MMWR Morb Mortal Wkly Rep. 2011 Jul 8;60(26):873-7.
Neisseria gonorrhoeae is a major cause of pelvic inflammatory disease, ectopic pregnancy, and infertility, and it can facilitate human immunodeficiency virus (HIV) transmission. Emergence of gonococcal resistance to penicillin and tetracycline occurred during the 1970s and became widespread during the early 1980s. More recently, resistance to fluoroquinolones developed. Resistance was documented first in Asia, then emerged in the United States in Hawaii followed by other western states. It then became prevalent in all other regions of the United States. In Hawaii, fluoroquinolone resistance was first noted among heterosexuals; however, resistance in the United States initially became prevalent among men who have sex with men (MSM) before generalizing to heterosexuals. This emergence of resistance led CDC, in 2007, to discontinue recommending any fluoroquinolone regimens for the treatment of gonorrhea. CDC now recommends dual therapy for gonorrhea with a cephalosporin (ceftriaxone 250 mg) plus either azithromycin or doxycycline. This report summarizes trends in cephalosporin susceptibility among N. gonorrhoeae isolates in the United States during 2000-2010 using data from the Gonococcal Isolate Surveillance Project (GISP). During that period, the percentage of isolates with elevated minimum inhibitory concentrations (MICs) to cephalosporins (≥0.25 µg/mL for cefixime and ≥0.125 µg/mL for ceftriaxone) increased from 0.2% in 2000 to 1.4% in 2010 for cefixime and from 0.1% in 2000 to 0.3% in 2010 for ceftriaxone. Although cephalosporins remain an effective treatment for gonococcal infections, health-care providers should be vigilant for treatment failure and are requested to report its occurrence to state and local health departments. State and local public health departments should promote maintenance of laboratory capability to culture N. gonorrhoeae to allow testing of isolates for cephalosporin resistance. They also should develop enhanced surveillance and response protocols for gonorrhea treatment failures and report gonococcal treatment failures to CDC.
淋病奈瑟菌是盆腔炎、宫外孕和不孕的主要病因，并且它可以促进人类免疫缺陷病毒（HIV）的传播。20 世纪 70 年代，淋球菌对青霉素和四环素的耐药性出现，并在 20 世纪 80 年代初广泛传播。最近，对氟喹诺酮类药物的耐药性也出现了。耐药性首先在亚洲有记录，然后在美国夏威夷出现，随后在其他西部州也出现。随后，它在美国所有其他地区都很普遍。在夏威夷，首先在异性恋者中发现了氟喹诺酮类耐药性；然而，在美国，耐药性最初在男男性行为者（MSM）中流行，然后才在异性恋者中流行。这种耐药性的出现促使美国疾病控制与预防中心在 2007 年停止推荐任何氟喹诺酮类药物治疗淋病。美国疾病控制与预防中心现在推荐头孢菌素（头孢曲松 250mg）加阿奇霉素或多西环素的双重疗法治疗淋病。本报告总结了 2000-2010 年期间美国淋病奈瑟菌分离株对头孢菌素敏感性的趋势，使用了来自淋球菌分离监测项目（GISP）的数据。在此期间，头孢菌素最小抑菌浓度（MIC）升高的分离株比例（头孢克肟≥0.25μg/ml，头孢曲松≥0.125μg/ml）从 2000 年的 0.2%上升到 2010 年的 1.4%，头孢曲松从 2000 年的 0.1%上升到 2010 年的 0.3%。尽管头孢菌素仍然是治疗淋病感染的有效药物，但医疗保健提供者应警惕治疗失败，并被要求向州和地方卫生部门报告其发生情况。州和地方公共卫生部门应促进维持淋病奈瑟菌的实验室培养能力，以允许对分离株进行头孢菌素耐药性检测。他们还应制定针对淋病治疗失败的强化监测和应对方案，并向美国疾病控制与预防中心报告淋病治疗失败情况。
