BMC Infectious Diseases | |
Russian gonococcal antimicrobial susceptibility programme (RU-GASP) – resistance in Neisseria gonorrhoeae during 2009–2012 and NG-MAST genotypes in 2011 and 2012 | |
Magnus Unemo1  Rafil Khairullin2  Denis Vorobyev2  Vera Semina2  Viktoria Solomka2  Nataliya Frigo2  Alexey Kubanov2  Anna Kubanova2  | |
[1] WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Microbiology, Örebro University Hospital, SE-701 85 Örebro, Sweden;Тhe State Research Center of Dermatology, Venereology and Сosmetology of The Russian Ministry of Health (SRCDVC), Moscow, Russia | |
关键词: Russia; N. gonorrhoeae multiantigen sequence typing (NG-MAST); Treatment; Ceftriaxone; Extended-spectrum cephalosporins (ESCs); Russian gonococcal antimicrobial susceptibility programme (RU-GASP); National surveillance; Antimicrobial resistance; Gonorrhoea; Neisseria gonorrhoeae; | |
Others : 1127512 DOI : 10.1186/1471-2334-14-342 |
|
received in 2014-04-13, accepted in 2014-06-12, 发布年份 2014 | |
【 摘 要 】
Background
Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a major concern worldwide and gonococcal AMR surveillance globally is imperative for public health purposes. In Eastern Europe, gonococcal AMR surveillance is exceedingly rare. However, in 2004 the Russian gonococcal antimicrobial susceptibility programme (RU-GASP) was initiated. The aims of this study were to describe the prevalence and trends of gonococcal AMR from 2009 to 2012, and molecular epidemiological genotypes in 2011 and 2012 in Russia.
Methods
Gonococcal isolates from 12–46 surveillance sites distributed across Russia, obtained in 2009 (n = 1200), 2010 (n = 407), 2011 (n = 423), and 2012 (n = 106), were examined for antimicrobial susceptibility using agar dilution method. Gonococcal isolates from 2011 and 2012 were investigated with N. gonorrhoeae multi-antigen sequence typing (NG-MAST).
Results
During 2009–2012, the proportions of gonococcal isolates resistant to ciprofloxacin, penicillin G, azithromycin and spectinomycin ranged from 25.5% to 44.4%, 9.6% to 13.2%, 2.3% to 17.0% and 0.9% to 11.6%, respectively. Overall, the resistance level to penicillin G was stable, the resistance level to ciprofloxacin was decreasing, however, the level of resistance to azithromycin increased. All isolates were susceptible to ceftriaxone using the US CLSI breakpoints. However, using the European breakpoints 58 (2.7%) of the isolates were resistant to ceftriaxone. Interestingly, this proportion was decreasing, i.e. from 4.8% in 2009 to 0% in 2012.
Conclusions
In Russia, the diversified gonococcal population showed a high resistance to ciprofloxacin, penicillin G and azithromycin. In general, the MICs of ceftriaxone were relatively high, however, they were decreasing from 2009 to 2012. Ceftriaxone should be the first-line for empiric antimicrobial monotherapy of gonorrhoea in Russia. It is essential to further strengthen the surveillance of gonococcal AMR (ideally also gonorrhoea treatment failures) in Russia.
【 授权许可】
2014 Kubanova et al.; licensee BioMed Central Ltd.
【 预 览 】
Files | Size | Format | View |
---|---|---|---|
20150220215952735.pdf | 268KB | download | |
Figure 1. | 51KB | Image | download |
【 图 表 】
Figure 1.
【 参考文献 】
- [1]World Health Organization: Global incidence and prevalence of selected curable sexually transmitted infections - 2008. Geneva: World Health Organization; 2012. Available at: http://www.who.int/reproductivehealth/publications/rtis/2008_STI_estimates.pdf webcite (Accessed: June 3, 2014)
- [2]European Centre for Disease Prevention and Control: Sexually Transmitted Infections in Europe 2011. Stockholm: ECDC; 2013. Available at: http://www.ecdc.europa.eu/en/publications/publications/sexually-transmitted-infections-europe-2011.pdf webcite (Accessed: June 3, 2014)
- [3]Unemo M, Ison CA, Cole M, Spiteri G, van de Laar M, Khotenashvili L: Gonorrhoea and gonococcal antimicrobial resistance surveillance networks in the WHO European Region, including the independent countries of the former Soviet Union. Sex Transm Infect 2013, 89(Suppl 4):iv42-iv46.
- [4]Unemo M, Shipitsyna E, Domeika M: Recommended antimicrobial treatment of uncomplicated gonorrhoea in 2009 in 11 East European countries: implementation of a Neisseria gonorrhoeae antimicrobial susceptibility programme in this region is crucial. Sex Transm Infect 2010, 86:442-444.
- [5]Unemo M, Shipitsyna E, Domeika M: Gonorrhoea surveillance, laboratory diagnosis and antimicrobial susceptibility testing of Neisseria gonorrhoeae in 11 countries of the eastern part of the WHO European region. APMIS 2011, 119:643-649.
- [6]Tapsall JW, Ndowa F, Lewis DA, Unemo M: Meeting the public health challenge of multidrug- and extensively drug-resistant Neisseria gonorrhoeae. Expert Rev Anti Infect Ther 2009, 7:821-834.
- [7]Lewis DA: The gonococcus fights back: is this time a knock out? Sex Transm Infect 2010, 86:415-421.
- [8]Unemo M, Nicholas RA: Emergence of multi-drug resistant, extensively drug-resistant and untreatable gonorrhea. Future Microbiol 2012, 7:1401-1422.
- [9]Tapsall J: Antimicrobial resistance in Neisseria gonorrhoeae. WHO/CDS/DRS/2001.3:16. Geneva: World Health Organisation (WHO); 2001.
- [10]Whiley DM, Goire N, Lahra MM, Donovan B, Limnios AE, Nissen MD, Sloots TP: The ticking time bomb: escalating antibiotic resistance in Neisseria gonorrhoeae is a public health disaster in waiting. J Antimicrob Chemother 2012, 67:2059-2061.
- [11]Bolan GA, Sparling PF, Wasserheit JN: The emerging threat of untreatable gonococcal infection. N Engl J Med 2012, 366:485-487.
- [12]Spiteri G, Cole M, Unemo M, Hoffmann S, Ison C, van de Laar M: The European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP)--a sentinel approach in the European Union (EU)/European Economic Area (EEA). Sex Transm Infect 2013, 89(Suppl 4):iv16-iv18.
- [13]Tapsall J, Read P, Carmody C, Bourne C, Ray S, Limnios A, Sloots T, Whiley D: Two cases of failed ceftriaxone treatment in pharyngeal gonorrhoea verified by molecular microbiological methods. J Med Microbiol 2009, 58:683-687.
- [14]Unemo M, Golparian D, Hestner A: Ceftriaxone treatment failure of pharyngeal gonorrhoea verified by international recommendations, Sweden, July 2010. Euro Surveill 2011, 16(6):19792.
- [15]Unemo M, Golparian D, Potocnik M, Jeverica S: Treatment failure of pharyngeal gonorrhoea with internationally recommended first-line ceftriaxone verified in Slovenia, September 2011. Euro Surveill 2012, 17(25):20200.
- [16]Ohnishi M, Golparian D, Shimuta K, Saika T, Hoshina S, Iwasaku K, Nakayama S, Kitawaki J, Unemo M: Is Neisseria gonorrhoeae initiating a future era of untreatable gonorrhea?: detailed characterization of the first strain with high-level resistance to ceftriaxone. Antimicrob Agents Chemother 2011, 55:3538-3545.
- [17]Chen YM, Stevens K, Tideman R, Zaia A, Tomita T, Fairley CK, Lahra M, Whiley D, Hogg G: Failure of ceftriaxone 500 mg to eradicate pharyngeal gonorrhoea, Australia. J Antimicrob Chemother 2013, 68:1445-1447.
- [18]Read PJ, Limnios EA, McNulty A, Whiley D, Lahra LM: One confirmed and one suspected case of pharyngeal gonorrhoea treatment failure following 500 mg ceftriaxone in Sydney, Australia. Sex Health 2013, 10:460-462.
- [19]Unemo M, Golparian D, Nicholas R, Ohnishi M, Gallay A, Sednaoui P: High-level cefixime- and ceftriaxone-resistant Neisseria gonorrhoeae in France: novel penA mosaic allele in a successful international clone causes treatment failure. Antimicrob Agents Chemother 2012, 56:1273-1280.
- [20]Cámara J, Serra J, Ayats J, Bastida T, Carnicer-Pont D, Andreu A, Ardanuy C: Molecular characterization of two high-level ceftriaxone-resistant Neisseria gonorrhoeae isolates detected in Catalonia, Spain. J Antimicrob Chemother 2012, 67:1858-1860.
- [21]World Health Organization (WHO), Department of Reproductive Health and Research: Global action plan to control the spread and impact of antimicrobial resistance in Neisseria gonorrhoeae. Geneva: WHO; 2012:1-36. Available at: http://www.who.int/reproductivehealth/publications/rtis/9789241503501 webcite (Accessed: June 3, 2014)
- [22]European Centre for Disease Prevention and Control (ECDC): Response plan to control and manage the threat of multidrug-resistant gonorrhoea in Europe. Stockholm: ECDC; 2012:1-23. Available at: http://www.ecdc.europa.eu/en/publications/Publications/1206-ECDC-MDR-gonorrhoea-response-plan.pdf webcite (Accessed: June 3, 2014)
- [23]Centers for Disease Control and Prevention (CDC): Cephalosporin-resistant Neisseria gonorrhoeae public health response plan. 2012, 1-43. Available at: http://www.cdc.gov/std/treatment/ceph-r-responseplanjuly30-2012.pdf webcite (Accessed: June 3, 2014)
- [24]Kubanova A, Kubanov A, Frigo N, Sidorenko S, Priputnevich T, Vachnina T, Al-Khafaji N, Polevshikova S, Solomka V, Domeika M, Unemo M: National surveillance of antimicrobial susceptibility in Neisseria gonorrhoeae in 2005–2006 and recommendations of first-line antimicrobial drugs for gonorrhoea treatment in Russia. Sex Transm Infect 2008, 84:285-289.
- [25]Kubanova A, Frigo N, Kubanov A, Sidorenko S, Lesnaya I, Polevshikova S, Solomka V, Bukanov N, Domeika M, Unemo M: The Russian gonococcal antimicrobial susceptibility programme (RU-GASP) – national resistance prevalence in 2007 and 2008, and trends during 2005–2008. Euro Surveill 2010, 15(14):19533.
- [26]Unemo M, Fasth O, Fredlund H, Limnios A, Tapsall JW: Phenotypic and genetic characterization of the 2008 WHO Neisseria gonorrhoeae reference strain panel intended for global quality assurance and quality control of gonococcal antimicrobial resistance surveillance for public health purposes. J Antimicrob Chemother 2009, 63:1142-1151.
- [27]Expert counsil of the Russian society of dermatovenereologists and cosmetologists: Clinical recommendations on the management of patients with sexually transmitted infections and urogenital infections//Moscow, Russia. In Russian: Izdatel'skiy dom Delovoy ekspress. - 112 S; 2012.
- [28]Unemo M, Dillon JA: Review and international recommendation of methods for typing Neisseria gonorrhoeae isolates and their implications for improved knowledge of gonococcal epidemiology, treatment, and biology. Clin Microbiol Rev 2011, 24:447-458.
- [29]Unemo M, Vorobieva V, Firsova N, Ababkova T, Leniv I, Haldorsen BC, Fredlund H, Skogen V: The Neisseria gonorrhoeae population transmitted in Arkhangelsk, Russia in 2004 – phenotypic and genotypic heterogeneity. Clin Microbiol Infect 2007, 13:873-878.
- [30]Ilina EN, Oparina NY, Shitikov EA, Borovskaya AD, Govorun VM: Molecular surveillance of clinical Neisseria gonorrhoeae isolates in Russia. J Clin Microbiol 2010, 48:3681-3689.
- [31]Tapsall JW, Cheng JK: Rapid identification of pathogenic species of Neisseria by carbohydrate degradation tests: importance of glucose in media used for preparation of inocula. Br J Ven Dis 1981, 14:249-252.
- [32]Clinical and Laboratory Standards Institute: Performance standards for antimicrobial susceptibility testing, 24th informational supplement, CLSI document M100-S24. Wayne, PA: CLSI; 2014.
- [33]Martin IM, Ison CA, Aanensen DM, Fenton KA, Spratt BG: Rapid sequence-based identification of gonococcal transmission clusters in a large metropolitan area. J Infect Dis 2004, 189:1497-1505.
- [34]Chisholm SA, Unemo M, Quaye N, Johansson E, Cole MJ, Ison CA, Van de Laar MJ: Molecular epidemiological typing within the European gonococcal antimicrobial resistance surveillance programme reveals predominance of a multidrug-resistant clone. Euro Surveill 2013, 18(3):20358.
- [35]Grad YH, Kirkcaldy RD, Trees D, Dordel J, Harris SR, Goldstein E, Weinstock H, Parkhill J, Hanage WP, Bentley S, Lipsitch M: Genomic epidemiology of Neisseria gonorrhoeae with reduced susceptibility to cefixime in the USA: a retrospective observational study. Lancet Infect. Dis 2014, 14:220-226.
- [36]Glazkova S, Golparian D, Titov L, Pankratova N, Suhabokava N, Shimanskaya I, Domeika M, Unemo M: Antimicrobial susceptibility/resistance and molecular epidemiological characteristics of Neisseria gonorrhoeae in 2009 in Belarus. APMIS 2011, 119:537-542.
- [37]Palmer HM, Young H, Winter A, Dave J: Emergence and spread of azithromycin-resistant Neisseria gonorrhoeae in Scotland. J Antimicrob Chemother 2008, 62:490-494.
- [38]Chisholm SA, Dave J, Ison CA: High-level azithromycin resistance occurs in Neisseria gonorrhoeae as a result of a single point mutation in the 23S rRNA genes. Antimicrob Agents Chemother 2012, 54:3812-3816.
- [39]Starnino S, Stefanelli P, Neisseria gonorrhoeae Italian Study Group I: Azithromycin-resistant Neisseria gonorrhoeae strains recently isolated in Italy. J Antimicrob Chemother 2009, 63:1200-1204.
- [40]Galarza PG, Abad R, Canigia LF, Buscemi L, Pagano I, Oviedo C, Vázquez JA: New mutation in 23S rRNA gene associated with high level of azithromycin resistance in Neisseria gonorrhoeae. Antimicrob Agents Chemother 2010, 54:1652-1653.
- [41]Katz AR, Komeya AY, Soge OO, Kiaha MI, Lee MV, Wasserman GM, Maningas EV, Whelen AC, Kirkcaldy RD, Shapiro SJ, Bolan GA, Holmes KK: Neisseria gonorrhoeae with high-level resistance to azithromycin: case report of the first isolate identified in the United States. Clin Infect Dis 2012, 54:841-843.
- [42]Unemo M, Golparian D, Hellmark B: First three Neisseria gonorrhoeae isolates with high-level resistance to azithromycin in Sweden: a threat to currently available dual-antimicrobial regimens for treatment of gonorrhea? Antimicrob Agents Chemother 2013, 58:624-625.
- [43]Boslego JW, Tramont EC, Takafuji ET, Diniega BM, Mitchell BS, Small JW, Khan WN, Stein DC: Effect of spectinomycin use on the prevalence of spectinomycin-resistant and penicillinase-producing Neisseria gonorrhoeae. N Engl J Med 1987, 317:272-278.
- [44]Galimand M, Gerbaud G, Courvalin P: Spectinomycin resistance in Neisseria spp. due to mutations in 16S rRNA. Antimicrob Agents Chemother 2000, 44:1365-1366.
- [45]Unemo M, Golparian D, Skogen V, Olsen AO, Moi H, Syversen G, Hjelmevoll SO: Neisseria gonorrhoeae strain with high-level resistance to spectinomycin due to a novel resistance mechanism (mutated ribosomal protein S5) verified in Norway. Antimicrob Agents Chemother 2013, 57:1057-1061.
- [46]Ilina EN, Malakhova MV, Bodoev IN, Oparina NY, Filimonova AV, Govorun VM: Mutation in ribosomal protein S5 leads to spectinomycin resistance in Neisseria gonorrhoeae. Front Microbiol 2013, 4:186.
- [47]Ison CA, Town K, Obi C, Chisholm S, Hughes G, Livermore DM, Lowndes CM, and GRASP collaborative group: Decreased susceptibility to cephalosporins among gonococci: data from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) in England and Wales, 2007–2011. Lancet Infect Dis 2013, 13:762-768.
- [48]Jeverica S, Golparian D, Maticic M, Potočnik M, Mlakar B, Unemo M: Phenotypic and molecular characterization of Neisseria gonorrhoeae isolates from Slovenia, 2006-12: rise and fall of the multidrug-resistant NG-MAST genogroup 1407 clone? J Antimicrob Chemother 2014, 69:1517-1525.
- [49]Bala M, Kakran M, Singh V, Sood S, Ramesh V, Members of WHO GASP SEAR Network: Monitoring antimicrobial resistance in Neisseria gonorrhoeae in selected countries of the WHO South-East Asia Region between 2009 and 2012: a retrospective analysis. Sex Transm Infect 2013, 89(Suppl 4):iv28-iv35.
- [50]Centers for Disease Control and Prevention (CDC): Update to CDC's sexually transmitted diseases treatment guidelines, 2010: Oral cephalosporins no longer recommended for treatment of gonococcal infections. MMWR Morb Mortal Wkly Rep 2012, 61:590-594.
- [51]Bignell C, Unemo M, on behalf of the European STI Guidelines Editorial Board: European guideline on the diagnosis and treatment of gonorrhoea in adults. Int J STD AIDS 2013, 24:85-92.