Background Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a major concern worldwide. AMR surveillance globally is crucial for guiding effective treatment and accordingly for public health purposes. In the former Soviet countries, the knowledge regarding AMR has been limited. However, in 2004 the Russian gonococcal antimicrobial susceptibility programme (RU-GASP), which now acts also under WHO protocols, was initiated. The aims of the present study were to examine and describe the prevalence of N gonorrhoeae AMR in 2010 in Russia, and reveal trends during 2005–2010.
Methods In 2010, N gonorrhoeae isolates (one isolate per patient; n=407) collected from 46 surveillance sites distributed in all eight Federal Districts of Russia were examined regarding their susceptibility to ceftriaxone, spectinomycin, azithromycin, penicillin G, ciprofloxacin, and tetracycline using agar dilution method, according to CLSI and WHO protocols. β-Lactamase production was identified using nitrocefin discs.
Results In 2010, the AMR (intermediate susceptibility) levels were as follows - ceftriaxone 0% (0%), spectinomycin 4.4% (12.3%), azithromycin 4.9% (10.4%), penicillin G 32.5% (39.9%), ciprofloxacin 53.2% (3.0%), and tetracycline 41.9% (26.6%). Three isolates (0.7%) were resistant to all antimicrobials except ceftriaxone. During 2005–2010, the AMR has remained high to penicillin G, tetracycline, and ciprofloxacin. The proportion of resistant isolates to spectinomycin and azithromycin has ranged from 0% (2005) to 7.2% (2008), and 0.4% (2008) to 4.9% (2010), respectively. All isolates in 2005–2010 were susceptible to ceftriaxone. Nevertheless, the minimum inhibitory concentration (MIC) distribution of ceftriaxone has rapidly shifted to higher MICs, and isolates at the breakpoint for intermediate susceptibility/resistance (0.25 mg/l; n=8 [2%] in 2010) have rapidly increased over the years.
Conclusions The AMR of N gonorrhoeae in Russia is high and ceftriaxone (3250 mg) should be first-line for empirical treatment. If there are no access to ceftriaxone or in the presence of severe β-lactam antimicrobial allergy, spectinomycin is recommended for use. However, despite exceedingly rare in most countries spectinomycin resistance is annually identified in Russia, and accordingly the level of this resistance is crucial to monitor. Continuous, quality assured and quality controlled gonococcal AMR surveillance in Russia is crucial. RU-GASP now also works under WHO protocols.