Neisseria Reference Laboratory and World Health Organization Collaborating Centre for STI and AMR, Sydney; New South Wales Health Pathology, Microbiology, The Prince of Wales Hospital, Randwick, NSW 2031, Australia.
School of Medical Sciences, Faculty of Medicine, The University of New South Wales, NSW 2052, Australia.
Commun Dis Intell (2018). 2021 Feb 26;45. doi: 10.33321/cdi.2021.45.12.
The key issues with Neisseria gonorrhoeae infections, in Australia and elsewhere, are coincident increases in disease rates and in antimicrobial resistance (AMR), although these factors have not been shown to be correlated. Despite advances in diagnosis, control of this disease remains elusive, and incidence in Australia continues to increase. Of the Australian jurisdictions, New South Wales (NSW) has the highest N. gonorrhoeae notifications, and over the five-year period 2015-2019, notifications in NSW have increased above the national average (by 116% versus 85%, respectively). Gonococcal disease control is reliant on effective antibiotic regimens. However, escalating AMR in N. gonorrhoeae is a global health priority, as the collateral injury of untreated infections has substantive impacts on sexual and newborn health. Currently, our first-line therapy for gonorrhoea is also our last line, with no ideal alternative identified. Despite some limitations, gentamicin is licensed and readily available in Australia, and is proposed for treatment of resistant N. gonorrhoeae in national guidelines; however, supportive published microbiological data are lacking. Analysis of gonococcal resistance patterns within Australia for the period 1991-2019, including 35,000 clinical isolates from NSW, illustrates the establishment and spread of population-level resistance to all contemporaneous therapies. An analysis of gentamicin susceptibility on 2,768 N. gonorrhoeae clinical isolates from NSW, for the period 2015-2020, demonstrates that the median minimum inhibitory concentration (MIC) for gentamicin in NSW has remained low, at 4.0 mg/L, and resistance was not detected in any isolate. There has been no demonstration of MIC drift over time (p = 0.91, Kruskal-Wallis test), nor differences in MIC distributions according to patients' sex or site of specimen collection. This is the first large-scale evaluation of gentamicin susceptibility in N. gonorrhoeae in Australia. No gentamicin resistance was detected in clinical isolates, 2015-2020, hence this is likely to be an available treatment option for resistant gonococcal infections in NSW.
澳大利亚和其他地方淋病奈瑟菌感染的主要问题是疾病发病率和抗微生物药物耐药性（AMR）同时增加，尽管这些因素尚未显示相关。尽管在诊断方面取得了进展，但这种疾病的控制仍然难以实现，澳大利亚的发病率仍在继续上升。在澳大利亚的司法管辖区中，新南威尔士州（NSW）的淋病奈瑟菌通知数量最多，在 2015 年至 2019 年的五年期间，NSW 的通知数量高于全国平均水平（分别增加了 116%和 85%）。淋病的疾病控制依赖于有效的抗生素方案。然而，淋病奈瑟菌中不断升级的 AMR 是全球卫生的重点，因为未经治疗的感染带来的附带伤害对性健康和新生儿健康有实质性影响。目前，我们治疗淋病的一线药物也是最后一线药物，尚未确定理想的替代药物。尽管存在一些局限性，但庆大霉素在澳大利亚获得许可并广泛使用，并在国家指南中提议用于治疗耐药淋病奈瑟菌；然而，缺乏支持性的已发表微生物学数据。对 1991 年至 2019 年期间澳大利亚淋病奈瑟菌耐药模式的分析，包括来自新南威尔士州的 35,000 例临床分离株，说明了人群水平对所有同时代治疗方法的耐药性的建立和传播。对 2015 年至 2020 年期间来自新南威尔士州的 2,768 例淋病奈瑟菌临床分离株的庆大霉素敏感性分析表明，新南威尔士州庆大霉素的中位最小抑菌浓度（MIC）保持在较低水平，为 4.0mg/L，且未在任何分离株中检测到耐药性。随着时间的推移，MIC 漂移没有得到证实（p = 0.91，Kruskal-Wallis 检验），也没有根据患者的性别或标本采集部位的不同而导致 MIC 分布的差异。这是澳大利亚首次对淋病奈瑟菌中庆大霉素敏感性进行的大规模评估。在 2015 年至 2020 年期间的临床分离株中未检测到庆大霉素耐药性，因此这可能是新南威尔士州耐药淋病奈瑟菌感染的一种可行治疗选择。
