Background Active surveillance of the antimicrobial susceptibility (AS) of Neisseria gonorrhoeae (Ng) isolates was carried out by the Gonococcal Antimicrobial Surveillance Program (GASP) in Latin America and the Caribbean (LAC) during the 1990s. A retrospective analysis of surveillance activities undertaken during the 2000s was conducted to describe trends in Ng AS and to re-initiate the GASP network.
Methods Ng isolates were collected and tested for AS to penicillin (Pen), tetracycline (Tet), ciprofloxacin (Cip), ceftriaxone (Cef), azithromycin (Azi) and spectinomycin (Spe) in 11 countries between 2000 and 2009. Agar dilution, disc diffusion and Etest methods were used as described by CLSI and previously established in the GASP-LAC network. Trends in AS were retrospectively analysed in each country and aggregated at the GASP-LAC Co-ordinating Centre.
Results 6 countries collected data over the entire study period and five countries tested for AS sporadically. In total, 9026 Ng isolates were tested. Cip resistance first appeared in 2000 with 2%, (19/784) and resistant per cent increased to 30% (297/975) in 2009. Cip resistance was observed in 10 countries. Azi resistance per cent increased from 6% (41/646) in 2000 to 27% (224/842) in 2009; one country reported no resistance. Pen resistance per cents ranged between 29% (299/1035) in 2000 and 33% (256/772) in 2006. Tet resistance percents declined from 61% (633/1041) in 2000 to 35% (323/931) in 2009. The majority of Ng isolates were susceptible to Cef and Spe. However, 7/110 isolates showed decreased susceptibility to Cef in one country in 2007 and 2/25 isolates showed intermediate susceptible to Spe in another country in 2009.
Conclusions Cip for primary treatment of uncomplicated gonococcal infections is currently recommended in 10 of the 11 countries, 1 country recommended Cef in 2007. The emergence and spread of resistance to Cip and Azi, indicate that current treatment guidelines be reviewed using respective national antimicrobial surveillance data. The emergence of a few strains with reduced susceptibility to third-generation cephalosporins indicates that on-going GASP surveillance is warranted.
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