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Epidemiology
Short report
Low gonorrhoea antimicrobial resistance and culture positivity rates in general practice: a pilot study
  1. Maartje Visser1,
  2. Mireille van Westreenen2,3,
  3. Jan van Bergen1,4,5,
  4. Birgit H B van Benthem1
  1. 1 Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
  2. 2 Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
  3. 3 STAR-SHL Medical Diagnostic Centre, Rotterdam, The Netherlands
  4. 4 STI AIDS Netherlands, Amsterdam, The Netherlands
  5. 5 Division of Clinical Methods and Public Health, Department of General Practice, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
  1. Correspondence to Maartje Visser, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven 3720 BA, The Netherlands; maartje.visser{at}rivm.nl

Abstract

Objective In the Netherlands, the Gonococcal Resistance to Antimicrobials Surveillance (GRAS) programme is carried out at Centres for Sexual Health (CSH), which provide care for sexual high-risk populations. However, half of gonorrhoea infections are diagnosed in general practice (GP). We performed a pilot study to explore expanding GRAS to GPs using laboratory-based surveillance. Additionally, antimicrobial resistance patterns of GP and CSH patients were compared.

Methods Three laboratories from different regions were included, which all perform gonorrhoea diagnostics for GPs and used ESwab for patient sampling. Additional culturing for all GP patients with gonorrhoea took place from February to July 2018. After positive PCR-nucleic acid amplification test, residual ESwab material was used for culture. In positive cultures, susceptibility testing was performed for azithromycin, ciprofloxacin, cefotaxime and ceftriaxone using Etest.

Results During the study period, 484 samples were put in culture. 16.5% of cultures were positive (n=80). Antimicrobial resistance levels were low, with 2.6% resistance to azithromycin, 21.5% to ciprofloxacin and 0.0% to cefotaxime and ceftriaxone. Resistance levels in CSH GRAS data (first half of 2018) were 19.2% for azithromycin, 31.5% for ciprofloxacin, 1.9% for cefotaxime and 0.0% for ceftriaxone.

Conclusions Culture positivity rates for GP patients were low, probably due to long transportation times and awaiting PCR test results before attempting culture. Positivity rates might be improved by making changes in sampling and/or transportation methods, but that would require involvement of GPs and patients instead of keeping the surveillance lab based. Resistance levels appeared to be lower at GPs than at the CSH, indicating that resistance might emerge first in more high-risk populations. It is important to consider all potentially relevant patient populations when establishing a gonococcal antimicrobial resistance surveillance programme. However, based on the findings from this study the current GRAS programme will not be extended to GPs.

  • Neisseria gonorrhoeae
  • antimicrobial resistance
  • surveillance
  • general practice
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/sextrans-2019-054006

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    Footnotes

    • Handling editor Claudia S Estcourt

    • Contributors All authors were involved in establishing the study design. MV coordinated the execution of the study, analysed the data and drafted the manuscript. All authors contributed to interpretation of the results and commented on the manuscript. All authors read and approved the final manuscript.

    • Funding This study was funded by the Dutch Ministry of Health, Welfare and Sport.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval This study used anonymised data collection without the involvement of the patient. This study was declared to fall outside the scope of the Dutch law on medical scientific research with human subjects (WMO) by the Medical Ethical committee of the Erasmus Medical Centre in Rotterdam (MEC-2017-570). Therefore, further ethical approval was not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data from this study are not publicly available, but may be provided for scientific purposes upon reasonable request.