Global emergence of resistance to extended-spectrum cephalosporins (ESCs) cefixime and ceftriaxone is alarming scientific and healthcare communities. Following cases in Japan, a case was reported last year in England - and a Ceftriaxone-Resistant Multidrug-Resistant Neisseria gonorrhoeae (NG) was reported in Singapore in 2019. In Latin America, first isolates with reduced sensitivity to ceftriaxone were reported in Argentina, Brazil, Cuba, Chile and Uruguay (GASP Latin America). Most were observed in 2012 (12 isolates). After four unsuccessful attempts to implement national gonococcal antimicrobial surveillance, in 2016/2017 Brazil established a first national surveillance system with 550 isolates from seven sites across the country. Minimal inhibitory concentration (MIC), determined by agar dilution, revealed 42% to 79% of isolates resistant to ciprofloxacin, and 4% to 9.9% resistant to azithromycin, along with expected high rates of resistance to penicillin and tetracycline. Regarding resistance to ESCs, isolates with cefixime MIC bordering resistance (MIC=0.125 mg/L) were observed according to European cefixime resistance breakpoint, and were found in all five regions of Brazil (3.1 to 10.8%). This result led to revision of the Brazilian Guidelines for STI Treatment; current recommendation is intramuscular (IM) ceftriaxone 500 mg associated with azithromycin 1g (VO) in a single dose. The rates of resistance have concerned Brazil’s Ministry of Health and led to a new surveillance study including new collection sites (12), further epidemiological data, and samples from different anatomic sites, so as to monitor the spread of isolates and increase national representativeness. Challenges are to improve etiological diagnostics among PrEP users and PLHIV as well as in STI clinics; moreover, systematic surveillance of Neisseria gonorrhoeae antimicrobial resistance in Brazil and many Latin American countries is related to the organization of health systems, which do not require notification and often treat STI through a syndromic approach.
Disclosure No significant relationships.
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