WHO global antimicrobial resistance surveillance for Neisseria gonorrhoeae 2017–18: a retrospective observational study

Magnus Unemo, ProfPhD; Monica M Lahra, ProfFRCPA; Martina Escher, MD; Sergey Eremin, MD; Michelle J Cole, DBMS; Patricia Galarza, PhD; Francis Ndowa, MD; Irene Martin, BSc; Jo-Anne R Dillon, ProfPhD; Marcelo Galas, MD; Pilar Ramon-Pardo, MD; Hillard Weinstock, MD; Teodora Wi, MD

The Lancet Microbe (Nov 2021)

WHO global antimicrobial resistance surveillance for Neisseria gonorrhoeae 2017–18: a retrospective observational study

Magnus Unemo, ProfPhD,
Monica M Lahra, ProfFRCPA,
Martina Escher, MD,
Sergey Eremin, MD,
Michelle J Cole, DBMS,
Patricia Galarza, PhD,
Francis Ndowa, MD,
Irene Martin, BSc,
Jo-Anne R Dillon, ProfPhD,
Marcelo Galas, MD,
Pilar Ramon-Pardo, MD,
Hillard Weinstock, MD,
Teodora Wi, MD

Affiliations

Magnus Unemo, ProfPhD: WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Correspondence to: Prof Magnus Unemo, WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro SE 701 85, Sweden
Monica M Lahra, ProfFRCPA: WHO Collaborating Centre for Sexually Transmitted Infections and Antimicrobial Resistance, New South Wales Health Pathology, Microbiology, Randwick, NSW, Australia
Martina Escher, MD: Department of the Global HIV, Hepatitis and STI programmes, WHO, Geneva, Switzerland
Sergey Eremin, MD: Surveillance, Evidence and Laboratory Strengthening, Antimicrobial Resistance Division, WHO, Geneva, Switzerland
Michelle J Cole, DBMS: National Infection Service, Public Health England, London, UK
Patricia Galarza, PhD: WHO Collaborating Centre for Antimicrobial Resistance, National Reference Laboratory for STDs, National Institute of Infectious Diseases–ANLIS Dr Carlos G Malbrán, Buenos Aires, Argentina
Francis Ndowa, MD: Skin and Genitourinary Medicine Clinic, Harare, Zimbabwe
Irene Martin, BSc: Public Health Agency of Canada, National Microbiology Laboratory, Winnipeg, MB, Canada
Jo-Anne R Dillon, ProfPhD: Vaccine and Infecious Disease Organization–International Vaccine Centre, University of Saskatchewan, Saskatoon, SK, Canada
Marcelo Galas, MD: Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization, Washington, DC, USA
Pilar Ramon-Pardo, MD: Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization, Washington, DC, USA
Hillard Weinstock, MD: Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
Teodora Wi, MD: Department of the Global HIV, Hepatitis and STI programmes, WHO, Geneva, Switzerland

Journal volume & issue: Vol. 2, no. 11
pp. e627 – e636

Abstract

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Summary: Background: Gonorrhoea and antimicrobial resistance (AMR) in Neisseria gonorrhoeae are major health concerns globally. Increased global surveillance of gonococcal AMR is essential. We aimed to describe the 2017–18 data from WHO's global gonococcal AMR surveillance, and to discuss priorities essential for the effective management and control of gonorrhoea. Methods: We did a retrospective observational study of the AMR data of gonococcal isolates reported to WHO by 73 countries in 2017–18. WHO recommends that each country collects at least 100 gonococcal isolates per year, and that quantitative methods to determine the minimum inhibitory concentration of antimicrobials, interpreted by internationally standardised resistance breakpoints, are used. Findings: In 2017–18, 73 countries provided AMR data for one or more drug. Decreased susceptibility or resistance to ceftriaxone was reported by 21 (31%) of 68 reporting countries and to cefixime by 24 (47%) of 51 reporting countries. Resistance to azithromycin was reported by 51 (84%) of 61 reporting countries and to ciprofloxacin by all 70 (100%) reporting countries. The annual proportion of decreased susceptibility or resistance across countries was 0–21% to ceftriaxone and 0–22% to cefixime, and that of resistance was 0–60% to azithromycin and 0–100% to ciprofloxacin. The number of countries reporting gonococcal AMR and resistant isolates, and the number of examined isolates, have increased since 2015–16. Surveillance remains scarce in central America and the Caribbean and eastern Europe, and in the WHO African, Eastern Mediterranean, and South-East Asian regions. Interpretation: In many countries, ciprofloxacin resistance was exceedingly high, azithromycin resistance was increasing, and decreased susceptibility or resistance to ceftriaxone and cefixime continued to emerge. WHO's global surveillance of gonococcal AMR needs to expand internationally to provide imperative data for national and international management guidelines and public health policies. Improved prevention, early diagnosis, treatment of index patients and partners, enhanced surveillance (eg, infection, AMR, treatment failures, and antimicrobial use or misuse), and increased knowledge on antimicrobial selection, stewardship, and pharmacokinetics or pharmacodynamics are essential. The development of rapid, accurate, and affordable point-of-care gonococcal diagnostic tests, new antimicrobials, and gonococcal vaccines is imperative. Funding: None.

Published in The Lancet Microbe

ISSN: 2666-5247 (Online)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Medicine: Medicine (General); Science: Microbiology
Website: https://www.journals.elsevier.com/the-lancet-microbe

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