Kakooza Francis, Kiggundu Reuben, Mboowa Gerald, Kateete Patrick David, Nsangi Olga Tendo, Kabahita Jupiter Marina, Ssentalo Bagaya Bernard, Golparian Daniel, Unemo Magnus
Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
Department of Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda.
Front Microbiol. 2023 Apr 6;14:1148817. doi: 10.3389/fmicb.2023.1148817. eCollection 2023.
Antimicrobial resistance (AMR) in (NG), compromising gonorrhea treatment, is a global public health concern. Improved, quality-assured NG AMR monitoring at the global level is essential. This mini-review examined NG AMR susceptibility surveillance and AMR data from the African continent from 2001 to 2020. Eligible peer-reviewed publications (n = 30) containing NG AMR data for antimicrobials currently recommended for gonorrhea treatment were included. Overall, very limited NG surveillance and AMR data was available. Furthermore, the NG AMR surveillance studies varied greatly regarding surveillance protocols (e.g., populations and samples tested, sample size, antimicrobials examined), methodologies (e.g., antimicrobial susceptibility testing method [agar dilution, minimum inhibitory concentration (MIC) gradient strip test, disc diffusion test] and interpretative criteria), and quality assurance (internal quality controls, external quality assessments [EQA], and verification of AMR detected). Moreover, most studies examined a suboptimal number of NG isolates, i.e., less than the WHO Global Gonococcal Antimicrobial Surveillance Program (GASP) and WHO Enhanced GASP (EGASP) recommendations of ≥100 isolates per setting and year. The notable inter-study variability and frequently small sample sizes make appropriate inter-study and inter-country comparisons of AMR data difficult. In conclusion, it is imperative to establish an enhanced, standardized and quality-assured NG AMR surveillance, ideally including patient metadata and genome sequencing as in WHO EGASP, in Africa, the region with the highest gonorrhea incidence globally. This will enable the monitoring of AMR trends, detection of emerging AMR, and timely refinements of national and international gonorrhea treatment guidelines. To achieve this aim, national and international leadership, political and financial commitments are imperative.
淋病奈瑟菌（NG）中的抗菌药物耐药性（AMR）危及淋病治疗，是一个全球公共卫生问题。在全球层面改进并确保质量的NG AMR监测至关重要。本综述考察了2001年至2020年非洲大陆的NG AMR药敏监测及AMR数据。纳入了符合条件的同行评审出版物（n = 30），这些出版物包含目前推荐用于淋病治疗的抗菌药物的NG AMR数据。总体而言，可用的NG监测和AMR数据非常有限。此外，NG AMR监测研究在监测方案（如检测的人群和样本、样本量、检测的抗菌药物）、方法（如抗菌药物敏感性检测方法[琼脂稀释法、最低抑菌浓度（MIC）梯度条试验、纸片扩散试验]及解释标准）以及质量保证（内部质量控制、外部质量评估[EQA]和检测到的AMR的验证）方面差异很大。此外，大多数研究检测的NG分离株数量未达最佳，即低于世界卫生组织全球淋球菌抗菌药物监测计划（GASP）和世界卫生组织强化GASP（EGASP）的建议，即每个地点和年份≥100株分离株。研究间显著的变异性以及样本量经常较小使得难以对AMR数据进行适当的研究间和国家间比较。总之，在全球淋病发病率最高的非洲地区，必须建立强化的、标准化且质量有保证的NG AMR监测，理想情况下包括患者元数据和基因组测序，如同世界卫生组织EGASP那样。这将能够监测AMR趋势、检测新出现的AMR，并及时完善国家和国际淋病治疗指南。要实现这一目标，国家和国际层面的领导、政治和财政承诺必不可少。
