Article Text

Download PDFPDF

P648 Factors associated with neisseria gonorrhoeae azithromycin resistance in the quebec sentinel network, 2015–2017
  1. Karine Blouin1,
  2. Fannie Defay2,
  3. Sylvie Venne3,
  4. Brigitte Lefebvre4,
  5. Annick Trudelle2,
  6. Annie-Claude Labbe5
  1. 1Institut National de Santé Publique du Québec, Infections Transmissibles Sexuellement et par le Sang, Québec, Canada
  2. 2Institut National de Santé Publique, Montréal, Canada
  3. 3Quebec Health Ministry, Public Health Direction, STD Prevention Direction, Montréal, Canada
  4. 4Laboratoire Santé Publique du Québec, Montréal, Canada
  5. 5Montreal University, Departement de Microbiologie Infectiologie, Montreal, Canada


Background N. gonorrhoeae azithromycin resistance (MIC ≥ 2 mg/L) increased from 1.7% to 30.9% between 2013 and 2017 in Quebec, Canada. The Quebec sentinel network aims to 1) maintain a sufficient number of cultures for antimicrobial resistance surveillance; 2) link antimicrobial susceptibility surveillance to epidemiological and clinical information; and 3) monitor treatment failures. We herein examine the associations between N. gonorrhoeae azithromycin resistance and epidemiological/clinical characteristics.

Methods Three regions participated: Montréal (two clinics recruiting mostly men having sex with men (MSM)), Montérégie (22 clinics recruiting mostly heterosexuals) and Nunavik (participated only in 2016, recruited mainly heterosexual Inuit people). One strain per year, per individual was selected. When data was presented for 2015–2017 (2015 was incomplete), the most recent strain per individual was considered. Proportions were compared using chi-square tests.

Results Between September 2015 and December 2017, 68% of episodes (840/1240) had a culture performed and 571 strains were obtained, including all duplicates. This analysis includes 190 strains in 2016, 270 strains in 2017 and 469 strains for 2015–2017. Most isolates were collected in MSM (349/469; 76%). Sampling sites were urethra (329/469; 70.2%), rectum (90/469; 19.2%) and pharynx (50/469; 10.7%). Azithromycin resistance was significantly higher in MSM (25.5% vs 9.2% in heterosexuals, p<0.001), in cases who reported previous gonorrhea (27.3% vs 15.3%, p=0.004), syphilis (29.5% vs 19.8%, p=0.045), HIV (31.8% vs 20.1%, p=0.035) and who reported a sex partner outside Quebec in 2016 (36.7% vs 16.8%, p=0.021), but this difference was not maintained in 2017 (21.2% vs 21.7%, p=0.951). No significant difference was observed with regard to age, number of sex partners, anatomical site and presence of symptoms.

Conclusion Recommendations to perform cultures appear to be well implemented (70% of episodes). Azithromycin resistance seems to be well established in Quebec with a possible declining contribution of travel-acquired resistant infection.

Disclosure No significant relationships.

  • Neisseria gonorrhoeae
  • antimicrobial resistance
  • surveillance

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.