Antimicrobial susceptibility and molecular epidemiology of Neisseria gonorrhoeae in Germany
Introduction
Neisseria gonorrhoeae is one of the most frequent pathogens causing sexual transmitted diseases worldwide. According to the latest WHO assessment, gonococcal infections represent 106 million of the estimated 499 million new cases of curable sexually transmitted infections (STI) that occur globally every year (WHO, 2008). Antimicrobial resistance in N. gonorrhoeae has progressively developed over the years and the emerging threat of untreatable gonococcal infection becomes apparent (Bolan et al., 2012, ECDC, 2012, Unemo and Nicholas, 2012a, Ison et al., 2013, WHO, 2012). The European surveillance report on antimicrobial resistance in N. gonorrhoeae reveals high rates of resistance to many previously recommended therapeutic agents in many European countries such as ciprofloxacin, tetracycline and penicillin (Cole et al., 2010). The report further concludes that continual surveillance of antimicrobial resistance is essential to monitor for increasing and emerging resistance to clinical relevant antibiotics and to adapt treatment guidelines accordingly (Cole et al., 2010). Hence, the present study was performed to provide first nationwide data on the epidemiology of antibiotic resistance among gonococcal isolates in Germany.
Section snippets
N. gonorrhoeae isolates
In a prospective surveillance study conducted by the Paul Ehrlich Society for Chemotherapy between October 2010 and December 2011, 23 laboratories all over Germany were requested to send consecutive N. gonorrhoeae isolates to the study laboratory at the Institute of Medical Microbiology and Infection Control at the Hospital of Goethe-University in Frankfurt am Main according to a study protocol. Data concerning participating laboratories with regard to location, type of laboratory and number of
Results
A total of 213 gonococcal isolates were analyzed in this nationwide study. Isolates were recovered from 179 males and 34 females. Mean age of the males and females was 31.9 years (median age: 31 years; range: 18–67 years) and 25.4 years (median age: 25 years; range: 18–55 years), respectively. The sites of isolation were urethra 69.0%, cervix 8.0%, rectum 3.8%, throat 0.5%, and 18.8% not reported.
Discussion
Data on the spread of antibiotic resistance among gonococcal isolates in Germany is scarce. Previously published reports from Germany only reflected the local situation in various parts of the country (Schäfer et al., 1995, Wagner et al., 2000, Ungeheuer and Michalewski-Zietz, 2001, Enders et al., 2006, Rosenthal et al., 2009). A consiliary laboratory for gonococci in Germany has been established in 2010 that reports on antimicrobial susceptibility data based on voluntary transmittal of
Conflict of interest statements
TAW has accepted speaking invitations from various pharmaceutical companies, though none poses a conflict of interest with the work presented here.
MK is a partner and CEO of Antiinfectives Intelligence GmbH, a research organization providing services to pharmaceutical companies.
BK-I is an employee of Antiinfectives Intelligence GmbH.
NNH, CW, SG declare that they have no competing interests.
Funding sources
No external funding sources were received.
Acknowledgements
Members of the Working Party: Dr. R. Hörnle, Dr. R. Speer (Gesundheitsamt Berlin, Zentrum für sexuelle Gesundheit); Dr. B. Hornei (synlab Leverkusen); Dr. H. Gerlach-Piontek, C. Gehre/Dr. A-U Wagner (Landesuntersuchungsanstalt für das Gesundheits- und Veterinärwesen Sachsen/Gesundheitsamt Dresden); Prof. R. Gottschalk (Amt für Gesundheit Frankfurt am Main); Dr. G. Walter (Gesundheitsamt Hamburg); Dr. A. Berger, Dr. H. Bischoff (Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit,
References (38)
- et al.
Antimicrobial susceptibility of Neisseria gonorrhoeae isolates determined by the agar dilution, disk diffusion and Etest methods: comparison of results using GC agar and chocolate agar
Int. J. Antimicrob. Agents
(2010) - et al.
Comparative assessment of Etest for testing susceptibilities of Neisseria gonorrhoeae to penicillin, tetracycline, ceftriaxone, cefotaxime, and ciprofloxacin: investigation using 510(k) review criteria, recommended by the Food and Drug Administration
J. Clin. Microbiol.
(1996) - et al.
Azithromycin in the treatment of infection with Neisseria gonorrhoeae
Sex. Transm. Infect.
(2010) - et al.
UK national guideline for the management of gonorrhoea in adults, 2011
Int. J. STD AIDS
(2011) - et al.
The emerging threat of untreatable gonococcal infection
N. Engl. J. Med.
(2012) Update to CDC's Sexually transmitted diseases treatment guidelines, 2010: oral cephalosporins no longer a recommended treatment for gonococcal infections
MMWR Morb. Mortal Wkly. Rep.
(2012)- et al.
Molecular epidemiological typing within the European Gonococcal Antimicrobial Resistance Surveillance Programme reveals predominance of a multidrugresistant clone
Euro Surveill.
(2013) Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically. Approved standard M7-A8
(2009)- et al.
European surveillance of antimicrobial resistance in Neisseria gonorrhoeae
Sex. Transm. Infect.
(2010) - et al.
Antimicrobial resistance of Neisseria gonorrhoeae isolates from the Stuttgart and Heidelberg areas of southern Germany
Eur. J. Clin. Microbiol. Infect. Dis.
(2006)
Response plan to control and manage the threat of multidrugresistant gonorrhoea in Europe
ECDC surveillance report, Gonococcal antimicrobial susceptibility surveillance in Europe, 2011
New mutation in 23S rRNA gene associated with high level of azithromycin resistance in Neisseria gonorrhoeae
Antimicrob. Agents Chemother.
Current and future treatment options for gonorrhoea
Sex Transm. Infect.
Comparability of laboratory diagnosis and antimicrobial susceptibility testing of Neisseria gonorrhoeae from reference laboratories in Western Europe
J. Antimicrob. Chemother.
Neisseria gonorrhoeae with high-level resistance to azithromycin: case report of the first isolate identified in the United States
Clin. Infect. Dis.
Phenotypic and genetic characterization of the first two cases of extended-spectrum-cephalosporin-resistant Neisseria gonorrhoeae infection in South Africa and association with cefixime treatment failure
J. Antimicrob. Chemother.
Rapid sequence-based identification of gonococcal transmission clusters in a large metropolitan area
J. Infect. Dis.
Antimicrobial susceptibilities and distribution of sequence types of Neisseria gonorrhoeae isolates in Canada: 2010
Can. J. Microbiol.
Cited by (14)
Neisseria gonorrhoeae molecular typing for understanding sexual networks and antimicrobial resistance transmission: A systematic review
2018, Journal of InfectionCitation Excerpt :For example, Horn et al.31 found that isolates classified as genogroup 25 were predominantly from women, whereas those classified as genogroup 1407 were predominantly from men. In general, only the most common sequence types, which formed the largest clusters, were described in this way.10,11,15–19,21,27,31,32,40,47,48,50,53 Where sequence types were statistically associated with one group of patients, such as MSM, authors inferred that this provided evidence of a discrete sexual network.
Urethritis in Men and Women
2017, European Urology, SupplementsIncreased incidences of multidrug-resistant gonorrhea in Taiwanese men: Experiences from a single institute
2016, Urological ScienceCitation Excerpt :Gonorrhea can also increase the risk of developing other acute infections and complications. Treatment options are diminishing because N. gonorrhoeae has developed resistance to several commonly used antimicrobial drugs, such as the sulfonamides, penicillin, tetracyclines, and quinolones.12,13,15–18 An effective detection method combining efficient treatment for gonorrhea is urgently needed in order to stop the increasing risks that are emerging for the disease.
Molecular Epidemiology of Penicillinase-Producing Neisseria gonorrhoeae Isolates and Their bla<inf>TEM-135</inf> Gene Variant in Bangkok, Thailand, 2015–2017
2023, Japanese Journal of Infectious DiseasesGlobal status of Azithromycin and Erythromycin Resistance Rates in Neisseria gonorrhoeae: A Systematic Review and Meta-analysis
2022, Yale Journal of Biology and Medicine