Drug sensitivity of N. gonorrhoeae in teaching hospitals
Neisseria gonorrhoeae Infection, one of the most common sexually transmitted diseases, is a global problem.1 In mainland China, the incidence of N. gonorrhoeae infection has steadily increased, with the incidence rate among the top five nationally notifiable infectious diseases.2 A wide range of clinical manifestations and complications of N. gonorrhoeae infection has been observed and the vaccine against N. gonorrhoeae is not currently available. Therefore, infection control relies primarily on prompt diagnosis and appropriate antibiotic therapy.1–4 Overtime, Neisseria gonorrhoeae has developed resistance to a wide range of antimicrobial agents. Some sensitive antibiotics, such as ceftriaxone, have become ineffective in recent years.5.6 The rapid development of N. gonorrhoeae resistance to antimicrobial agents worldwide will threaten the management of N. gonorrhoeae infection.1
This study is a retrospective analysis of the drug sensitivity of Neisseria gonorrhoeae in the two university hospitals in southern China from 2016 to 2020.
Materials and methods
Retrospective analysis of drug sensitivity of Neisseria gonorrhoeae in two university hospitals in Guangzhou, southern China, from 2016 to 2020 was carried out.
Patient demographic and clinical information such as gender, age and symptoms were collected using an electronic record system. Each isolate was cultured and verified.7 MICs for penicillin, cefuroxime, ceftriaxone (CRO), cefepime, ciprofloxacin, ceftazidime and azithromycin (AZM) were determined by the agar dilution method. Antimicrobial susceptibility was interpreted according to criteria defined by the WHO.8.9
-Lactamase was detected by enzyme-linked immunosorbent assay (ELISA).ten Ureaplasma urealyticum and Mycoplasma hominis was determined by culture in liquid medium, and Chlamydia was detected by a rapid antigen test.ten All results were collected using an electronic case system and an electronic clinical review system.
Statistical significance was assessed using SPSS 18.0. Chi-square tests were used for statistical analyzes. A P
Three hundred and four patients with Neisseria gonorrhoeae infection were included in this study. The study included 282 men and 22 women. The age range ranged from 16 to 75 years, with an average age of 30.30 ± 9.11 years. From 2016 to 2020, the rate of resistance to ceftriaxone was 6.38%, 8.06%, 8.86%, 14.29% and 11.67%, respectively, the mean resistance was 9.87% . Azithromycin resistance was 6.38%, 9.68%, 10.13%, 12.50%, and 16.67%, respectively, from 2016 to 2020, and the average resistance was 11.18% (table 1). The differences in resistance rates between 2016 and 2020 were statistically significant for ceftriaxone and azithromycin (P
Table 1 Antimicrobial resistance to Neisseria gonorrhoeae Infection from 2016 to 2020
From 2016 to 2020, -lactamase positive of Neisseria gonorrhoeae increased every year (P Neisseria gonorrhoeae infection associated with Chlamydial infection and Ureaplasma urealyticum the infection also gradually increased (P
Table 2 Neisseria gonorrhoeae Infection in CHUs from 2016 to 2020
The vaccine against N. gonorrhoeae is not currently available; a wide range of clinical manifestations and complications N. gonorrhoeae the infection gradually increased. Therefore, N. gonorrhoeae infection control relies primarily on accurate diagnoses and prompt antibiotic therapy after antibiotic susceptibility testing.1–4
In recent years, the management of N. gonorrhoeae infection has been difficult due to the rapid development of resistance to a wide range of antimicrobial agents.1
In order to limit the development of antimicrobial resistance and ensure effective treatment, treatment with ceftriaxone 250 or 500 mg given intramuscularly plus azithromycin 1 or 2 g orally has been widely accepted as the first choice for treatment. of N. gonorrhoeae infection.11 The emergence of therapeutic failures using cephalosporins having been documented in several countries in the 2000s and the alert susceptibility of N. gonorrhoeae, some researchers recommend the use of 1000 mg of ceftriaxone intramuscularly.3 In this retrospective study, N. gonorrhoeae the rate of resistance to ceftriaxone was 6.38%, 8.06%, 8.86%, 14.29% and 11.67%, respectively, from 2016 to 2020. The mean resistance was 9.87% . This is consistent with previous studies.5–7
Located in southern China, Guangzhou is the major hub of the “Silk Road” and “Belt and Road”, which has a large passing population of foreign visitors and business partners. The importation and spread of antimicrobial resistance is a constant threat to public health in Guangzhou. Multidrug-resistant ceftriaxone resistant N. gonorrhoeae compromises the effectiveness of the currently recommended first-line dual therapy. It is imperative to strengthen surveillance of antimicrobial susceptibility, in order to detect and monitor trends in drug resistance. Neisseria gonorrhoeae, in order to ensure the effectiveness of its treatment.1.3
In this study, the resistance rate from 2016 to 2020 significantly increased for ceftriaxone and azithromycin. Too, Neisseria gonorrhoeae infection associated with Chlamydia infection and Ureaplasma urealyticum the infection also gradually increased. Pathogenic examination, in particular N. gonorrhoeae culture and drug susceptibility testing, is more important for the selection of sensitive antibiotics. A limitation of this study is that a small number of cases were evaluated.
The study was approved by the ethics committee of the First Affiliated Hospital of Jinan University and the Third Affiliated Hospital of Southern Medical University. All subjects were adults and provided written informed consent.
This study was carried out in accordance with the Declaration of Helsinki.
This work was supported by grants from the Scientific Research Project of the Traditional Chinese Medicine Bureau of Guangdong Province (grant no-20212147).
All authors have made substantial contributions to conception and design, data acquisition or data analysis and interpretation; participated in the writing of the article or its critical review for significant intellectual content; agreed to submit to the current journal; gave final approval to the version to be published; and accepting to be responsible for all aspects of the job.
The authors have no conflicts of interest to declare.
1. Unemo M, Bradshaw CS, Hocking JS, et al. Sexually Transmitted Infections: The Challenges Ahead. Lancet Infect Dis. 2017; 17 (8): e235 – e279.
2. Wan C, Li Y, Le WJ, et al. Increased resistance to azithromycin in Neisseria gonorrhoeae in Eastern Chinese Cities: Resistance Mechanisms and Genetic Diversity Among Nanjing Isolates. Antimicrobial agents Chemotherapy. 2018; 62 (5): e02499-17. doi: 10.1128 / AAC.02499-17
3. Liu YH, Wang YH, Liao CH, Hsueh PR. Appearance and spread of Neisseria gonorrhoeae strains with high level of resistance to azithromycin in Taiwan from 2001 to 2018. Antimicrobial agents Chemotherapy. 2019; 63 (9): e00773–19. doi: 10.1128 / AAC.00773-19
4. Yao HY, Wang CH. Preseptal cellulitis caused by Neisseria gonorrhoeae: a rare disease must be vigilant. J Microbiol Immunol Infect. 2017; 50 (3): 397-398. doi: 10.1016 / j.jmii.2015.05.024
5. Ko KKK, Chio MTW, Goh SS et al. First case of multidrug-resistant ceftriaxone Neisseria gonorrhoeae in Singapore. Antimicrobial agents Chemotherapy. 2019; 63 (5): e02624–18. doi: 10.1128 / AAC.02624-18
6. Chen SC, Yin YP, Chen XS. Cephalosporin resistant Neisseria gonorrhoeae clone, China. Emerg Infect Dis. 2018; 24 (4): 804-806. doi: 10.3201 / eid2404.171817
7. Liang JY, Cao WL, Li XD et al. Azithromycin resistant Neisseria gonorrhoeae isolates in Guangzhou, China (2009-2013): coevolution with reduced sensitivities to ceftriaxone and genetic characteristics. BMC Infect Dis. 2016; 16: 152. doi: 10.1186 / s12879-016-1469-3
8. World Health Organization. Global Plan of Action to Control the Spread and Impact of Antimicrobial Resistance in Neisseria gonorrhoeae; 2012. Available from: http://www.who.int/reproductivehealth/publications/rtis/9789241503501/en/.
9. Lusti-Narasimhan M, Pessoa-Silva CL, Temmerman M. Moving forward in the fight against antimicrobial resistance: actions by WHO. Infect sexual transmission. 2013; 89 (Suppl4): iv57 – iv59. doi: 10.1136 / sextrans-2012-050910
10. Tsevat DG, Wiesenfeld HC, Parks C, Peipert JF. Sexually transmitted diseases and infertility. Am J Obstet Gyneco. 2017; 216 (1): 1–9. doi: 10.1016 / j.ajog.2016.08.008
11. Unemo M, Shafer WM. Antimicrobial resistance in Neisseria gonorrhoeae in the 21st century: past, evolution and future. Clin Microbiol Rev. 2014; 27 (3): 587-613.