Sexually Transmitted Bacteria Reference Unit, Microbiological Services, Public Health England, London, UK.
Lancet Infect Dis. 2013 Sep;13(9):762-8. doi: 10.1016/S1473-3099(13)70143-9. Epub 2013 Jun 11.
Effective treatment of gonorrhoea is fundamental to public health control; however, the ability of Neisseria gonorrhoeae to successively develop resistance to different treatments has hampered control efforts. The extended-spectrum cephalosporins--cefixime and ceftriaxone--have been recommended in the UK for treatment of gonorrhoea since 2005. We looked at surveillance data from England and Wales to ascertain the current usefulness of these drugs and to inform changes to national treatment guidelines.
We obtained data from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) for patients attending 26 genitourinary medicine clinics in England and Wales between 2007 and 2011. We did analyses with univariate and multivariable logistic regression methods to identify trends in susceptibility to cephalosporins and risk factors associated with infection with isolates with decreased susceptibility to cefixime, and we assessed changes in prescribing practices. We did molecular typing to investigate genetic relatedness of non-susceptible isolates.
The prevalence of decreased susceptibility to both cefixime and ceftriaxone rose between 2007 and 2010 but was more noticeable for cefixime (an increase from 1·5% in 2007 to 17·1% in 2010), with a bimodal distribution of minimum inhibitory concentration recorded between 2009 and 2010. By multivariable analysis, isolates with decreased susceptibility to cefixime were associated with infection in men who have sex with men (odds ratio 5·47, 95% CI 3·99-7·48; p<0·0001) and year of isolation (in 2010, 13·08, 7·49-22·8; p<0·0001). Such isolates had a largely clonal population, with most belonging to genogroup G1407 and harbouring the penA mosaic gene. Data from 2011 showed a significant decline in prevalence of isolates with decreased cefixime susceptibility, falling from 17·1% in 2010 to 10·8% in 2011 (p<0·0001), concomitant with the change in prescribing practice in 2010 from cefixime to ceftriaxone plus azithromycin.
Guidance for treatment of gonorrhoea in England and Wales was changed in 2010 to prolong the use of cephalosporins. The decline in prevalence of isolates with decreased cefixime susceptibility cannot be attributed unequivocally to this change in prescribing practice; however, the association is striking.
Department of Health (England), Public Health England.
有效治疗淋病对公共卫生控制至关重要；然而，淋球菌不断产生对不同治疗方法的耐药性，这阻碍了控制工作的开展。头孢克肟和头孢曲松已被推荐在英国用于治疗淋病，自 2005 年以来。我们查看了英格兰和威尔士的监测数据，以确定这些药物的当前用途，并为国家治疗指南的修改提供信息。
我们从英格兰和威尔士 26 家泌尿科诊所的淋病耐药性监测计划（GRASP）中获得了 2007 年至 2011 年间患者的数据。我们使用单变量和多变量逻辑回归方法进行分析，以确定对头孢菌素的敏感性趋势以及与头孢克肟敏感性降低的分离株感染相关的危险因素，并评估处方实践的变化。我们进行了分子分型，以研究非敏感性分离株的遗传相关性。
头孢克肟和头孢曲松的耐药率在 2007 年至 2010 年间有所上升，但头孢克肟更为明显（从 2007 年的 1.5%上升到 2010 年的 17.1%），2009 年至 2010 年间记录到最小抑菌浓度的双峰分布。多变量分析显示，头孢克肟耐药的分离株与男男性行为者（OR 5.47，95%CI 3.99-7.48；p<0.0001）和分离年份（2010 年，13.08，7.49-22.8；p<0.0001）有关。这些分离株具有主要的克隆种群，大多数属于 G1407 基因群，携带 penA 嵌合基因。2011 年的数据显示，头孢克肟耐药分离株的流行率显著下降，从 2010 年的 17.1%下降到 2011 年的 10.8%（p<0.0001），这与 2010 年从头孢克肟到头孢曲松加阿奇霉素的处方实践改变相一致。
英格兰和威尔士的淋病治疗指南在 2010 年进行了修改，以延长头孢菌素的使用时间。头孢克肟耐药分离株流行率的下降不能完全归因于这种处方实践的改变；然而，这种关联是显著的。
英国卫生部、英国公共卫生署。
