Antimicrobial resistance in Neisseria gonorrhoeae in nine sentinel countries within the World Health Organization Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP), 2023: a retrospective observational study
Ismaël Maatouk, Phiona Vumbugwa, Thitima Cherdtrakulkiat, Heng Li, Irving Hoffman, Noel Palaypayon, Francis Kakooza, Rossaphorn Kittiyaowamarn, Peter Kyambadde, Monica M Lahra, Phạm Thị Lan, Venessa Maseko, Mitch Matoga, Anna Machiha, E Müller, Thuy Thi Phan Nguyen, Le Huu Doanh, Vichea Ouk, Vivi Setiawaty, Sonia Sia, Teguh Sarry Hartono, Mot Virak, Nguyễn Thị Thúy Vân, Magnus Unemo, Teodora Wi, Heng Li, Vichea Ouk, Mot Virak, Phal Kun Mom, Phal Kun Mom, Vivi Setiawaty, Endang Lukitosari, Nurhalina Afriana, Verawati Sulaiman, Teguh Sarry Hartono, Maria Laurensia, Ni Luh Putu Pitawati, Mitch Matoga, Irving Hoffman, Robert Krysiak, Jane Chen, Naomi Bonongwe, Claightone Chirombo, Edward Jere, James Kapha, Sonia Sia, Manuel C Jamoralin, Marietta L Lagrada, June M Gayeta, Jaywardeen P Abad, Noel Palaypayon, Diana Lim, Iftizar N. Haron, J C E Sangco, Felyrose Fuertes, August Cesar Abrajano, Ruby Rusia-Uy, Christine Ivy Paula S. Agtuca, Ma. Theresa A. Fedoc-Minguito, Louwela A. Jerusalem, Venessa Maseko, E Müller, Lindy Gumede, Portia Baloyi, Rossaphorn Kittiyaowamarn, Natnaree Girdthep, Porntip Paopang, Pongsathorn Sangprasert, Thitima Cherdtrakulkiat, Jaray Tongtoyai, Francis Kakooza, Peter Kyambadde, Emmanuel Mande, Martha Nakasi, Le Huu Doanh, Phạm Thị Lan, Hoa Quynh Pham, Pham Dieu Hoa, Thuy Thi Phan Nguyen, Hao Trong Nguyen, Nhi Thi Uyen Pham, Phuong Thi Thanh Nguyen, Nguyễn Thị Thúy Vân, Francis Slaughter, Anna Machiha, Owen Mugurungi, Agnes Juru, Tatenda Ngorima, Lucia Sisya, Lucia Sisya, Andrew Tarupiwa, Muchaneta Mugabe, Mkhokheli Ngwenya, Precious Paidamoyo Andifasi, Monica M Lahra, Sebastian van Hal, Magnus Unemo, Daniel Golparian, Susanne Jacobsson, Daniel Schröder
Abstract
Background The global spread of antimicrobial resistance (AMR) in Neisseria gonorrhoeae threatens empiric single-dose gonorrhoea treatment. Enhanced global AMR surveillance is imperative. We report i) gonococcal antimicrobial susceptibility and resistance data from 2023 in the World Health Organization Enhanced Gonococcal Antimicrobial Surveillance Programme (WHO EGASP) in the WHO Western Pacific Region (Cambodia, the Philippines, Viet Nam), Southeast Asian Region (Indonesia, Thailand), and African Region (Malawi, South Africa, Uganda, Zimbabwe), and ii) metadata of the gonorrhoea patients. Methods In 2023, WHO EGASP included men with urethral discharge (n = 3498) and gonococcal isolates (n = 2491). Minimum inhibitory concentrations (MICs, mg/L) values were determined for ceftriaxone, cefixime, azithromycin, gentamicin, and ciprofloxacin using Etest (bioMérieux). Breakpoints from the European Committee on Antimicrobial Susceptibility Testing (EUCAST) were applied. Clinical and epidemiological variables associated with AMR isolates were assessed using univariable and multivariable logistic regression analyses of odds ratios. Findings Overall, 3.8% (95% confidence interval (95% CI) 3.1–4.6%; 95/2487), 8.9% (95% CI 7.9–10.1%; 222/2484), 3.6% (95% CI 2.9–4.4%; 89/2487), and 95.3% (95% CI 93.2–97.5%; 1801/1890) of isolates were resistant to ceftriaxone, cefixime, azithromycin, and ciprofloxacin, respectively. All the ceftriaxone-resistant isolates were from Cambodia (15.3% (95% CI 11.5–20.1%), 42/274) and Viet Nam (20.4% (95% CI 15.9–25.7%), 53/260). In univariable analysis, ceftriaxone resistance was associated with travelling within the country during previous 30 days (OR 4.66, 95% CI 3.06–7.16; p < 0.001), and this association remained in multivariable analysis (aOR 4.12, 95% CI 2.65–6.65; p < 0.001). Interpretation Resistance to ceftriaxone, cefixime, and azithromycin is a major global concern, and expanded and improved resistance surveillance is essential. The WHO EGASP has been substantially expanded in the recent years. Additionally, resistance breakpoints have been harmonised and test-of-cure, whole-genome sequencing, and extragenital sampling implemented, where feasible. Novel antimicrobials for gonorrhoea treatment are critical; zoliflodacin and gepotidacin are promising. Funding WHO, Global Fund.