High prevalence of ceftriaxone-resistant and XDR Neisseria gonorrhoeae in several cities of Cambodia, 2022-23: WHO Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP).

IF 3.7 Q2 INFECTIOUS DISEASES JAC-Antimicrobial Resistance Pub Date : 2024-04-04 eCollection Date: 2024-04-01 DOI:10.1093/jacamr/dlae053
V Ouk, L Say Heng, M Virak, S Deng, M M Lahra, R Frankson, K Kreisel, R McDonald, M Escher, M Unemo, T Wi, I Maatouk
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Abstract

Objectives: Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a global public health concern. Ceftriaxone is the last effective and recommended option for empirical gonorrhoea therapy worldwide, but several ceftriaxone-resistant cases linked to Asia have been reported internationally. During January 2022-June 2023, the WHO Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP) investigated N. gonorrhoeae AMR and epidemiological factors in patients from 10 clinical sentinel sites in Cambodia.

Methods: Urethral swabs from males with urethral discharge were cultured. ETEST determined the MIC of five antimicrobials, and EGASP MIC alert values and EUCAST breakpoints were used. EGASP demographic, behavioural and clinical variables were collected using a standardized questionnaire.

Results: From 437 male patients, 306 had positive N. gonorrhoeae cultures, AMR testing and complete epidemiological data. Resistance to ceftriaxone, cefixime, azithromycin and ciprofloxacin was 15.4%, 43.1%, 14.4% and 97.1%, respectively. Nineteen (6.2%) isolates were resistant to all four antimicrobials and, accordingly, categorized as XDR N. gonorrhoeae. These XDR isolates were collected from 7 of the 10 sentinel sites. No EGASP MIC alert values for gentamicin were reported. The nationally recommended cefixime 400 mg plus azithromycin 1 g (65.4%) or ceftriaxone 1 g plus azithromycin 1 g (34.6%) was used for treatment.

Conclusions: A high prevalence of ceftriaxone-resistant, MDR and XDR N. gonorrhoeae in several cities of Cambodia were found during 2022-23 in WHO EGASP. This necessitates expanded N. gonorrhoeae AMR surveillance, revision of the nationally recommended gonorrhoea treatment, mandatory test of cure, enhanced sexual contact notification, and ultimately novel antimicrobials for the treatment of gonorrhoea.

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柬埔寨多个城市耐头孢曲松和XDR淋病奈瑟菌的高流行率,2022-23年:世界卫生组织淋球菌抗菌监测强化计划(EGASP)。
目的:淋病奈瑟菌的抗菌药耐药性(AMR)是一个全球性的公共卫生问题。头孢曲松是世界范围内经验性淋病治疗的最后有效推荐方案,但国际上已报告了几例与亚洲有关的头孢曲松耐药病例。2022年1月至2023年6月期间,世界卫生组织淋球菌抗菌药物强化监测计划(EGASP)对柬埔寨10个临床哨点患者的淋球菌AMR和流行病学因素进行了调查:对有尿道分泌物的男性尿道拭子进行培养。ETEST 确定了五种抗菌药物的 MIC,并使用了 EGASP MIC 警戒值和 EUCAST 断点。通过标准化问卷收集了 EGASP 人口、行为和临床变量:结果:在 437 名男性患者中,306 人的淋球菌培养、AMR 检测和流行病学数据均呈阳性。对头孢曲松、头孢克肟、阿奇霉素和环丙沙星的耐药性分别为15.4%、43.1%、14.4%和97.1%。19株(6.2%)分离菌株对所有四种抗菌药均有耐药性,因此被归类为XDR淋球菌。这些 XDR 分离物来自 10 个哨点中的 7 个。未报告庆大霉素的 EGASP MIC 临界值。治疗中使用了国家推荐的头孢克肟 400 毫克加阿奇霉素 1 克(65.4%)或头孢曲松 1 克加阿奇霉素 1 克(34.6%):2022-23年期间,世卫组织EGASP在柬埔寨多个城市发现了耐头孢曲松、MDR和XDR淋球菌的高流行率。因此,有必要扩大淋球菌 AMR 监测范围,修订国家推荐的淋病治疗方法,强制进行治愈测试,加强性接触通知,并最终采用新型抗菌药物治疗淋病。
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