Background Appropriate and timely treatment for Neisseria gonorrhoeae infection is an essential clinical and public health action. Antimicrobial susceptibility testing (AST) predicts therapeutic failure and guides selection of appropriate treatment.
Increasing antimicrobial resistance in N. gonorrhoeae prompted the publication of the global action plan by the World Health Organisation to control its spread. This document highlighted the lack of or use of different methodologies for AST making the inter-laboratories and international comparisons and monitoring difficult.
Aims The aim of this study was to explore whether laboratories offered AST for N. gonorrhoeae and which methodologies were being used to detect resistance particularly to current recommended treatment.
Methods A web based survey with 23 questions regarding AST was developed and rolled out to the members of British Society for Microbiology Technology and UK Standards for Microbiology Investigations from November 2012 to January 2013.
Results There were 327 responses from 118 laboratories from across the UK. After excluding duplicate and empty responses, 206 responses were analysed.
196 respondents (95%) conducted AST for N. gonorrhoeae with 46% performing this daily. 147 respondents (75%) used British Society of Antimicrobial Chemotherapy method and 8% used European Committee on Antimicrobial Susceptibility Testing breakpoints. 80% respondents always tested penicillin susceptibility, 71% always tested ceftriaxone and 55% always tested azithromycin. The most common methods used were disc diffusion (73% respondents) and E-test (48% respondents). 26% respondents did not archive isolates with potentially decreased susceptibility to cephalosporins and 19% did not use control strains for AST.
Conclusion This study highlights the diversity in approach to AST by different laboratories across the UK. Ceftriaxone and azithromycin, the antibiotics of choice for uncomplicated anogenital infections, were not consistently tested. AST is the basis for detecting resistance and modifying therapy accordingly and a consistent approach is required for both patient treatment and surveillance.
- N. gonorrhoeae