Background The widespread antimicrobial resistance (AMR) of Neisseria gonorrhoeae (NG) is a serious problem for the treatment of gonorrhoea. Because NG infections are not reportable in Germany, only limited data on disease epidemiology and antimicrobial susceptibility patterns are available. The Gonococcal Resistance Network (GORENET) monitors trends of NG AMR in Germany and links this to epidemiological data and NG multiantigen sequence typing (NG-MAST) data to guide treatment algorithms and target future prevention strategies.
Methods Between April 2014 and December 2018, NG isolates and data on patient-related information were collected from laboratories nationwide and centralized susceptibility testing using E-test was performed. Susceptibility results for cefixime, ceftriaxone, azithromycin, ciprofloxacin and penicillin were defined according to EUCAST 4.0 standards.
Results Of 2115 isolates, 91.6% of isolates were from men. The most frequently tested materials among men were urethral (92.4%) and rectal swabs (3.8%), and among women mainly endocervical swabs (80.9%). Resistance to ceftriaxone (MIC ≥0.125 mg/L) occurred only sporadically (0–0.3%) during the entire observation period (2015 and 2018), while 1.0–2.1% of isolates were resistant to cefixime (MIC ≥0.125 mg/L). Proportion of isolates resistant to azithromycin (MIC ≥ 0.5 mg/L) was 11.4% (2014), 11.3% (2015), 4.3% (2016), 3.7% (2017), 9.4% (2018). 53.4–71.7% were resistant to ciprofloxacin, and 14.2–24.3.1% were resistant to penicillin.
Conclusion Resistance to ceftriaxone and to cefixime was low, whereas azithromycin resistance showed a discontinuous presentation with partly high levels during the observation period. Rates of ciprofloxacin and penicillin resistance were very high. According to the current national guidelines, ceftriaxone 1-2g IV and azithromycin 1,5g orally are usually used in dual therapy. Shortly revised national guidelines will state that use of azithromycin should be avoided if possible if a test of cure can be guaranteed and a susceptibility test is available. Continued surveillance of NG AMR remains relevant to ensure efficient disease management.
Disclosure No significant relationships.
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