Systematic review and survey of Neisseria gonorrhoeae ceftriaxone and azithromycin susceptibility data in the Asia Pacific, 2011 to 2016

Antimicrobial resistance in Neisseria gonorrhoeae is a global concern, with the ongoing emergence of ceftriaxone and azithromycin resistance threatening current treatment paradigms. To monitor the emergence of antimicrobial resistance in N. gonorrhoeae, the World Health Organization (WHO) Gonococcal...

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Bibliographic Details
Published in:	PloS one 2019-04, Vol.14 (4), p.e0213312-e0213312
Main Authors:	George, C R Robert, Enriquez, Rodney P, Gatus, Barrie J, Whiley, David M, Lo, Ying-Ru, Ishikawa, Naoko, Wi, Teodora, Lahra, Monica M
Format:	Article
Language:	eng
Subjects:	Antibiotics Antiinfectives and antibacterials Antimicrobial agents Antimicrobial resistance Asia Azithromycin Azithromycin - pharmacology Azithromycin - therapeutic use Biology and Life Sciences Ceftriaxone Ceftriaxone - pharmacology Ceftriaxone - therapeutic use Ceftriaxone sodium Chemotherapy Disease transmission Dosage and administration Drug resistance Drug resistance in microorganisms Drug Resistance, Bacterial Drug therapy Emergence Epidemiological Monitoring Gonorrhea - drug therapy Gonorrhea - microbiology Health Hospitals Humans Infections Intelligence gathering Laboratories Literature reviews Medicine and Health Sciences Methods Microbial drug resistance Microbial Sensitivity Tests - statistics & numerical data Microbial Sensitivity Tests - trends Minimum inhibitory concentration Neisseria gonorrhoeae Neisseria gonorrhoeae - isolation & purification Neisseria gonorrhoeae - physiology Neisseria infections Oceania Pathology Penicillin People and Places Physiological aspects Polls & surveys Public health Research and Analysis Methods Reviews Sexually transmitted diseases STD Surveillance Surveillance equipment Surveys Systematic review World Health Organization
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Summary:	Antimicrobial resistance in Neisseria gonorrhoeae is a global concern, with the ongoing emergence of ceftriaxone and azithromycin resistance threatening current treatment paradigms. To monitor the emergence of antimicrobial resistance in N. gonorrhoeae, the World Health Organization (WHO) Gonococcal Antimicrobial Surveillance Programme (GASP) has operated in the Western Pacific and South East Asian regions since 1992. The true burden of antimicrobial resistance remains unknown. In response, the objective of this study was to survey ceftriaxone and azithromycin susceptibility in N. gonorrhoeae across the western Pacific and south-east Asia, and interlink this data with systematically reviewed reports of ceftriaxone and azithromycin resistance. The WHO Collaborating Centre for Sexually Transmitted Infections and Antimicrobial Resistance, Sydney, coordinated annual surveys of gonococcal susceptibilities with participating laboratories, and additionally undertook a systematic review of reports detailing gonococcal ceftriaxone and azithromycin susceptibility data for locations geographically in the Asia Pacific from 2011 to 2016. It was found that surveillance of gonococcal antimicrobial resistance remains limited in the Asia Pacific, with weaker surveillance of azithromycin versus ceftriaxone. Ninety-three published reports were identified (including national reports) which documented susceptibility data for ceftriaxone and azithromycin. GASP survey data was available for 21 countries, territories or areas, and suggested MICs are increasing for ceftriaxone and azithromycin. Between 2011 and 2016, the percentage of locations reporting >5% of gonococcal isolates with MICs to ceftriaxone meeting WHO's definition of decreased susceptibility (MIC ≥ 0.125 mg/L) increased from 14.3% to 35.3% and the percentage of locations reporting >5% of gonococcal isolates with azithromycin resistance (MIC ≥ 1 mg/L) increased from 14.3% to 38.9%. Published reports were available for several countries that did not provide GASP surveillance responses for ceftriaxone (n = 5) and azithromycin (n = 3) respectively. Over the study period, there was a 183% increase in the number of countries providing surveillance data for GASP for both ceftriaxone and azithromycin, and a 30.6% increase in ceftriaxone MIC testing across the Asia Pacific facilitated by this project. This study provides the first comprehensive illustration of increasing MICs to ceftriaxone in the Asia Pacific. The survey a
ISSN:	1932-6203 1932-6203