2022 - 23年柬埔寨多个城市头孢曲松耐药和广泛耐药的高流行率：世界卫生组织强化淋球菌抗菌药物监测计划（EGASP）
High prevalence of ceftriaxone-resistant and XDR in several cities of Cambodia, 2022-23: WHO Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP).
作者信息
Ouk V, Heng L Say, Virak M, Deng S, Lahra M M, Frankson R, Kreisel K, McDonald R, Escher M, Unemo M, Wi T, Maatouk I
机构信息
National Center for HIV/AIDS, Dermatology and Sexually Transmitted Diseases, Phnom Penh, Cambodia.
Laboratory of the National Institute of Public Health, Phnom Penh, Cambodia.
出版信息
JAC Antimicrob Resist. 2024 Apr 4;6(2):dlae053. doi: 10.1093/jacamr/dlae053. eCollection 2024 Apr.
OBJECTIVES
Antimicrobial resistance (AMR) in is a global public health concern. Ceftriaxone is the last effective and recommended option for empirical gonorrhoea therapy worldwide, but several ceftriaxone-resistant cases linked to Asia have been reported internationally. During January 2022-June 2023, the WHO Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP) investigated AMR and epidemiological factors in patients from 10 clinical sentinel sites in Cambodia.
METHODS
Urethral swabs from males with urethral discharge were cultured. ETEST determined the MIC of five antimicrobials, and EGASP MIC alert values and EUCAST breakpoints were used. EGASP demographic, behavioural and clinical variables were collected using a standardized questionnaire.
RESULTS
From 437 male patients, 306 had positive cultures, AMR testing and complete epidemiological data. Resistance to ceftriaxone, cefixime, azithromycin and ciprofloxacin was 15.4%, 43.1%, 14.4% and 97.1%, respectively. Nineteen (6.2%) isolates were resistant to all four antimicrobials and, accordingly, categorized as XDR . These XDR isolates were collected from 7 of the 10 sentinel sites. No EGASP MIC alert values for gentamicin were reported. The nationally recommended cefixime 400 mg plus azithromycin 1 g (65.4%) or ceftriaxone 1 g plus azithromycin 1 g (34.6%) was used for treatment.
CONCLUSIONS
A high prevalence of ceftriaxone-resistant, MDR and XDR in several cities of Cambodia were found during 2022-23 in WHO EGASP. This necessitates expanded AMR surveillance, revision of the nationally recommended gonorrhoea treatment, mandatory test of cure, enhanced sexual contact notification, and ultimately novel antimicrobials for the treatment of gonorrhoea.
目的
淋球菌的抗菌药物耐药性是一个全球公共卫生问题。头孢曲松是全球经验性治疗淋病的最后一种有效且推荐的药物，但国际上已报告了几例与亚洲相关的头孢曲松耐药病例。在2022年1月至2023年6月期间，世界卫生组织强化淋球菌抗菌药物监测计划（EGASP）对柬埔寨10个临床哨点的患者的淋球菌抗菌药物耐药性及流行病学因素进行了调查。
方法
对有尿道分泌物的男性患者的尿道拭子进行培养。使用ETEST测定了五种抗菌药物的最低抑菌浓度（MIC），并采用了EGASP MIC警报值和欧洲抗菌药物敏感性试验委员会（EUCAST）的断点值。使用标准化问卷收集了EGASP的人口统计学、行为学和临床变量。
结果
在437名男性患者中，306名患者的淋球菌培养、抗菌药物耐药性检测及完整的流行病学数据呈阳性。对头孢曲松、头孢克肟、阿奇霉素和环丙沙星的耐药率分别为15.4%、43.1%、14.4%和97.1%。19株（6.2%）分离株对所有四种抗菌药物均耐药，因此被归类为广泛耐药淋球菌（XDR-NG）。这些XDR分离株是从10个哨点中的7个收集到的。未报告庆大霉素的EGASP MIC警报值。治疗采用国家推荐的头孢克肟400mg加阿奇霉素1g（65.4%）或头孢曲松1g加阿奇霉素1g（34.6%）。
结论
在2022 - 2023年期间，世界卫生组织EGASP在柬埔寨的几个城市发现了头孢曲松耐药、多重耐药和广泛耐药淋球菌的高流行率。这就需要扩大淋球菌抗菌药物耐药性监测，修订国家推荐的淋病治疗方案，进行强制性治愈检测，加强性接触者通报，最终研发治疗淋病的新型抗菌药物。
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