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P686 The enhanced surveillance of antimicrobial-resistant gonorrhea (ESAG) in canada
  1. Stephanie Alexandre1,
  2. Kristina Tomas1,
  3. Cassandra Lybeck1,
  4. Irene Martin2,
  5. Pam Sawatzky2,
  6. Walter Demczuk3,
  7. Jennifer Gratrix4,
  8. Petra Smyczek4,
  9. David Alexander5,
  10. Carla Loeppky6,
  11. Todd Hatchette7,
  12. Erin Leonard7,
  13. Chris Archibald1
  1. 1Public Health Agency of Canada, Surveillance and Epidemiology Division, CCDIC, IDPCP, Ottawa, Canada
  2. 2Public Health Agency of Canada, National Microbiology Laboratory, Winnipeg, Canada
  3. 3National Microbiology Laboratory, Winnipeg, Canada
  4. 4Alberta Health Services, STI Services, Edmonton, Canada
  5. 5Cadham Provincial Laboratory, Winnipeg, Canada
  6. 6Manitoba Health, Seniors and Active Living, Winnipeg, Canada
  7. 7Nova Scotia Health Authority, Halifax, Canada


Background Gonorrhea (GC) is the most commonly reported drug resistant sexually transmitted infection (STI) in Canada with 23,708 cases reported in 2016, double the 11,874 cases reported in 2007, corresponding to an 81% increase in rates. Only about 19% of these were cultured, meaning that direct AMR data was only available for one-fifth of GC cases. The Public Health Agency of Canada (PHAC) launched the Enhanced Surveillance of Antimicrobial-Resistance Gonorrhea (ESAG) program in 2013 in three jurisdictions (Alberta, Manitoba, and Nova Scotia) in order to improve the understanding of current trends of AMR-GC. This enhanced laboratory-epidemiological linked surveillance program collects data not available via its existing routine and laboratory surveillance.

Methods All cultures and data from participating jurisdictions are included in the surveillance program. The National Microbiology Laboratory performs antimicrobial susceptibility testing for a panel of antimicrobials and sequence typing. Enhanced epidemiological data collected includes treatment information and risk factors.

Results From 2014–2017, ESAG captured 2767 cultures from 2566 cases. The majority of the cases were male (81%) and less than 40 years old (83%). There was a 25% decrease from 2014 to 2017 in the number of cases from men who have sex with men. The proportion of isolates demonstrating resistance to at least one antibiotic agent steadily increased from 2014 (54%) to 2016 (66%), dropping to 58% in 2017. Large declines in decreased susceptibility to both cefixime (91%) and ceftriaxone (88%) and increasing rates of resistance to azithromycin were observed.

Conclusion ESAG data for 2014–2017 demonstrated decreased susceptibility to the preferred therapy antimicrobials, suggesting that resistance to these key antimicrobials could complicate GC treatment considerably in the future. The expansion of ESAG remains a priority with negotiations currently underway with the remaining jurisdictions with the goal national representation.

Disclosure No significant relationships.

  • Neisseria gonorrhoeae
  • antimicrobial resistance
  • surveillance

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