Antimicrobial resistance and decreased susceptibility to ceftriaxone by region of birth, Euro-GASP isolates 2010–2014
| Country of birth of foreign-born* | Natives, no. (%) | P value† | ||||||||
| WHO EUR | WHO EMR, no. (%) | WHO AMRO, no. (%) | WHO AFR, no. (%) | WHO SEAR, no. (%) | WHO WPR, no. (%) | Total foreign-born, no. (%) | ||||
| EU/EEA, no. (%) | Non-EU/EEA, no. (%) | |||||||||
| Ciprofloxacin resistant (n=4088)ठ| 103 (40.7) | 66 (71.7) | 55 (66.3) | 54 (31.0) | 20 (36.4) | 14 (63.6) | 14 (56.0) | 326 (46.3) | 1693 (50.0) | 0.07 |
| Azithromycin resistant (n=4048)§ | 17 (6.7) | 10 (11.2) | 6 (7.6) | 15 (8.6) | 0 (0.0) | 1 (4.8) | 1 (4.0) | 50 (7.2) | 251 (7.5) | 0.8 |
| Cefixime resistant (n=4050)§ | 6 (2.4) | 8 (9.1) | 7 (8.9) | 2 (1.1) | 1 (1.8) | 1 (4.5) | 0 (0.0) | 25 (3.6) | 192 (5.7) | 0.02 |
| Ceftriaxone resistant (n=4098)§ | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 4 (0.1) | 1.0 |
| Decreased susceptibility to ceftriaxone (n=4098)§ | 4 (1.6) | 8 (8.7) | 8 (9.6) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 20 (2.8) | 63 (1.9) | 0.10 |
| Penicillinase production (n=3352) | 21 (11.6) | 9 (11.4) | 11 (16.7) | 7 (7.4) | 4 (10.3) | 1 (7.1) | 4 (28.6) | 57 (11.7) | 240 (8.4) | 0.02 |
| Resistant isolates (n=4098) | 118 (46.6) | 72 (78.3) | 57 (68.7) | 68 (39.1) | 22 (40.0) | 14 (63.6) | 15 (60.0) | 366 (52.0) | 1817 (53.5) | 0.45 |
The MIC ranges in the isolates resistant to ciprofloxacin, azithromycin, cefixime and ceftriaxone were 0.125–>32, 1–>256, 0.25–0.5 and 0.25 mg/L, respectively.
*Divided into WHO regions: EUR, European Region (28 European Union [EU] countries, 3 European Economic Area [EEA] countries and 23 non-EU/EEA countries).
†P value (Pearson’s χ2 test or by Fisher’s exact test if cell numbers were <5) between total number of isolates from foreign-born and native patients.
‡Number of isolates with known country of birth tested for each antimicrobial.
§The clinical breakpoints (susceptible, resistant) were as follows: ceftriaxone and cefixime (MIC ≤0.12 mg/L, MIC >0.12 mg/L), azithromycin (MIC ≤0.25 mg/L, MIC >0.5 mg/L) and ciprofloxacin (MIC ≤0.03 mg/L, MIC >0.06 mg/L). Furthermore, strains with a ceftriaxone MIC of 0.12 mg/L have previously caused gonorrhoea treatment failures and can be considered to have a decreased susceptibility.8 25 26 Only whole MIC doubling dilutions were analysed.
AFR, African Region; AMRO, Region of the Americas; EMR, Eastern Mediterranean Region; Euro-GASP, European Gonococcal Antimicrobial Surveillance Programme; MIC, minimum inhibitory concentration; SEAR, South-East Asia Region; WPR, Western Pacific Region.