Emergence and spread of ciprofloxacin-resistant Neisseria gonorrhoeae in New South Wales, Australia: lessons from history

2019 ◽  
Vol 74 (8) ◽  
pp. 2214-2219 ◽  
Author(s):  
Jane K Hanrahan ◽  
Tiffany R Hogan ◽  
Cameron Buckley ◽  
Ella Trembizki ◽  
Hazel Mitchell ◽  
...  
Keyword(s):  
Neisseria Gonorrhoeae ◽  
New South ◽  
New South Wales ◽  
Treatment Change ◽  
Resistant Genotype ◽  
South Wales ◽  
Overseas Travel ◽  
Single Clone ◽  
Ciprofloxacin Resistance ◽  
Index Cases

Abstract Objectives Our aim was to investigate the emergence and spread of ciprofloxacin resistance in clinical Neisseria gonorrhoeae isolates in New South Wales, Australia, from the first reported case in 1991 until ciprofloxacin resistance was sustained at or above the WHO threshold for treatment change of 5% (1999), to inform future strategies for controlling gonococcal antimicrobial resistance. Methods The index isolate and all subsequent clinical isolates of ciprofloxacin-resistant N. gonorrhoeae in New South Wales from 1991 to 1999 were genotyped using a previously described method on the Agena MassARRAY iPLEX platform. Region of acquisition data, where available, were used to determine whether cases were travel associated. Results In New South Wales, of the 325 ciprofloxacin-resistant N. gonorrhoeae isolates reported from 1991 to 1999, 98% (320/325) were able to be recovered and 100% (320/320) were genotyped. There were 66 different genotypes, comprising 1–99 isolates each. Notably no single clone was found to account for ciprofloxacin resistance being sustained in the population, with considerable variability in genotype prevalence observed throughout the study period. A total of 65% (209/320) of genotyped isolates had information regarding the likely place of acquisition; of these, 44% (93/209) were associated with overseas travel or sexual contact with an overseas visitor. The first ciprofloxacin-resistant N. gonorrhoeae in New South Wales was associated with travel to Thailand. Index cases of each resistant genotype were significantly more likely to have been acquired overseas (51.5%), predominantly in Asia (45%, 30/66). Conclusions The continued importation of multiple genotypes, rather than the expansion of a single genotype, led to ciprofloxacin-resistant N. gonorrhoeae being established in New South Wales.

Whole genome sequencing to characterise azithromycin resistant Neisseria gonorrhoeae from New South Wales in 2017

Pathology ◽  
2018 ◽  
Vol 50 ◽  
pp. S51
Author(s):  
C.R.Robert George ◽  
R. Rockett ◽  
David M. Whiley ◽  
Rodney P. Enriquez ◽  
R. Kundu ◽  
...  
Keyword(s):  
Neisseria Gonorrhoeae ◽  
Whole Genome Sequencing ◽  
Genome Sequencing ◽  
New South ◽  
New South Wales ◽  
Whole Genome ◽  
South Wales

scholarly journals Azithromycin-resistant Neisseria gonorrhoeae spreading amongst men who have sex with men (MSM) and heterosexuals in New South Wales, Australia, 2017

2018 ◽  
Vol 73 (5) ◽  
pp. 1242-1246 ◽  
Author(s):  
David M Whiley ◽  
Ratan L Kundu ◽  
Amy V Jennison ◽  
Cameron Buckley ◽  
Athena Limnios ◽  
...  
Keyword(s):  
Neisseria Gonorrhoeae ◽  
New South ◽  
New South Wales ◽  
South Wales ◽  
Sex With Men

scholarly journals Australian Gonococcal Surveillance Programme Annual Report, 2019

2020 ◽  
Vol 44 ◽  
Author(s):  
Monica M Lahra ◽  
Masoud Shoushtari ◽  
CR Robert George ◽  
Benjamin H Armstrong ◽  
Tiffany R Hogan
Keyword(s):  
Antimicrobial Resistance ◽  
Neisseria Gonorrhoeae ◽  
Western Australia ◽  
New South ◽  
Northern Territory ◽  
Clinical Isolates ◽  
Surveillance Programme ◽  
South Wales ◽  
Ciprofloxacin Resistance ◽  
Mic Value

The Australian Gonococcal Surveillance Programme (AGSP) has continuously monitored antimicrobial resistance in clinical isolates of Neisseria gonorrhoeae since 1981. In 2019, a total of 9,668 clinical isolates of gonococci from the public and private sector in all jurisdictions were tested for in vitro antimicrobial susceptibility by standardised methods. The current treatment recommendation for gonorrhoea, for the majority of Australia, continues to be dual therapy with ceftriaxone and azithromycin. Decreased susceptibility (DS) to ceftriaxone (minimum inhibitory concentration [MIC] value ≥ 0.06 mg/L) was found nationally in 1.3% of isolates. Five N. gonorrhoeae clinical isolates were ceftriaxone-resistant (MIC value ≥ 0.25 mg/L), and therefore also resistant to penicillin; all were resistant to ciprofloxacin but susceptible to azithromycin. These isolates were reported from Victoria (3), non-remote Western Australia (1) and New South Wales (1). Resistance to azithromycin (MIC value ≥ 1.0 mg/L) was found nationally in 4.6% of N. gonorrhoeae isolates, continuing a downward trend observed and reported since 2017. Isolates with high-level resistance to azithromycin (MIC value ≥ 256 mg/L) continue to be reported sporadically in Australia, with eight detected in 2019: two each from New South Wales, Queensland, and Victoria, and one each from Tasmania and non-remote Western Australia. In 2019, in Australia, 2,136 gonococcal isolates (22.1%) were penicillin resistant; however, there remains considerable variation by jurisdiction, and in some remote settings there is little resistance and this drug is recommended empiric therapy. In 2019, in the remote Northern Territory, no penicillin resistance was reported, however in remote Western Australia six out of 85 isolates (7.1%) were penicillin resistant. There was no ciprofloxacin resistance reported from isolates tested from remote regions of the Northern Territory, and ciprofloxacin resistance rates remain comparatively low (7/85; 8.2%) in remote Western Australia. Keywords: antimicrobial resistance; disease surveillance; gonococcal infection; Neisseria gonorrhoeae

scholarly journals Is gentamicin a viable therapeutic option for treating resistant Neisseria gonorrhoeae in New South Wales?

2021 ◽  
Vol 45 ◽  
Author(s):  
Benjamin H Armstrong ◽  
Athena Limnios ◽  
David A Lewis ◽  
Tiffany Hogan ◽  
Ratan Kundu ◽  
...  
Keyword(s):  
Neisseria Gonorrhoeae ◽  
Large Scale ◽  
New South ◽  
Therapeutic Option ◽  
New South Wales ◽  
Newborn Health ◽  
Population Level ◽  
Clinical Isolates ◽  
National Guidelines ◽  
South Wales

The key issues with Neisseria gonorrhoeae infections, in Australia and elsewhere, are coincident increases in disease rates and in antimicrobial resistance (AMR), although these factors have not been shown to be correlated. Despite advances in diagnosis, control of this disease remains elusive, and incidence in Australia continues to increase. Of the Australian jurisdictions, New South Wales (NSW) has the highest N. gonorrhoeae notifications, and over the five-year period 2015–2019, notifications in NSW have increased above the national average (by 116% versus 85%, respectively). Gonococcal disease control is reliant on effective antibiotic regimens. However, escalating AMR in N. gonorrhoeae is a global health priority, as the collateral injury of untreated infections has substantive impacts on sexual and newborn health. Currently, our first-line therapy for gonorrhoea is also our last line, with no ideal alternative identified. Despite some limitations, gentamicin is licensed and readily available in Australia, and is proposed for treatment of resistant N. gonorrhoeae in national guidelines; however, supportive published microbiological data are lacking. Analysis of gonococcal resistance patterns within Australia for the period 1991–2019, including 35,000 clinical isolates from NSW, illustrates the establishment and spread of population-level resistance to all contemporaneous therapies. An analysis of gentamicin susceptibility on 2,768 N. gonorrhoeae clinical isolates from NSW, for the period 2015–2020, demonstrates that the median minimum inhibitory concentration (MIC) for gentamicin in NSW has remained low, at 4.0 mg/L, and resistance was not detected in any isolate. There has been no demonstration of MIC drift over time (p = 0.91, Kruskal-Wallis test), nor differences in MIC distributions according to patients’ sex or site of specimen collection. This is the first large-scale evaluation of gentamicin susceptibility in N. gonorrhoeae in Australia. No gentamicin resistance was detected in clinical isolates, 2015–2020, hence this is likely to be an available treatment option for resistant gonococcal infections in NSW.

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