WHO global antimicrobial resistance surveillance for Neisseria gonorrhoeae 2017-18: a retrospective observational study
WHO global antimicrobial resistance surveillance for Neisseria gonorrhoeae 2017-18: a retrospective observational study
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DOI：
10.1016/s2666-5247(21)00171-3
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发表时间：
2021-11-02
期刊：
影响因子：
38.2
通讯作者：
Wi, Teodora
中科院分区：
文献类型：
--
作者：
Unemo, Magnus;Lahra, Monica M.;Wi, Teodora
背景淋病奈瑟菌的淋病和抗菌素耐药性(AMR)是全球关注的主要健康问题。加强对淋球菌AMR的全球监测至关重要。我们旨在描述世界卫生组织2017-18年全球淋球菌耐药监测的数据，并讨论对有效管理和控制淋病至关重要的优先事项。方法对2017-18年73个国家向世界卫生组织报告的淋球菌分离株的AMR数据进行回顾性观察研究。世卫组织建议每个国家每年至少收集100个淋球菌分离株，并使用定量方法确定抗菌剂的最低抑菌浓度，根据国际标准化的耐药性转折点进行解释。2017-18年，73个国家提供了一种或多种药物的AMR数据。68个报告国中有21个(31%)报告对头孢曲松的敏感性或耐药性降低，51个报告国中有24个(47%)报告头孢克辛的敏感性或耐药性下降。61个报告国中有51个(84%)报告对阿奇霉素耐药，所有70个报告国(100%)报告对环丙沙星耐药。各国每年对头孢曲松和头孢克辛的敏感率和耐药率分别为0-21%和0-22%，对阿奇霉素和环丙沙星的耐药率分别为0-60%和0-100%。自2015-16年以来，报告淋球菌AMR和耐药菌株的国家数量以及接受检查的菌株数量有所增加。在中美洲和加勒比地区、东欧以及世卫组织非洲、东地中海和东南亚地区，监测仍然很少。据许多国家的解释，环丙沙星耐药性极高，阿奇霉素耐药性正在增加，对头孢曲松和头孢克肟的敏感性或耐药性继续下降。世卫组织对淋球菌AMR的全球监测需要在国际上扩大，以便为国家和国际管理指南和公共卫生政策提供必要的数据。加强预防、早期诊断、对有指征的患者和伴侣进行治疗、加强监测(例如，感染、AMR、治疗失败和使用或误用抗菌剂)以及增加有关抗菌剂选择、管理和药代动力学或药效学的知识是至关重要的。开发快速、准确和负担得起的淋病诊断试验、新的抗菌剂和淋病疫苗势在必行。版权所有(C)2021作者(S)。爱思唯尔有限公司出版。
Background Gonorrhoea and antimicrobial resistance (AMR) in Neisseria gonorrhoeae are major health concerns globally. Increased global surveillance of gonococcal AMR is essential. We aimed to describe the 2017-18 data from WHO's global gonococcal AMR surveillance, and to discuss priorities essential for the effective management and control of gonorrhoea.Methods We did a retrospective observational study of the AMR data of gonococcal isolates reported to WHO by 73 countries in 2017-18. WHO recommends that each country collects at least 100 gonococcal isolates per year, and that quantitative methods to determine the minimum inhibitory concentration of antimicrobials, interpreted by internationally standardised resistance breakpoints, are used.Findings In 2017-18, 73 countries provided AMR data for one or more drug. Decreased susceptibility or resistance to ceftriaxone was reported by 21(31%) of 68 reporting countries and to cefixime by 24 (47%) of 51 reporting countries. Resistance to azithromycin was reported by 51 (84%) of 61 reporting countries and to ciprofloxacin by all 70 (100%) reporting countries. The annual proportion of decreased susceptibility or resistance across countries was 0-21% to ceftriaxone and 0-22% to cefixime, and that of resistance was 0-60% to azithromycin and 0-100% to ciprofloxacin. The number of countries reporting gonococcal AMR and resistant isolates, and the number of examined isolates, have increased since 2015-16. Surveillance remains scarce in central America and the Caribbean and eastern Europe, and in the WHO African, Eastern Mediterranean, and South-East Asian regions.Interpretation In many countries, ciprofloxacin resistance was exceedingly high, azithromycin resistance was increasing, and decreased susceptibility or resistance to ceftriaxone and cefixime continued to emerge. WHO's global surveillance of gonococcal AMR needs to expand internationally to provide imperative data for national and international management guidelines and public health policies. Improved prevention, early diagnosis, treatment of index patients and partners, enhanced surveillance (eg, infection, AMR, treatment failures, and antimicrobial use or misuse), and increased knowledge on antimicrobial selection, stewardship, and pharmacokinetics or pharmacodynamics are essential. The development of rapid, accurate, and affordable point-of-care gonococcal diagnostic tests, new antimicrobials, and gonococcal vaccines is imperative. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.