Machado Hanalydia de Melo, Martins Jéssica Motta, Schörner Marcos André, Gaspar Pamela Cristina, Bigolin Alisson, Ramos Mauro Cunha, Ferreira Willian Antunes, Pereira Gerson Fernando Mendes, Miranda Angélica Espinosa, Unemo Magnus, Bazzo Maria Luiza
Molecular Biology, Microbiology and Serology Laboratory (LBMMS), Federal University of Santa Catarina, Florianópolis, Brazil.
Department of Chronic Diseases and STI, Brazilian Ministry of Health, Brasília, Brazil.
JAC Antimicrob Resist. 2022 Jul 5;4(4):dlac076. doi: 10.1093/jacamr/dlac076. eCollection 2022 Aug.
To (i) describe the nationwide antimicrobial susceptibility of (NG) isolates cultured across Brazil in 2018-20 and compare it with NG antimicrobial resistance data from 2015-16, and (ii) present epidemiological data of the corresponding gonorrhoea patients in 2018-20.
Twelve representative sentinel sites cultured NG isolates from men with urethral discharge. Susceptibility to eight antimicrobials was examined using agar dilution method, according to WHO standards. The consenting participants were invited to provide epidemiological data.
In total, 633 NG isolates (one isolate per participant) were analysed, and 449 (70.9%) questionnaires were answered. Heterosexual (68.2%) and homosexual (23.1%) sexual orientations were common, and most prevalent types of unprotected sexual intercourse were vaginal insertive (69.9%), oral giving (56.6%) and anal insertive (47.4%). The levels of NG resistance to ciprofloxacin, tetracycline, benzylpenicillin, azithromycin, cefixime, gentamicin, spectinomycin and ceftriaxone were 67.3%, 40.0%, 25.7%, 10.6%, 0.3%, 0%, 0% and 0%, respectively. Compliance with the recommended first-line ceftriaxone 500 mg plus azithromycin 1 g therapy was high (90.9%).
Compared with 2015-16, ciprofloxacin resistance has remained high and azithromycin and cefixime resistance rates have increased in Brazil. Resistance remained lacking to ceftriaxone, gentamicin and spectinomycin, which all are gonorrhoea treatment options. The increasing azithromycin resistance in Brazil and internationally may threaten the future use of azithromycin in dual regimens for treatment of gonorrhoea. Consequently, continued and enhanced quality-assured surveillance of gonococcal AMR, and ideally also treatment failures and including WGS, is imperative in Brazil and worldwide.
(i) 描述2018 - 2020年在巴西全国范围内培养的淋病奈瑟菌（NG）分离株的抗菌药物敏感性，并将其与2015 - 2016年的NG抗菌药物耐药数据进行比较；(ii) 呈现2018 - 2020年相应淋病患者的流行病学数据。
12个具有代表性的哨点对尿道分泌物男性患者的NG分离株进行培养。根据世界卫生组织标准，采用琼脂稀释法检测对8种抗菌药物的敏感性。邀请获得同意的参与者提供流行病学数据。
共分析了633株NG分离株（每位参与者1株），449份（70.9%）问卷得到回复。异性恋（68.2%）和同性恋（23.1%）性取向较为常见，无保护性行为最常见的类型为阴道插入（69.9%）、口交（56.6%）和肛门插入（47.4%）。NG对环丙沙星、四环素、苄星青霉素、阿奇霉素、头孢克肟、庆大霉素、壮观霉素和头孢曲松的耐药水平分别为67.3%、40.0%、25.7%、10.6%、0.3%、0%、0%和0%。推荐的一线头孢曲松500 mg加阿奇霉素1 g治疗方案的依从性较高（90.9%）。
与2015 - 2016年相比，巴西环丙沙星耐药率仍然很高，阿奇霉素和头孢克肟耐药率有所上升。头孢曲松、庆大霉素和壮观霉素仍无耐药情况，这些都是淋病的治疗选择。巴西及国际上阿奇霉素耐药性的增加可能会威胁到阿奇霉素在淋病联合治疗方案中的未来应用。因此，在巴西和全球范围内，持续并加强有质量保证的淋球菌抗菌药物耐药性监测，理想情况下还包括治疗失败情况监测并纳入全基因组测序，势在必行。
