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Antibiotics 2018, 7(3), 58; https://doi.org/10.3390/antibiotics7030058

Trends in Neisseria gonorrhoeae Antimicrobial Resistance over a Ten-Year Surveillance Period, Johannesburg, South Africa, 2008–2017

1
Centre for HIV & Sexually Transmitted Infections, National Institute for Communicable Diseases, Johannesburg 2131, South Africa
2
Department of Clinical Microbiology & Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2195, South Africa
3
School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2195, South Africa
*
Author to whom correspondence should be addressed.
Received: 30 May 2018 / Revised: 21 June 2018 / Accepted: 4 July 2018 / Published: 12 July 2018
(This article belongs to the Special Issue Multi-Drug Resistant Neisseria gonorrhoeae)
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Abstract

Background: In South Africa, sexually transmitted infections (STIs) are managed through a syndromic approach at primary healthcare centres (PHCs). Neisseria gonorrhoeae is the predominant cause of male urethritis syndrome. We describe antimicrobial resistance patterns and trends in Neisseria gonorrhoeae during a ten-year surveillance period at a large PHC in Johannesburg. Methods: Neisseria gonorrhoeae was cultured from genital discharge swab specimens obtained from consenting adult patients presenting at the Alexandra Health Centre in Johannesburg between 2008 and 2017. Isolates were tested for antimicrobial susceptibility by Etest™ (cefixime, ceftriaxone, ciprofloxacin) or agar dilution (penicillin, tetracycline, azithromycin). Results: During the period of surveillance, high-level resistance prevalence increased from 30% to 51% for penicillin (p-value for trend < 0.001), 75% to 83% for tetracycline (p-value for trend = 0.008), and 25% to 69% for ciprofloxacin (p-value for trend < 0.001). Analysis did not reveal high-level resistance to spectinomycin or a minimum inhibitory concentration (MIC) creep for extended-spectrum cephalosporins, and the prevalence of intermediate-resistance to azithromycin was less than 5%. Conclusions: High prevalence resistance to penicillin, tetracycline, and ciprofloxacin in N. gonorrhoeae obviates their use in future national treatment algorithms for genital discharge. It is essential to continue monitoring for emerging resistance to currently recommended antimicrobial therapy in this rapidly evolving pathogen. View Full-Text
Keywords: Neisseria gonorrhoeae; antimicrobial resistance Neisseria gonorrhoeae; antimicrobial resistance
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Kularatne, R.; Maseko, V.; Gumede, L.; Kufa, T. Trends in Neisseria gonorrhoeae Antimicrobial Resistance over a Ten-Year Surveillance Period, Johannesburg, South Africa, 2008–2017. Antibiotics 2018, 7, 58.

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