Jacobsson Susanne, Cole Michelle J, Schröder Daniel, Jansen van Rensburg Melissa, Day Michaela, Ködmön Csaba, Unemo Magnus
WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
UK Health Security Agency (UKHSA), London, UK.
Lancet Reg Health Eur. 2025 May 10;54:101318. doi: 10.1016/j.lanepe.2025.101318. eCollection 2025 Jul.
Since 2009, the European Centre for Disease Prevention and Control (ECDC) has coordinated the European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP) to monitor antimicrobial resistance (AMR) in across the European Union and European Economic Area (EU/EEA). The aims of this study were to report Euro-GASP 2022 data and to compare with the most recently published Euro-GASP data (from 2016 to 2019), to identify changes in AMR and in risk groups for AMR.
In this observational study, 23 EU/EEA countries submitted AMR data for gonococcal isolates from 2022, linked to patient epidemiological data, to The European Surveillance System (TESSy). Statistical analyses (Z-test) were used to determine the significance of the differences between the epidemiological data and proportion of AMR isolates in 2022 versus 2019 and 2016. The risk factors associated with AMR isolates were assessed using univariate and multivariable logistic regression analyses of odds ratios.
Ceftriaxone resistance in 2022 (0.03%, 1/3008) remained low (0.06% (2/3239) in 2019), and cefixime resistance (0.3%, 10/3008) had decreased (0.8% (26/3239) in 2019). Azithromycin resistance (24.9%, 749/3008) and ciprofloxacin resistance (65.8%, 1980/3008) had increased (9.0% (284/3159) and 57.4% (1665/2884), respectively, in 2019). A marked increase in the number (575; 502 in 2019) and proportion (19.2%; 15.8% in 2019) of female gonorrhoea cases was also identified in 2022. In the univariate analysis, azithromycin resistance was associated with oropharyngeal (OR 1.67, CI 1.28-2.18; p < 0.0001) and anorectal infections (OR 1.38, CI 1.08-1.76; p = 0.0094), men-who-have-sex-with-men (MSM) (OR 3.88, CI 2.80-5.37; p < 0.0001), and females (1.71, CI 1.21-2.41; p = 0.0022). In the multivariable logistic regression model, only azithromycin resistance and MSM remained associated (OR 2.85, CI 1.33-4.73; p = 0.0040).
While ceftriaxone resistance remains sporadically detected in Euro-GASP, the increase in reports of occasional ceftriaxone resistance in EU/EEA countries and substantial increase in azithromycin resistance underscore the urgent need for enhanced AMR surveillance. The Euro-GASP data is crucial for refining treatment guidelines and mitigating the spread of AMR gonococcal strains. Novel effective antimicrobials for gonorrhoea treatment remain imperative.
ECDC.
自2009年以来，欧洲疾病预防控制中心（ECDC）协调开展了欧洲淋球菌抗菌药物监测计划（Euro - GASP），以监测整个欧盟和欧洲经济区（EU/EEA）的抗菌药物耐药性（AMR）。本研究的目的是报告2022年Euro - GASP的数据，并与最近公布的Euro - GASP数据（2016年至2019年）进行比较，以确定AMR及其风险群体的变化。
在这项观察性研究中，23个欧盟/欧洲经济区国家向欧洲监测系统（TESSy）提交了2022年淋球菌分离株的AMR数据，并与患者流行病学数据相关联。使用统计分析（Z检验）来确定2022年与2019年和2016年相比，流行病学数据和AMR分离株比例之间差异的显著性。使用单变量和多变量逻辑回归分析比值比来评估与AMR分离株相关的危险因素。
2022年头孢曲松耐药率（0.03%，1/3008）仍然较低（2019年为0.06%（2/3239）），而头孢克肟耐药率（0.3%，10/3008）有所下降（2019年为0.8%（26/3239））。阿奇霉素耐药率（24.9%，749/3008）和环丙沙星耐药率（65.8%，1980/3008）有所上升（2019年分别为9.0%（284/3159）和57.4%（1665/2884））。2022年还发现女性淋病病例数量（575例；2019年为502例）和比例（19.2%；2019年为15.8%）显著增加。在单变量分析中，阿奇霉素耐药与口咽感染（比值比1.67，置信区间1.28 - 2.18；p < 0.0001）、肛门直肠感染（比值比1.38，置信区间1.08 - 1.76；p = 0.0094）、男男性行为者（MSM）（比值比3.88，置信区间2.80 - 5.37；p < 0.0001）以及女性（1.71，置信区间1.21 - 2.41；p = 0.0022）相关。在多变量逻辑回归模型中，只有阿奇霉素耐药和MSM仍然相关（比值比2.85，置信区间1.33 - 4.73；p = 0.0040）。
虽然在Euro - GASP中仍偶尔检测到头孢曲松耐药，但欧盟/欧洲经济区国家偶尔出现的头孢曲松耐药报告增加以及阿奇霉素耐药大幅增加凸显了加强AMR监测的迫切需求。Euro - GASP数据对于完善治疗指南和减轻AMR淋球菌菌株的传播至关重要。治疗淋病的新型有效抗菌药物仍然必不可少。
欧洲疾病预防控制中心。
