Unit 'Sexually Transmitted Bacterial Infections', Department for Infectious Diseases, Robert Koch Institute, Berlin, Germany.
Unit 'HIV/AIDS, STI and Blood-borne Infections', Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
Euro Surveill. 2020 Oct;25(41). doi: 10.2807/1560-7917.ES.2020.25.41.1900648.
BackgroundEmerging antimicrobial resistance (AMR) challenges gonorrhoea treatment and requires surveillance.AimThis observational study describes the genetic diversity of isolates in Germany from 2014 to 2017 and identifies multi-antigen sequence typing (NG-MAST) genogroups associated with AMR or some patient demographics.Methods1,220 gonococcal isolates underwent AMR testing and NG-MAST. Associations between genogroups and AMR or sex/age of patients were statistically assessed.ResultsPatients' median age was 32 years (interquartile range: 25-44); 1,078 isolates (88.4%) originated from men. In total, 432 NG-MAST sequence types including 156 novel ones were identified, resulting in 17 major genogroups covering 59.1% (721/1,220) of all isolates. Genogroups G1407 and G10557 (G7072) were significantly associated with decreased susceptibility to cefixime (Kruskal-Wallis chi-squared: 549.3442, df: 16, p < 0.001). Their prevalences appeared to decline during the study period from 14.2% (15/106) to 6.2% (30/481) and from 6.6% (7/106) to 3.1% (15/481) respectively. Meanwhile, several cefixime susceptible genogroups' prevalence seemed to increase. Proportions of isolates from men differed among genogroups (Fisher's exact test, p < 0.001), being e.g. lower for G25 (G51) and G387, and higher for G5441 and G2992. Some genogroups differed relative to each other in affected patients' median age (Kruskal-Wallis chi-squared: 47.5358, df: 16, p < 0.001), with e.g. G25 (G51) and G387 more frequent among ≤ 30 year olds and G359 and G17420 among ≥ 40 year olds.ConclusionAMR monitoring with molecular typing is important. Dual therapy (ceftriaxone plus azithromycin) recommended in 2014 in Germany, or only the ceftriaxone dose of this therapy, might have contributed to cefixime-resistant genogroups decreasing.
新出现的抗菌素耐药性（AMR）对淋病治疗构成挑战，需要进行监测。
本观察性研究描述了 2014 年至 2017 年德国分离株的遗传多样性，并确定了与 AMR 或某些患者人口统计学特征相关的多抗原序列分型（NG-MAST）基因群。
对 1,220 株淋病奈瑟菌进行 AMR 检测和 NG-MAST 检测。统计评估基因群与 AMR 或患者的性别/年龄之间的关系。
患者的中位年龄为 32 岁（四分位间距：25-44）；1,078 株（88.4%）来自男性。共鉴定出 432 种 NG-MAST 序列类型，包括 156 种新序列类型，产生了 17 种主要基因群，覆盖了所有分离株的 59.1%（721/1,220）。基因群 G1407 和 G10557（G7072）与头孢克肟的敏感性降低显著相关（Kruskal-Wallis 卡方检验：549.3442，df：16，p<0.001）。它们的流行率在研究期间似乎有所下降，从 14.2%（15/106）降至 6.2%（30/481）和 6.6%（7/106）降至 3.1%（15/481）。与此同时，一些头孢克肟敏感的基因群的流行率似乎有所增加。不同基因群的男性分离株比例不同（Fisher 确切检验，p<0.001），例如 G25（G51）和 G387 的比例较低，G5441 和 G2992 的比例较高。一些基因群在受影响患者的中位年龄方面彼此不同（Kruskal-Wallis 卡方检验：47.5358，df：16，p<0.001），例如 G25（G51）和 G387 在≤30 岁的患者中更为常见，G359 和 G17420 在≥40 岁的患者中更为常见。
用分子分型进行 AMR 监测很重要。2014 年在德国推荐的双重治疗（头孢曲松加阿奇霉素），或该治疗的头孢曲松剂量，可能导致头孢克肟耐药基因群减少。
