Unemo Magnus, Lahra Monica M, Escher Martina, Eremin Sergey, Cole Michelle J, Galarza Patricia, Ndowa Francis, Martin Irene, Dillon Jo-Anne R, Galas Marcelo, Ramon-Pardo Pilar, Weinstock Hillard, Wi Teodora
WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
WHO Collaborating Centre for Sexually Transmitted Infections and Antimicrobial Resistance, New South Wales Health Pathology, Microbiology, Randwick, NSW, Australia.
Lancet Microbe. 2021 Nov;2(11):e627-e636. doi: 10.1016/S2666-5247(21)00171-3. Epub 2021 Sep 2.
Gonorrhoea and antimicrobial resistance (AMR) in Neisseria gonorrhoeae are major health concerns globally. Increased global surveillance of gonococcal AMR is essential. We aimed to describe the 2017-18 data from WHO's global gonococcal AMR surveillance, and to discuss priorities essential for the effective management and control of gonorrhoea.
We did a retrospective observational study of the AMR data of gonococcal isolates reported to WHO by 73 countries in 2017-18. WHO recommends that each country collects at least 100 gonococcal isolates per year, and that quantitative methods to determine the minimum inhibitory concentration of antimicrobials, interpreted by internationally standardised resistance breakpoints, are used.
In 2017-18, 73 countries provided AMR data for one or more drug. Decreased susceptibility or resistance to ceftriaxone was reported by 21 (31%) of 68 reporting countries and to cefixime by 24 (47%) of 51 reporting countries. Resistance to azithromycin was reported by 51 (84%) of 61 reporting countries and to ciprofloxacin by all 70 (100%) reporting countries. The annual proportion of decreased susceptibility or resistance across countries was 0-21% to ceftriaxone and 0-22% to cefixime, and that of resistance was 0-60% to azithromycin and 0-100% to ciprofloxacin. The number of countries reporting gonococcal AMR and resistant isolates, and the number of examined isolates, have increased since 2015-16. Surveillance remains scarce in central America and the Caribbean and eastern Europe, and in the WHO African, Eastern Mediterranean, and South-East Asian regions.
In many countries, ciprofloxacin resistance was exceedingly high, azithromycin resistance was increasing, and decreased susceptibility or resistance to ceftriaxone and cefixime continued to emerge. WHO's global surveillance of gonococcal AMR needs to expand internationally to provide imperative data for national and international management guidelines and public health policies. Improved prevention, early diagnosis, treatment of index patients and partners, enhanced surveillance (eg, infection, AMR, treatment failures, and antimicrobial use or misuse), and increased knowledge on antimicrobial selection, stewardship, and pharmacokinetics or pharmacodynamics are essential. The development of rapid, accurate, and affordable point-of-care gonococcal diagnostic tests, new antimicrobials, and gonococcal vaccines is imperative.
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淋病及淋病奈瑟菌的抗菌药物耐药性（AMR）是全球主要的健康问题。加强全球淋病抗菌药物耐药性监测至关重要。我们旨在描述世界卫生组织（WHO）全球淋病抗菌药物耐药性监测2017 - 2018年的数据，并讨论有效管理和控制淋病所需的重点事项。
我们对73个国家在2017 - 2018年向WHO报告的淋病奈瑟菌分离株的抗菌药物耐药性数据进行了回顾性观察研究。WHO建议每个国家每年至少收集100株淋病奈瑟菌分离株，并采用通过国际标准化耐药断点解释的定量方法来确定抗菌药物的最低抑菌浓度。
在2017 - 2018年，73个国家提供了一种或多种药物的抗菌药物耐药性数据。68个报告国家中有21个（31%）报告对头孢曲松的敏感性降低或耐药，51个报告国家中有24个（47%）报告对头孢克肟的敏感性降低或耐药。61个报告国家中有51个（84%）报告对阿奇霉素耐药，所有70个（100%）报告国家均报告对环丙沙星耐药。各国对头孢曲松敏感性降低或耐药的年度比例为0 - 21%，对头孢克肟为0 - 22%，对阿奇霉素耐药的比例为0 - 60%，对环丙沙星为0 - 100%。自2015 - 2016年以来，报告淋病抗菌药物耐药性和耐药分离株的国家数量以及检测的分离株数量均有所增加。中美洲和加勒比地区以及东欧，以及WHO非洲、东地中海和东南亚区域的监测仍然匮乏。
在许多国家，环丙沙星耐药率极高，阿奇霉素耐药率在上升，对头孢曲松和头孢克肟的敏感性降低或耐药情况仍在不断出现。WHO的全球淋病抗菌药物耐药性监测需要在国际上扩大范围，以提供制定国家和国际管理指南及公共卫生政策所需的关键数据。改善预防、早期诊断、对索引患者及其性伴的治疗、加强监测（如感染、抗菌药物耐药性、治疗失败以及抗菌药物的使用或滥用情况），并增加对抗菌药物选择、管理以及药代动力学或药效学的了解至关重要。开发快速、准确且经济实惠的即时检测淋病诊断试验、新型抗菌药物和淋病疫苗势在必行。
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