TY - JOUR
T1 - Complete ciprofloxacin resistance in gonococcal isolates in an urban Ugandan clinic
T2 - findings from a cross-sectional study
AU - Mabonga, Emily
AU - Parkes-Ratanshi, Rosalind
AU - Riedel, Stefan
AU - Nabweyambo, Sheila
AU - Mbabazi, Olive
AU - Taylor, Chris
AU - Gaydos, Charlotte
AU - Manabe, Yukari C.
N1 - Funding Information:
The authors disclosed receipt of the following financial support for the research, of this article: This work was supported by grants from Foundation for the National Institutes of Health (grant number 5U54EB007958 to Professor Charlotte Gaydos and Dr Yukari Manabe), the Sacharuna Foundation and the Johns Hopkins Center for Innovative Medicine. The funders had no role in data collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript for publication
Publisher Copyright:
© The Author(s) 2018.
PY - 2019/3/1
Y1 - 2019/3/1
N2 - Antimicrobial resistance (AMR) to gonorrhoea is a threat to global health security. There have been concerns expressed that countries with high rates of disease have poor surveillance. The objectives of the study were to determine the AMR patterns of Neisseria gonorrhoeae clinical isolates to antimicrobial agents in patients with HIV or high risk of HIV acquisition, to compare the concordance of disk diffusion and agar dilution as methods for determining AMR to N. gonorrhoeae, and to describe methodological challenges to carrying out AMR testing. The study was conducted at an HIV outpatient service for at-risk populations and an outreach clinic for commercial sex workers in Kampala. Patients were offered a sexually transmitted infection screen using a polymerase chain reaction (PCR)-based assay. Samples positive for gonorrhoea were cultured. Antimicrobial susceptibility testing was performed using disk diffusion and isolates were sent to a reference laboratory for agar dilution direct susceptibility testing. Five hundred and seventy-five patients were screened. There were 33 (5.7%) patients with gonorrhoea detected by PCR. Of the 16 viable N. gonorrhoeae isolates, 100% were resistant to ciprofloxacin and tetracycline by disk diffusion and 31% exhibited reduced susceptibility to ceftriaxone and cefixime. By agar dilution, 100% of isolates were resistant to ciprofloxacin and all isolates were susceptible to ceftriaxone and cefixime. There was concordance between disk diffusion and agar dilution for ciprofloxacin and tetracycline resistance and a significant discordance for third-generation cephalosporins. More than half the women with gonorrhoea were asymptomatic and represent a potential reservoir for ongoing transmission. AMR testing of N. gonorrhoeae isolates is needed to ensure optimal treatment and prevention of antibiotic resistance progression.
AB - Antimicrobial resistance (AMR) to gonorrhoea is a threat to global health security. There have been concerns expressed that countries with high rates of disease have poor surveillance. The objectives of the study were to determine the AMR patterns of Neisseria gonorrhoeae clinical isolates to antimicrobial agents in patients with HIV or high risk of HIV acquisition, to compare the concordance of disk diffusion and agar dilution as methods for determining AMR to N. gonorrhoeae, and to describe methodological challenges to carrying out AMR testing. The study was conducted at an HIV outpatient service for at-risk populations and an outreach clinic for commercial sex workers in Kampala. Patients were offered a sexually transmitted infection screen using a polymerase chain reaction (PCR)-based assay. Samples positive for gonorrhoea were cultured. Antimicrobial susceptibility testing was performed using disk diffusion and isolates were sent to a reference laboratory for agar dilution direct susceptibility testing. Five hundred and seventy-five patients were screened. There were 33 (5.7%) patients with gonorrhoea detected by PCR. Of the 16 viable N. gonorrhoeae isolates, 100% were resistant to ciprofloxacin and tetracycline by disk diffusion and 31% exhibited reduced susceptibility to ceftriaxone and cefixime. By agar dilution, 100% of isolates were resistant to ciprofloxacin and all isolates were susceptible to ceftriaxone and cefixime. There was concordance between disk diffusion and agar dilution for ciprofloxacin and tetracycline resistance and a significant discordance for third-generation cephalosporins. More than half the women with gonorrhoea were asymptomatic and represent a potential reservoir for ongoing transmission. AMR testing of N. gonorrhoeae isolates is needed to ensure optimal treatment and prevention of antibiotic resistance progression.
KW - Gonorrhoea
KW - HIV
KW - antimicrobial resistance
KW - sexually transmitted infections
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U2 - 10.1177/0956462418799017
DO - 10.1177/0956462418799017
M3 - Article
C2 - 30392463
AN - SCOPUS:85060135050
SN - 0956-4624
VL - 30
SP - 256
EP - 263
JO - International Journal of STD and AIDS
JF - International Journal of STD and AIDS
IS - 3
ER -