Analysis of Neisseria gonorrhoeae susceptibility trends (MIC creep) from North India: A 15-years' experience!

IF 3.2 4区 医学 Q2 DERMATOLOGY
Seema Sood, Somesh Gupta, Rachna Verma, Rajendra Singh, Sonu Kumari Agrawal, Neeraj Mahajan, Vinod Kumar Sharma
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引用次数: 0

Abstract

Background Neisseria gonorrhoeae (NG) is a highly transformable strict human pathogen with the potential to evolve into a 'superbug' Resource-limited settings like ours rely on the syndromic diagnostic approach recommended by the WHO and adopted by the National AIDS Control Organisation (NACO) for the management of sexually transmitted infections (STIs). The 'Grey kit" comprising of cefixime 400 mg and azithromycin 1 gm is recommended for genitourinary discharge in India. Aim The objective of this study was to examine putative changes in minimum inhibitory concentration (MICs) of ceftriaxone/cefixime and azithromycin during a ∼15-year period to assess the need for dosage adjustment. Methods All clinical isolates of NG obtained from patients attending the STI clinic of our hospital were included in the study. The MIC for penicillin, tetracycline, ciprofloxacin, ceftriaxone, cefixime, azithromycin, and spectinomycin was determined using the E-test method. The results were interpreted according to the Calibrated Dichotomous Sensitivity (CDS) criteria except for azithromycin (up to 2011) and cefixime, where Clinical & Laboratory Standards Institute (CLSI) guidelines were used. We analysed our data by years (2008-2012 vs. 2013-2017) and examined the limited data available thereafter until June 2023 (in light of COVID). MIC50 and MIC90 (MIC values that stop the growth of 50% and 90% of bacterial isolates respectively) data were analysed for determination of MIC creep. Results A total of 183 NG isolates were collected during the study period (151 during 2008-2017 and 32, 2018 onwards). All isolates were from male patients presenting with urethritis. High resistance levels were observed for penicillin, tetracycline, and ciprofloxacin, but decreased susceptibility to ceftriaxone or cefixime remained (<10%), as did resistance to azithromycin (<5%). Notably, no ceftriaxone resistance was detected over the ∼15-year period, and no significant increase in MIC (MIC creep) was observed for ceftriaxone and azithromycin. Only two isolates showed concurrent resistance to azithromycin and decreased susceptibility to ceftriaxone. All isolates were susceptible to spectinomycin. Limitations The clinical isolates were obtained from a single site, and the numbers were limited. There is a paucity of data during the COVID-19 pandemic due to limited clinical services being offered. Conclusion There appears to be no immediate threat to the therapies currently being used in syndromic management for genitourinary discharge. However, MIC-based monitoring of crucial antimicrobials is imperative.

印度北部淋病奈瑟菌敏感性趋势分析(MIC蠕变):15年的经验!
淋病奈瑟菌(NG)是一种高度可转化的严格的人类病原体,有可能演变成一种“超级细菌”。像我们这样资源有限的国家依赖于世卫组织推荐的综合征诊断方法,并由国家艾滋病控制组织(NACO)采用,用于管理性传播感染(STIs)。在印度,推荐使用由头孢克肟400毫克和阿奇霉素1克组成的“灰色工具包”用于泌尿生殖系统排泄。目的:本研究的目的是检查头孢曲松/头孢克肟和阿奇霉素在约15年期间的最低抑制浓度(mic)的推定变化,以评估剂量调整的必要性。方法将在我院性病门诊就诊的患者中分离到的NG纳入研究。采用E-test法测定青霉素、四环素、环丙沙星、头孢曲松、头孢克肟、阿奇霉素和大观霉素的MIC。除阿奇霉素(截至2011年)和头孢克肟(使用临床与实验室标准协会(CLSI)指南)外,结果根据校准的二法敏感性(CDS)标准进行解释。我们按年分析了我们的数据(2008-2012年与2013-2017年),并检查了此后直到2023年6月(鉴于COVID)的有限数据。对MIC50和MIC90(分别使50%和90%的分离细菌停止生长的MIC值)数据进行分析,以确定MIC蠕变。结果研究期间共收集到NG分离株183株(2008-2017年151株,2018年以后32株)。所有分离株均来自表现为尿道炎的男性患者。对青霉素、四环素和环丙沙星的耐药水平较高,但对头孢曲松或头孢克肟的敏感性仍然降低(
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来源期刊
CiteScore
2.10
自引率
10.30%
发文量
247
审稿时长
6-12 weeks
期刊介绍: The Indian Association of Dermatologists, Venereologists & Leprologists (IADVL) is the national association of Indian medical specialists who manage patients with skin disorders, sexually transmitted infections (STIs) or leprosy. The current member strength of the association is about 3800. The association works for the betterment of the specialty by holding academic meetings, printing a journal and publishing a textbook. The IADVL has several state branches, each with their own office bearers, which function independently within the constitution of the IADVL. Established in 1940, the Indian Journal of Dermatology, Venereology and Leprology (IJDVL, ISSN 0378-6323) is the official publication of the IADVL (Indian Association of Dermatologists, Venereologists and Leprologists).
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