhoea and other STIs, Sweden, the minimum inhibitory concentrations (MICs; mg/L) of eight antimicrobials (ceftriaxone, cefixime, azithromycin, spectinomycin, ciprofloxacin, tetracycline, benzylpenicillin, and gentamicin) were determined by Etest (bioMerieux, Marcy-l'Etoile, France), following manufacturer's instructions and as described previously [39,40]. Results were interpreted using whole MIC dilutions and, where available, clinical breakpoints for susceptibility (S) and resistance (R) according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) [47].…”

Section: Antimicrobial Susceptibility Testingmentioning

confidence: 99%

“…In the European Union/European Economic Area (EU/EEA), the European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP) is monitoring the AMR since 2004 [12,[36][37][38]. However, in the non-EU/EEA countries of the WHO European Region, gonococcal AMR surveillance is extremely limited [5,6], and only sporadically available in Belarus, Russia and Ukraine [33,[39][40][41][42][43][44]. treatment is cefixime 400 mg×1 orally or spectinomycin 2 g×1 IM for men and 4 g×1 IM for women or ofloxacin 400 mg×1 orally, or lomefloxacin 800 mg×1 orally [45].…”

Section: Introductionmentioning

confidence: 99%

Antimicrobial resistance in Neisseria gonorrhoeae isolates and gonorrhoea treatment in the Republic of Belarus, Eastern Europe, 2009-2019

Aniskevich

Shimanskaya

Boiko

et al. 2020

Preprint

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Background: Increasing antimicrobial resistance (AMR) in Neisseria gonorrhoeae , including to first-line treatment options, is a great concern worldwide. However, very limited gonococcal AMR data are available in Eastern Europe. We investigated the AMR in N. gonorrhoeae isolates (n=522) cultured in three regions of the Republic of Belarus, 2009-2019, antimicrobial treatment recommended nationally, and treatment given to 1652 gonorrhoea patients in two of the regions (Minsk, 2013-2018; Mogilev, 2010-2019). Methods: Determination of minimum inhibitory concentrations (MICs) of eight antimicrobials was performed using Etest and, where available, resistance breakpoints from the European Committee on Antimicrobial Susceptibility Testing were applied. β-lactamase production was examined using a Nitrocefin test. Gonorrhoea treatment was analysed from medical records. Results: In total, 27.8% of isolates were resistant to tetracycline, 24.7% to ciprofloxacin, 7.0% to benzylpenicillin, 2.7% to cefixime, and 0.8% to azithromycin. No isolates were resistant to ceftriaxone, spectinomycin, or gentamicin. However, four (0.8%) isolates had a ceftriaxone MIC of 0.125 mg/L, which is exactly at the resistance breakpoint (MIC>0.125 mg/L). Only one (0.2%) isolate, from 2013, produced β-lactamase. From 2009-2019, the levels of resistance to ciprofloxacin and tetracycline were relatively stably high. Resistance to cefixime was not identified before 2013, but peaked at 22.2% in 2017. Only sporadic isolates with resistance to azithromycin were found in 2009 (n=1), 2012 (n=1) and 2018-2019 (n=2). Overall, 862 (52.2%) patients received first-line treatment in accordance with national guidelines (ceftriaxone 1 g). However, 154 (9.3%) patients received a nationally recommended alternative treatment (cefixime 400 mg or ofloxacin 400 mg), and 636 (38.5%) patients were given treatment non-compliant to the Belarusian national gonorrhoea guideline. Conclusions: Ceftriaxone 1 g, in combination with azithromycin 2 g particularly when chlamydial infection has not been excluded, should be recommended as empiric first-line treatment. Spectinomycin 2 g, where available, together with azithromycin 2 g could be an alternative treatment. When susceptibility has not been confirmed by testing, fluoroquinolones should not be used for treatment. Timely updating of and high compliance to national evidence-based gonorrhoea treatment guidelines that are based on quality-assured AMR data is imperative. Continued and expanded gonococcal AMR surveillance in Belarus is crucial.

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Antimicrobial susceptibility/resistance and molecular epidemiological characteristics of Neisseria gonorrhoeae in 2009 in Belarus

Cited by 10 publications

References 17 publications

Antimicrobial susceptibility and genetic characteristics of Neisseria gonorrhoeae isolates from Vietnam, 2011

Antimicrobial susceptibility and genetic characteristics of Neisseria gonorrhoeae isolates from Vietnam, 2011

Russian gonococcal antimicrobial susceptibility programme (RU-GASP) – resistance in Neisseria gonorrhoeae during 2009–2012 and NG-MAST genotypes in 2011 and 2012

Antimicrobial resistance in Neisseria gonorrhoeae isolates and gonorrhoea treatment in the Republic of Belarus, Eastern Europe, 2009-2019

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