Direction des risques biologiques, Institut national de santé publique du Québec, Québec, Québec, Canada
École de Santé Publique, Université de Montréal, Montréal, Québec, Canada.
BMJ Open. 2023 Aug 4;13(8):e073849. doi: 10.1136/bmjopen-2023-073849.
To examine correlates of antimicrobial resistance (AMR) to first-line antimicrobials (azithromycin, cefixime and ceftriaxone).
The sentinel surveillance network is an open cohort of gonococcal infection cases from Québec, Canada. Cross-sectional results are reported herein.
Between 1 January 2016 and 31 December 2019, data from 886 individuals accounting for 941 gonorrhoea cases were included.
Epidemiological and clinical data were collected using an auto-administered questionnaire, direct case interviews and chart reviews. Antimicrobial susceptibility testing was performed using the agar dilution method. Generalised estimating equations were used for regression.
The prevalence of azithromycin resistance with a minimal inhibitory concentration (MIC) of ≥2 mg/L was 21.3%. In 2016, men who have sex with men were more likely to be infected with an azithromycin-resistant isolate (adjusted prevalence ratio (aPR)=4.73, 95% CI 1.48 to 15.19) or with an isolate with increased third-generation cephalosporin (3GC) MIC (aPR=5.32, 95% CI 1.17 to 24.11 for cefixime (MIC≥0.06 mg/L) and aPR=4.38, 95% CI 1.53 to 12.54 for ceftriaxone (MIC≥0.03 mg/L)). However, these associations were not maintained between 2017 and 2019, with increased MIC observed in men who have sex exclusively with women and women. Overall, azithromycin resistance was significantly more likely in cases who self-reported HIV infection (aPR=1.65, 95% CI 1.00 to 2.71). Cefixime increased MIC were more likely in individuals 25-34 years old (aPR=2.23, 95% CI 1.18 to 4.21). Cefixime and ceftriaxone increased MIC were both more likely in cases who reported ≥5 sexual partners (cefixime: aPR=2.10, 95% CI 1.34 to 3.27 and ceftriaxone: aPR=1.62, 95% CI 1.14 to 2.30).
Significant correlates of AMR to first-line antimicrobials were observed. Antimicrobial stewardship may be particularly important for 3GC. Active monitoring and interventions are critical for 3GC non-susceptible strains, especially considering the very low prevalence in Québec.
研究一线抗菌药物（阿奇霉素、头孢克肟和头孢曲松）的耐药性（AMR）相关因素。
哨点监测网络是加拿大魁北克地区淋病感染病例的开放队列。本文报告了横断面结果。
2016 年 1 月 1 日至 2019 年 12 月 31 日，共纳入 886 名个体的 941 例淋病病例的数据。
使用自动管理问卷、直接病例访谈和图表审查收集流行病学和临床数据。采用琼脂稀释法进行抗菌药物敏感性试验。使用广义估计方程进行回归分析。
最低抑菌浓度（MIC）≥2mg/L 的阿奇霉素耐药率为 21.3%。2016 年，男男性接触者更有可能感染阿奇霉素耐药株（调整后患病率比[aPR]=4.73，95%CI 1.48 至 15.19）或三代头孢菌素 MIC 升高的株（头孢克肟[aPR]=5.32，95%CI 1.17 至 24.11，MIC≥0.06mg/L；头孢曲松[aPR]=4.38，95%CI 1.53 至 12.54，MIC≥0.03mg/L）。然而，2017 年至 2019 年间，这些关联并未持续存在，MIC 升高的情况出现在仅与女性发生性行为的男性和女性中。总体而言，报告 HIV 感染的病例中，阿奇霉素耐药的可能性显著增加（aPR=1.65，95%CI 1.00 至 2.71）。25-34 岁的个体更有可能出现头孢克肟 MIC 升高（aPR=2.23，95%CI 1.18 至 4.21）。报告性伴侣≥5 个的病例中，头孢克肟和头孢曲松 MIC 升高的可能性更大（头孢克肟：aPR=2.10，95%CI 1.34 至 3.27；头孢曲松：aPR=1.62，95%CI 1.14 至 2.30）。
观察到一线抗菌药物耐药性的显著相关因素。对于三代头孢菌素，抗菌药物管理可能尤为重要。主动监测和干预对于 3GC 不敏感菌株至关重要，尤其是考虑到魁北克的低流行率。
