Epidemiological surveillance study of gonococcal infection in Northern Spain / Estudio de vigilancia epidemiológica de la infección gonocócica en el Norte de España

BACKGROUND: Treatment of gonorrhoea is threatened by antimicrobial resistance, and decreased susceptibility to recommended therapies is emerging. Thus, gonococcal infection (GI) is becoming a public health problem. The objectives of the present study were to monitor the antimicrobial sensitivity in Neisseria gonorrhoeae (NG) during 2011-2015 and to study their genogroups. METHODS: Antimicrobial susceptibility was studied by disc diffusion, in addition to the agar dilution method for cefixime and ceftriaxone and the Etest(R) for azithromycin. Genotyping was performed by the NG multi-antigen sequence typing (NG-MAST) method. Genogroups of closely related sequence types (STs) were defined. RESULTS: All the strains were susceptible to cefixime, ceftriaxone and gentamicin and 1.8% of the strains were resistant to azithromycin. A total of 531 STs and 6 genotypes (Gs) were identified during 2012-2015 period. G2992 was the largest and was associated with resistance to azithromycin, and with men who have sex with men (MSM), alongside G2400. G1407 and G2400 strains were related to high minimum inhibitory concentration (MICs) to cefixime and G1407 also to ceftriaxone. For the first time, G1861 and G2018 were described and associated with ciprofloxacin resistance and G2018 also with high MICs to ceftriaxone. CONCLUSION: Molecular typing is a useful tool to predict antimicrobial resistance. These results show the need to develop novel antimicrobials or to design new antimicrobial therapies based on drugs that show their efficacy against GI. This also highlights the importance of developing sexually transmitted infection (STI) surveillance in homosexual populations

INTRODUCCIÓN: el tratamiento de la gonorrea está amenazado por la resistencia antimicrobiana, y la disminución de la sensibilidad a las terapias recomendadas está emergiendo. Por ello la infección gonocócica (IG) se está convirtiendo en un problema de salud pública. MÉTODOS: la sensibilidad antimicrobiana se estudió por el método de difusión en disco, cefixima y ceftriaxona fueron testados por el método de dilución en agar y azitromicina por Etest. El genotipado se realizó por el método NG multi-antigen sequence typing (NG-MAST). Se definieron genogrupos con secuenciotipos (STs) relacionados. RESULTADOS: todas las cepas fueron sensibles a cefixima, ceftriaxona y gentamicina y el 1,8% resistentes a azitromicina. Se identificaron 531 STs y 6 genotipos (Gs) durante el período 2012-2015. El G2992 fue el más grande y se relacionó con resistencia a azitromicina, y con hombres que tienen sexo con hombres (HSH) junto con el G2400. Las cepas pertenecientes a los G1407 y G2400 se relacionaron con altas concentraciones mínimas inhibitorias (CMIs) a cefixima y el G1407 también a ceftriaxona. Se describe por primera vez la presencia del G1861 y G2018 y su relación con la resistencia a ciprofloxacino y la relación del G2018 con alta CMI a ceftriaxona. CONCLUSIÓN: El tipado molecular es una herramienta útil para predecir la resistencia antimicrobiana. Estos resultados muestran la necesidad de desarrollar nuevos antimicrobianos o nuevas terapias basadas en fármacos que demuestren su eficacia contra la IG. También muestra la importancia del desarrollo de la vigilancia de las infecciones de transmisión sexual (ITS) en la población homosexual

Epidemiological surveillance study of gonococcal infection in Northern Spain.

BACKGROUND: Treatment of gonorrhoea is threatened by antimicrobial resistance, and decreased susceptibility to recommended therapies is emerging. Thus, gonococcal infection (GI) is becoming a public health problem. The objectives of the present study were to monitor the antimicrobial sensitivity in Neisseria gonorrhoeae (NG) during 2011-2015 and to study their genogroups. METHODS: Antimicrobial susceptibility was studied by disc diffusion, in addition to the agar dilution method for cefixime and ceftriaxone and the Etest® for azithromycin. Genotyping was performed by the NG multi-antigen sequence typing (NG-MAST) method. Genogroups of closely related sequence types (STs) were defined. RESULTS: All the strains were susceptible to cefixime, ceftriaxone and gentamicin and 1.8% of the strains were resistant to azithromycin. A total of 531 STs and 6 genotypes (Gs) were identified during 2012-2015 period. G2992 was the largest and was associated with resistance to azithromycin, and with men who have sex with men (MSM), alongside G2400. G1407 and G2400 strains were related to high minimum inhibitory concentration (MICs) to cefixime and G1407 also to ceftriaxone. For the first time, G1861 and G2018 were described and associated with ciprofloxacin resistance and G2018 also with high MICs to ceftriaxone. CONCLUSION: Molecular typing is a useful tool to predict antimicrobial resistance. These results show the need to develop novel antimicrobials or to design new antimicrobial therapies based on drugs that show their efficacy against GI. This also highlights the importance of developing sexually transmitted infection (STI) surveillance in homosexual populations.