An Unsettling Surge in Multidrug-Resistant and Extensively Drug-Resistant Neisseria gonorrhoeae : Insights From a
Devanshi Sharma1, Sumathi Muralidhar1, Naveen Chandra Joshi1
1From the Apex Regional STD Centre, VMMC, and Safdarjung Hospital.
Background:
The rapidly evolving drug resistance of Neisseria gonorrhoeae to various drugs used in its treatment has posed significant challenges, especially in developing countries. A rise in cephalosporin minimum inhibitory concentrations (MIC) among N. gonorrhoeae was identified in parts of Asia, as early as the late 1990s. Drugs such as penicillin, tetracycline, and ciprofloxacin, which were effective in the past, are now almost never used in treating gonorrhea. This research aimed to study the resistance trends of N. gonorrhoeae over a temporal span of 5 years.
Methods:
For 5 years, samples from STI clinic attendees were collected and processed for isolating N. gonorrhoeae . Confirmed isolates were subjected to antimicrobial susceptibility tests using the MIC E-strip method.
Results:
A total of 231 isolates of N. gonorrhoeae were studied, with 97.5% from male patients. Decreased susceptibility to third-generation cephalosporins (cefixime and ceftriaxone) was 6.06%. Azithromycin resistance was reported in 13.4% of isolates, with three-fourths from the states of North India (Delhi and Chandigarh). Of these isolates, 22.5% showed high-level resistance to azithromycin. In addition, 16 isolates were multidrug-resistant, and 1 isolate was an extensively drug-resistant N. gonorrhoeae.
Conclusions:
These findings highlight the urgent need for concerted efforts to address the burgeoning threat of antimicrobial resistance (AMR) in N. gonorrhoeae . Continued surveillance of drug resistance is crucial. Efforts should be made to explore novel, effective treatment options to resolve this issue.
Insights
Drug resistance in Neisseria gonorrhoeae is a growing concern, with significant azithromycin resistance observed. Continued surveillance and new treatments are urgently needed to combat antimicrobial resistance (AMR).
Area of Science:
- Microbiology
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Neisseria gonorrhoeae exhibits rapidly evolving drug resistance, challenging treatment efficacy globally.
- Past effective antibiotics like penicillin and ciprofloxacin are now largely obsolete for gonorrhea treatment.
- Increasing minimum inhibitory concentrations (MIC) for cephalosporins were noted in Asia by the late 1990s.
Purpose of the Study:
- To investigate the antimicrobial resistance trends of Neisseria gonorrhoeae over a five-year period.
- To assess the susceptibility of N. gonorrhoeae isolates to key antibiotics.
Main Methods:
- Collected and processed samples from attendees of STI clinics over five years.
- Isolated Neisseria gonorrhoeae and performed antimicrobial susceptibility testing using the MIC E-strip method.
Main Results:
- Studied 231 N. gonorrhoeae isolates, predominantly from male patients (97.5%).
- Observed decreased susceptibility to third-generation cephalosporins (6.06%) and significant azithromycin resistance (13.4%), with high-level resistance in 22.5% of these.
- Identified 16 multidrug-resistant and one extensively drug-resistant N. gonorrhoeae isolate.
Conclusions:
- Findings underscore the urgent need to address Neisseria gonorrhoeae antimicrobial resistance (AMR).
- Continuous surveillance of drug resistance patterns is essential for effective gonorrhea management.
- Exploration of novel therapeutic strategies is critical to overcome treatment challenges posed by resistant strains.
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