Trends in Antimicrobial Resistance over a Ten-Year Surveillance Period, Johannesburg, South Africa, 2008⁻2017.

BACKGROUND

In South Africa, sexually transmitted infections (STIs) are managed through a syndromic approach at primary healthcare centres (PHCs). is the predominant cause of male urethritis syndrome. We describe antimicrobial resistance patterns and trends in during a ten-year surveillance period at a large PHC in Johannesburg.

METHODS

was cultured from genital discharge swab specimens obtained from consenting adult patients presenting at the Alexandra Health Centre in Johannesburg between 2008 and 2017. Isolates were tested for antimicrobial susceptibility by Etest™ (cefixime, ceftriaxone, ciprofloxacin) or agar dilution (penicillin, tetracycline, azithromycin).

RESULTS

During the period of surveillance, high-level resistance prevalence increased from 30% to 51% for penicillin (-value for trend < 0.001), 75% to 83% for tetracycline (-value for trend = 0.008), and 25% to 69% for ciprofloxacin (-value for trend < 0.001). Analysis did not reveal high-level resistance to spectinomycin or a minimum inhibitory concentration (MIC) creep for extended-spectrum cephalosporins, and the prevalence of intermediate-resistance to azithromycin was less than 5%.

CONCLUSIONS

High prevalence resistance to penicillin, tetracycline, and ciprofloxacin in obviates their use in future national treatment algorithms for genital discharge. It is essential to continue monitoring for emerging resistance to currently recommended antimicrobial therapy in this rapidly evolving pathogen.