1887

Journal of Medical Microbiology logo

Volume 67, Issue 1

Antibiotic susceptibility pattern of strains isolated from five cities in India during 2013–2016 Free

Abstract

Emergence of multidrug resistance in an STI of public health significance is the biggest challenge to gonorrhoea control. Monitoring for antimicrobial resistance is essential for the early detection of emergent drug resistance patterns.

One hundred and twenty four strains were isolated between September 2013-August 2016 [82-New Delhi, 3-Pune, 3-Mumbai, 20-Secunderabad and 16-Hyderabad] to determine antimicrobial susceptibility and to compare the CLSI disc diffusion method with Etest for these strains. The results of the two methods were compared by using kappa statistics.

Ninety eight percent [CI: 96.2–100] of isolates were resistant to ciprofloxacin, 52 % [CI: 43.2–60.8] to penicillin, 56 % [CI: 47.2–64.7] to tetracycline and 5 % [CI: 1.2–8.8] to azithromycin. All the strains were susceptible to spectinomycin, ceftriaxone and cefixime except for two strains which showed decreased susceptibility to ceftriaxone and cefixime. Kappa scores for penicillin, azithromycin, ciprofloxacin, ceftriaxone and cefixime showed that the CLSI method had high agreement with Etest while tetracycline had substantial agreement.

Our data suggest that the disc diffusion method which is both cost effective and more feasible, can effectively be used routinely for monitoring antibiotic susceptibility in in limited resource countries like India. We demonstrate the emergence of decreased susceptibility to ceftriaxone and cefixime and threshold levels of resistance to azithromycin in India. This underscores the importance of maintaining continued surveillance for antibiotic resistance in and a potential requirement for strategic change in guidelines in the not so distant future.

  • Received:
  • Accepted:
  • Published Online:
Keyword(s): antibiotic resistance , India and N. gonorrhoeae
© 2018 The Authors
Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.000662
2018-01-01
2024-04-20
Loading full text...

Full text loading...

/deliver/fulltext/jmm/67/1/22.html?itemId=/content/journal/jmm/10.1099/jmm.0.000662&mimeType=html&fmt=ahah

References

  1. Holmes KK, Sparling PF, Stamm WE, Piot P, Wasserheit JN et al. Sexually Transmitted Diseases, 4th ed. New York: McGraw Hill; 2008
     [Google Scholar]
  2. Newman L, Rowley J, vander Hoorn S, Wijesooriya NS, Unemo M et al. Global estimates of the prevalence and incidence of four curable sexually transmitted infections in 2012 based on systematic review and global reporting. PLoS One 2015; 10:e0143304 [View Article][PubMed]
     [Google Scholar]
  3. Kirkcaldy RD, Harvey A, Papp JR, del Rio C, Soge OO et al. Neisseria gonorrhoeae antimicrobial susceptibility surveillance – the gonococcal isolate surveillance project, 27 sites, United States, 2014. MMWR Surveill Summ 2016; 65:1–19 [View Article][PubMed]
     [Google Scholar]
  4. Tapsall JW. WHO/CDS/DRS/2001.3. Geneva: World Health Organization 2001; Antimicrobial resistance in N. gonorrhoeae . www.who.int/csr/resources/publications/drugresist/WHO_CDS_CSR_DRS_2001_3/en/
  5. Unemo M, Nicholas RA. Emergence of multidrug-resistant, extensively drug-resistant and untreatable gonorrhea. Future Microbiol 2012; 7:1401–1422 [View Article][PubMed]
     [Google Scholar]
  6. Wi T, Lahra MM, Ndowa F, Bala M, Dillon JR et al. Antimicrobial resistance in Neisseria gonorrhoeae: Global surveillance and a call for international collaborative action. PLoS Med 2017; 14:e1002344 [View Article][PubMed]
     [Google Scholar]
  7. World Health Organization (WHO) Global Action Plan to Control the Spread and Impact of Antimicrobial Resistance In Neisseria gonorrhoeae Geneva: WHO; 2012 www.who.int/reproductivehealth/publications/rtis/9789241503501/en
     [Google Scholar]
  8. Workowski KA, Bolan GA. Centers for Disease Control and Prevention Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64:1–137
     [Google Scholar]
  9. Ison CA, Hussey J, Sankar KN, Evans J, Alexander S. Gonorrhoea treatment failures to cefixime and azithromycin in England, 2010. Euro Surveill 2011; 16:[PubMed]
     [Google Scholar]
  10. Unemo M, Golparian D, Syversen G, Vestrheim DF, Moi H. Two cases of verified clinical failures using internationally recommended first-line cefixime for gonorrhoea treatment, Norway, 2010. Euro Surveill 2010; 15: [View Article][PubMed]
     [Google Scholar]
  11. Unemo M, Golparian D, Stary A, Eigentler A. First Neisseria gonorrhoeae strain with resistance to cefixime causing gonorrhoea treatment failure in Austria, 2011. Euro Surveill 2011; 16:pii, 19998
     [Google Scholar]
  12. Barry PM, Klausner JD. The use of cephalosporins for gonorrhea: the impending problem of resistance. Expert Opin Pharmacother 2009; 10:555–577 [View Article][PubMed]
     [Google Scholar]
  13. Bala M, Ray K, Gupta SM, Muralidhar S, Jain RK. Changing trends of antimicrobial susceptibility patterns of Neisseria gonorrhoeae in India and the emergence of ceftriaxone less susceptible N. gonorrhoeae strains. J Antimicrob Chemother 2007; 60:582–586 [View Article][PubMed]
     [Google Scholar]
  14. Gose S, Kong CJ, Lee Y, Samuel MC, Bauer HM et al. Comparison of Neisseria gonorrhoeae MICs obtained by Etest and agar dilution for ceftriaxone, cefpodoxime, cefixime and azithromycin. J Microbiol Methods 2013; 95:379–380 [View Article][PubMed]
     [Google Scholar]
  15. Liu H, Taylor TH, Pettus K, Johnson S, Papp JR et al. Comparing the disk-diffusion and agar dilution tests for Neisseria gonorrhoeae antimicrobial susceptibility testing. Antimicrob Resist Infect Control 2016; 5:46–51 [View Article][PubMed]
     [Google Scholar]
  16. Singh V, Bala M, Kakran M, Ramesh V. Comparative assessment of CDS, CLSI disc diffusion and Etest techniques for antimicrobial susceptibility testing of Neisseria gonorrhoeae: a 6-year study. BMJ Open 2012; 2:e000969 [View Article][PubMed]
     [Google Scholar]
  17. World Health Organization. Laboratory Diagnosis of Gonorrhoea WHO Regional Publication, Geneva, 1999. South East Asia series no 33. Available from http://apps.who.int/iris/handle/10665/205402 (last accessed 7 April 2017)
  18. Clinical and Laboratory Standards Institute Performance Standards for Antimicrobial Susceptibility Testing: Twenty-Third Informational Supplement CLSI document, Approved Standard M100-S24 Wayne, PA: Clinical and Laboratory Standards Institute; 2014
     [Google Scholar]
  19. Viera AJ, Garrett JM. Understanding interobserver agreement: the kappa statistic. Fam Med 2005; 37:360–363[PubMed]
     [Google Scholar]
  20. Bala M. Antimicrobial resistance in Neisseria gonorrhoeae in South-East Asia WHO South-East Asia Regional Health Forum vol. 15 2011 pp. 63–73
     [Google Scholar]
  21. Kulkarni S, Bala M, Risbud A. Antimicrobial susceptibility testing, auxotyping, and serotyping of Neisseria gonorrhoeae strains isolated in India. Sex Transm Dis 2012; 39:188–190 [View Article][PubMed]
     [Google Scholar]
  22. Cao V, Ratsima E, van Tri D, Bercion R, Fonkoua MC et al. Antimicrobial susceptibility of Neisseria gonorrhoeae strains isolated in 2004–2006 in Bangui, Central African Republic; Yaoundé, Cameroon; Antananarivo, Madagascar; and Ho Chi Minh Ville and Nha Trang, Vietnam. Sex Transm Dis 2008; 35:941–945 [View Article][PubMed]
     [Google Scholar]
  23. Tapsall J. Multidrug-resistant Neisseria gonorrhoeae . CMAJ 2009; 180:268–269 [View Article][PubMed]
     [Google Scholar]
  24. Unemo M. Current and future antimicrobial treatment of gonorrhoea - the rapidly evolving Neisseria gonorrhoeae continues to challenge. BMC Infect Dis 2015; 15:364 [View Article][PubMed]
     [Google Scholar]
  25. Wang SA, Lee MV, O'Connor N, Iverson CJ, Ohye RG et al. Multidrug-resistant Neisseria gonorrhoeae with decreased susceptibility to cefixime-Hawaii, 2001. Clin Infect Dis 2003; 37:849–852 [View Article][PubMed]
     [Google Scholar]
  26. World Health Organization Western Pacific Gonococcal Antimicrobial Surveillance Programme. Surveillance of antibiotic resistance in Neisseria gonorrhoeae in the WHO Western Pacific Region, 2004. Commun Dis Intell 2006; 30:129–132
     [Google Scholar]
  27. Bala M, Ray K, Kumari S. Alarming increase in ciprofloxacin- and penicillin-resistant Neisseria gonorrhoeae isolates in New Delhi, India. Sex Transm Dis 2003; 30:523–525 [View Article][PubMed]
     [Google Scholar]
  28. Khaki P, Sharma A, Bhalla P. Comparison of two disc diffusion methods with minimum inhibitory concentration for antimicrobial susceptibility testing of Neisseria gonorrhoeae isolates. Ann Med Health Sci Res 2014; 4:453–456 [View Article][PubMed]
     [Google Scholar]
  29. Bala M, Kakran M, Singh V, Sood S, Ramesh V. Members of WHO GASP SEAR Network Monitoring antimicrobial resistance in Neisseria gonorrhoeae in selected countries of the WHO South-East Asia Region between 2009 and 2012: a retrospective analysis. Sex Transm Infect 2013; 89:iv28–iv35 [View Article][PubMed]
     [Google Scholar]
  30. Lahra MM, Lo YR, Whiley DM. Gonoccoccal antimicrobial resistance in the Western Pacific Region. Sex.Transm Infect 2013; 89:iv19–23
     [Google Scholar]
  31. Ali S, Sewunet T, Sahlemariam Z, Kibru G. Neisseria gonorrhoeae among suspects of sexually transmitted infection in Gambella hospital, Ethiopia: risk factors and drug resistance. BMC Res Notes 2016; 9:439 [View Article][PubMed]
     [Google Scholar]
  32. Cole MJ, Spiteri G, Chisholm SA, Hoffmann S, Ison CA et al. Emerging cephalosporin and multidrug-resistant gonorrhoea in Europe. Euro Surveill 2014; 19:20955–20959 [View Article][PubMed]
     [Google Scholar]
  33. Bala M, Singh V, Bhargava A, Ramesh V. Trends of resistance to antimicrobials recommended currently and in the past for management of gonorrhea in the Apex STD center in India and comparison of antimicrobial resistance profile between 2002-2006 and 2007-2012. Sex Transm Dis 2015; 42:218–222 [View Article][PubMed]
     [Google Scholar]
  34. Brunner A, Nemes-Nikodem E, Jeney C, Szabo D, Marschalko M et al. Emerging azithromycin-resistance among the Neisseria gonorrhoeae strains isolated in Hungary. Ann Clin Microbiol Antimicrob 2016; 15:53–58 [View Article][PubMed]
     [Google Scholar]
  35. Dillon JA, Trecker MA, Thakur SD. Gonococcal Antimicrobial Surveillance Program Network in Latin America and the Caribbean 1990–2011. Two decades of the gonococcal antimicrobial surveillance program in South America and the Caribbean: challenges and opportunities. Sex Transm Infect 2013; 89:iv36–iv41
     [Google Scholar]
  36. Tanaka M, Furuya R, Irie S, Kanayama A, Kobayashi I. High prevalence of azithromycin-resistant Neisseria gonorrhoeae isolates with a multidrug resistance phenotype in Fukuoka, Japan. Sex Transm Dis 2015; 42:337–341 [View Article][PubMed]
     [Google Scholar]
  37. Lahra MM. WHO Western Pacific and South East Asian Gonococcal Antimicrobial Surveillance Programme Surveillance of antibiotic resistance in Neisseria gonorrhoeae in the WHO Western Pacific and South East Asian Regions, 2010. Commun Dis Intell Q Rep 2012; 36:95–100[PubMed]
     [Google Scholar]
  38. Kirkcaldy R, Kidd S, Weinstock H, Papp J, Bolan G. Trends in antimicrobial resistance in Neisseria gonorrhoeae in the USA: the Gonococcal Isolate Surveillance Project (GISP), January 2006–June 2012.. Sex Transm Infect 2013:iv5–10
     [Google Scholar]
  39. Martin IM, Hoffmann S, Ison CA, Network E. ESSTI Network European Surveillance of Sexually Transmitted Infections (ESSTI): the first combined antimicrobial susceptibility data for Neisseria gonorrhoeae in Western Europe. J Antimicrob Chemother 2006; 58:587–593 [View Article][PubMed]
     [Google Scholar]
  40. Ndowa FJ, Francis JM, Machiha A, Faye-Kette H, Fonkoua MC. Gonococcal antimicrobial resistance: perspectives from the African region. Sex Transm Infect 2013; 89:iv11–iv15 [View Article][PubMed]
     [Google Scholar]
  41. Kulkarni MS, Shetty CR, Murti P. Antibiotic susceptibility of Neisseria gonorrhoeae . Indian J Sex Trans Dis 1983; 4:1
     [Google Scholar]
  42. Kulkarni S, Sane S, Mehendale S, Risbud A. Antimicrobial susceptibility of Neisseria gonorrhoeae in Pune from 1996 to 2007. Indian J Sex Transm Dis 2011; 32:58–59 [View Article][PubMed]
     [Google Scholar]
  43. Cole MJ, Unemo M, Grigorjev V, Quaye N, Woodford N. Genetic diversity of blaTEM alleles, antimicrobial susceptibility and molecular epidemiological characteristics of penicillinase-producing Neisseria gonorrhoeae from England and Wales. J Antimicrob Chemother 2015; 70:3238–3243 [View Article][PubMed]
     [Google Scholar]
  44. Dangor Y, de Jongh M, Adam A, Hoosen AA. Antimicrobial susceptibility patterns of gonococcal isolates in Pretoria, South Africa, over a 20-year period (1984-2004). South Afr J Epidemiol Infect 2010; 25:10–13 [View Article]
     [Google Scholar]
  45. Unemo M, Ison CA, Cole M, Spiteri G, van de Laar M et al. Gonorrhoea and gonococcal antimicrobial resistance surveillance networks in the WHO European Region, including the independent countries of the former Soviet Union. Sex Transm Infect 2013; 89 Suppl 4:iv42–iv46 [View Article][PubMed]
     [Google Scholar]
  46. World Health Organization Western Pacific Programme; South East Asian Gonococcal Antimicrobial Surveillance Programme Tapsall JW, Limnios EA, Abu Bakar HM et al. Surveillance of antibiotic resistance in Neisseria gonorrhoeae in the WHO Western Pacific and South East Asian regions, 2007–2008. Commun Dis Intell Q Rep 2010; 34:1–7
     [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.000662
Loading
Antibiotic susceptibility pattern of Neisseria gonorrhoeae strains isolated from five cities in India during 2013–2016
J. Med. Microbiol. 67, 22 (2018); https://doi.org/10.1099/jmm.0.000662
/content/journal/jmm/10.1099/jmm.0.000662
/content/journal/jmm/10.1099/jmm.0.000662
Loading

Data & Media loading...

Most cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error