Surveillance of antibiotic resistance in Neisseria gonorrhoeae in The Netherlands, 1977-95.
OBJECTIVE
To evaluate the prevalence and epidemiology of penicillinase producing Neisseria gonorrhoeae (PPNG) and tetracycline resistant N gonorrhoeae (TRNG) in the period 1977-95 in the Netherlands. To compare auxotypes, serovars, and antibiograms of PPNG, non-PPNG, and TRNG. To identify determinants in patient characteristics for the epidemic spread of TRNG/PPNG.


METHODS
With respect to the national gonococcal surveillance all PPNG isolates from 30 laboratories over the country in 1977-90 and all gonococcal isolates from five sentinel laboratories (during 1 month per quarter) in 1991-5 were collected. Isolates were auxotyped and serotyped, the susceptibility for various antibiotics was tested and plasmid contents were evaluated. Additional data on PPNG infected individuals were collected retrospectively during a microepidemic of TRNG/PPNG. Univariate and multivariate analyses were performed to identify risk factors for TRNG/PPNG infections.


RESULTS
In 1995 an overall high prevalence of PPNG infection (27%) and TRNG among PPNG infection (24%) was found in the Netherlands. Importantly, PPNG were found to have higher MICs for ceftriaxone and ciprofloxacin than non-PPNG; clinically relevant resistance to these antibiotics (or related agents) may emerge first among these strains. The observed diversity of strains (123 auxo/serovar classes since 1988) indicates a continuous introduction of new strains into the community. The epidemic increase of TRNG/PPNG was mainly caused by A/S classes NR/1B-6, PRO/1A-3, and PRO/1A-6, suggesting a clonal spread of a few strains; the rapid spread was associated with transmission in high risk individuals (that is, prostitutes and their clients).


CONCLUSIONS
The prevalence of PPNG in the Netherlands remains high and reduced sensitivity to other antimicrobials was detected among the PPNG strains. This underlines the necessity for a continuous national surveillance of resistance in gonococci including limited epidemiological information.
van de Laar
M J
MJ
Department for Infectious Diseases Epidemiology, National Institute of Public health and the Environment, Bilthoven, Netherlands.
van Duynhoven
Y T
YT
Dessens
M
M
van Santen
M
M
van Klingeren
B
B
D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D004196:Disease Outbreaks; D004352:Drug Resistance, Microbial; D005260:Female; D006069:Gonorrhea / Q000188:drug therapy* / Q000201:enzymology / Q000453:epidemiology; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D009426:Netherlands / Q000453:epidemiology; D010405:Penicillinase / Q000378:metabolism; D015995:Prevalence; D012189:Retrospective Studies; D013753:Tetracycline Resistance
D000890:Anti-Infective Agents; D002511:Cephalosporins; D002939:Ciprofloxacin; D002443:Ceftriaxone; D010405:Penicillinase