Cole Michelle J, Spiteri Gianfranco, Town Katy, Unemo Magnus, Hoffmann Steen, Chisholm Stephanie A, Amato-Gauci Andrew J, van de Laar Marita, Ison Catherine A
From the *Public Health England, London, United Kingdom; †European Centre for Disease Prevention and Control, Stockholm, Sweden; ‡Örebro University Hospital, Örebro, Sweden; §Statens Serum Institut, Copenhagen, Denmark.
Sex Transm Dis. 2014 Dec;41(12):723-9. doi: 10.1097/OLQ.0000000000000185.
The European Gonococcal Antimicrobial Surveillance Programme performs antimicrobial resistance surveillance and is coordinated by the European Centre for Disease Prevention and Control. This study used epidemiological and behavioral data combined with the gonococcal susceptibility profiles to determine risk factors associated with harboring resistant gonococci in Europe.
From 2009 to 2011, gonococcal isolates from 21 countries were submitted to the European Gonococcal Antimicrobial Surveillance Programme for antimicrobial susceptibility testing. Patient variables associated with resistance to azithromycin, cefixime, and ciprofloxacin were identified using univariate and multivariable logistic regression analyses of odds ratios. Geometric means for ceftriaxone and cefixime minimum inhibitory concentrations (MICs) were compared for patients of different sexual orientation and sex.
A total of 5034 gonococcal isolates were tested from 2009 to 2011. Isolates exhibiting resistance to cefixime (MIC > 0.125 mg/L) and ciprofloxacin (MIC > 0.5 mg/L) were significantly associated with infection in heterosexuals (males only for ciprofloxacin), older patients (>25 years of age), or those without a concurrent chlamydial infection in the multivariable analysis. The geometric mean of cefixime and ceftriaxone MICs decreased from 2009 to 2011, most significantly for men who have sex with men, and isolates from male heterosexuals exhibited the highest MICs in 2011.
The linking of epidemiological and behavioral data to the susceptibility profiles of the gonococcal isolates has allowed those at higher risk for acquiring antimicrobial resistant Neisseria gonorrhoeae to be identified. Improved data numbers and representativeness are required before evidence-based risk groups can be identified, and subsequent focused treatments or public health intervention strategies can be initiated with confidence.
欧洲淋球菌抗菌药物监测计划开展抗菌药物耐药性监测，由欧洲疾病预防控制中心协调。本研究结合流行病学和行为学数据以及淋球菌药敏谱，以确定欧洲携带耐药淋球菌的相关危险因素。
2009年至2011年，来自21个国家的淋球菌分离株被提交至欧洲淋球菌抗菌药物监测计划进行药敏试验。通过单变量和多变量逻辑回归分析比值比，确定与阿奇霉素、头孢克肟和环丙沙星耐药相关的患者变量。比较不同性取向和性别的患者头孢曲松和头孢克肟最低抑菌浓度（MIC）的几何均值。
2009年至2011年共检测了5034株淋球菌分离株。在多变量分析中，对头孢克肟（MIC>0.125mg/L）和环丙沙星（MIC>0.5mg/L）耐药的分离株与异性恋者（环丙沙星仅针对男性）、老年患者（>25岁）或无衣原体合并感染的患者感染显著相关。2009年至2011年，头孢克肟和头孢曲松MIC的几何均值下降，与男性发生性关系的男性下降最为显著，2011年男性异性恋者的分离株MIC最高。
将流行病学和行为学数据与淋球菌分离株的药敏谱相结合，使得能够识别出获得耐抗菌药物淋病奈瑟菌风险较高的人群。在能够确定基于证据的风险群体并自信地启动后续针对性治疗或公共卫生干预策略之前，需要提高数据数量和代表性。
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