Infection and Drug Resistance (Jul 2020)
Disk-Diffusion Testing Is an Inappropriate Screening Tool for Cephalosporin-Resistant Gonorrhoea Strains in Clinical Practice in China
Abstract
Yan Han,1,2 Yue-Ping Yin,1,2 Wen-Qi Xu,1,2 Xiao-Yu Zhu,1,2 Shao-Chun Chen,1,2 Xiu-Qin Dai,1,2 Li-Gang Yang,3,4 Bang-Yong Zhu,5 Na Zhong,6 Wen-Ling Cao,7 Xiao-Hui Zhang,3,4 Zhi-Zhou Wu,8 Liu-Feng Yuan,9 Zhong-Jie Zheng,10 Jun Liu,11 Xiang-Sheng Chen1,2 1Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu, People’s Republic of China; 2National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, Jiangsu, People’s Republic of China; 3Dermatology Hospital, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China; 4Guangdong Provincial Dermatology Hospital, Guangzhou, Guangdong, People’s Republic of China; 5Institute of Dermatology, Nanning, Guangxi Autonomous Region, People’s Republic of China; 6Hainan Provincial Center for STD/Skin Disease Control and Prevention, Haikou, Hainan, People’s Republic of China; 7Guangzhou Institute of Dermatology, Guangzhou, Guangdong, People’s Republic of China; 8Jiangmen Dermatology Hospital, Jiangmen, Guangdong, People’s Republic of China; 9Beijing Ditan Hospital Capital Medical University, Beijing, People’s Republic of China; 10Tianjin Center for Disease Control and Prevention, Tianjin, People’s Republic of China; 11Harvard Medical School, Boston, MA, USACorrespondence: Yue-Ping YinInstitute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, 12 Jiangwangmiao Street, Nanjing 210042, People’s Republic of ChinaTel/ Fax +86 258 547 8024Email [email protected]: Injectable ceftriaxone and oral cefixime are the last agents effective against Neisseria gonorrhoeae. In vitro antimicrobial-susceptibility testing (AST) is done to identify the most efficacious antibiotic needed to combat the infection in that particular individual. The objective of this study was to evaluate whether Kirby–Bauer (KB) disk-diffusion tests can detect N. gonorrhoeae isolates that have decreased susceptibility to ceftriaxone and cefixime for appropriate clinical management.Methods: A total of 1,633 consecutive clinical isolates of N. gonorrhoeae were collected from January 1, 2013 to December 31, 2017 from seven dermatology clinics located in five provinces in China. Consistency between KB disk-diffusion tests and the agar-dilution method, as well as sensitivity of the KB test for detecting N. gonorrhoeae isolates with decreased susceptibility to ceftriaxone and cefixime, were determined using 1,306 clinical isolates that had been recovered to complete agar-dilution AST.Results: The prevalence of isolates with decreased susceptibility to ceftriaxone and cefixime was 12.1% (198 of 1,633) and 12.7% (208 of 1,633), respectively, using KB disk-diffusion tests. The prevalence of isolates with decreased susceptibility was 9.9% (129 of 1,306) for ceftriaxone and 9.9% (129 of 1,305) for cefixime using agar-dilution AST. The categorical agreement of these two methods was 80.9% for both ceftriaxone and cefixime. Compared to agar-dilution AST, the sensitivity of the KB test for detecting N. gonorrhoeae isolates with decreased susceptibility was 22.5% (29 of 129) for ceftriaxone and 29.5% (38 of 129) for cefixime, and its specificity 87.3% (1,028 of 1,177) for ceftriaxone and 86.7% (1,018 of 1,176) for cefixime.Conclusion: Although KB tests are easy to carry out in clinical practice, their ability to detect cephalosporin-resistant gonorrhoea strains is limited. This method is not an appropriate selection for screening cephalosporin-resistant gonorrhoea strains in clinical practice in China.Keywords: Neisseria gonorrhoeae, Kirby–Bauer disk-diffusion tests, agar-dilution method, susceptibility, screen
