Temporal and geographic trends in extended-spectrum cephalosporins resistance among Neisseria gonorrhoeae isolates worldwide: a systematic review and meta-analysis.

The global emergence of antibiotic resistance in Neisseria gonorrhoeae (NG) infections poses a critical public health challenge. This study aimed to evaluate global resistance rates to extended-spectrum cephalosporins (ESCs) in N. gonorrhoeae, considering factors such as time, geography, antimicrobial susceptibility testing (AST), and resistance interpretation. A systematic review and meta-analysis (from 1988 to 2025) of 252 studies from 71 countries reported a weighted pooled resistance rate (WPR) of ≤ 2.5% for ESCs. Significant temporal variation in ESCs-resistant isolates (P < 0.05) underscores the dynamic nature of resistance development. Significantly, there was a difference in penicillin resistance rates between countries/ continents, and AST (P < 0.001). These findings emphasize the urgent need for effective antimicrobial stewardship, enhanced contact tracing, and comprehensive monitoring systems to combat antimicrobial resistance in gonococcal infections.