Worldwide susceptibility rates of Neisseria gonorrhoeae isolates to cefixime and cefpodoxime: a systematic review and meta-analysis.
BACKGROUND
Neisseria gonorrhoeae (NG) infection is a serious public health problem. The third-generation extended-spectrum cephalosporins (ESCs) have been used as the first-line treatment for NG infection for almost three decades. However, in recent years, treatment failures with the oral third-generation ESCs have been reported worldwide. This study aimed to estimate worldwide susceptibility rates of NG to cefixime and cefpodoxime by analyzing data from all relevant published studies.


RESULTS
Two researchers independently searched five databases to identify studies on susceptibilities of NG to cefixime and cefpodoxime published between January 1, 1984 and October 15, 2012. A fixed-effect model was used to perform group analysis, and a χ2 test was employed to make subgroup comparison. Publication bias was assessed with the Begg rank correlation test. The pooled susceptibility rate of NG isolates to cefixime was 99.8% (95% CI: 99.7%-99.8%). The cefixime susceptibility rate of NG isolates from men was significantly lower than that from patients without information of gender or from men and women; the susceptibility rate of NG isolates from Asia was significantly lower than that from other continents; and the susceptibility rate of NG isolates collected before or during 2003 was significantly higher than that after 2003. The pooled susceptibility rate of NG isolates to cefpodoxime was 92.8% (95% CI: 89.0%-95.3%), which was lower than that to cefixime (92.8% vs. 99.8%, χ2 = 951.809, P<0.01).


CONCLUSIONS
The susceptibility rate of NG isolates to cefixime varied with the gender of patients and geographical location from which NG isolates were collected, and declined with time. The reported lower susceptibility rate of NG isolates to cefixime and associated treatment failures, as well as the emergence of NG strains with cephalosporin resistance call for the more effective control of NG infection and the development of new antibiotics.
Reference STD Lab, National Center for STD Control, Chinese CDC, Institute of Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, Jiangsu Province, China.
Rui-xing
RX
Yu
Reference STD Lab, National Center for STD Control, Chinese CDC, Institute of Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, Jiangsu Province, China.
Yueping
Y
Yin
Department of STD, Anhui Provincial Institute of Dermatology, Hefei, Anhui Province, China.
Guan-qun
GQ
Wang
Reference STD Lab, National Center for STD Control, Chinese CDC, Institute of Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, Jiangsu Province, China.
Shao-chun
SC
Chen
Reference STD Lab, National Center for STD Control, Chinese CDC, Institute of Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, Jiangsu Province, China.
Bing-jie
BJ
Zheng
Reference STD Lab, National Center for STD Control, Chinese CDC, Institute of Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, Jiangsu Province, China.
Xiu-qin
XQ
Dai
Reference STD Lab, National Center for STD Control, Chinese CDC, Institute of Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, Jiangsu Province, China.
Yan
Y
Han
Reference STD Lab, National Center for STD Control, Chinese CDC, Institute of Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, Jiangsu Province, China.
Qi
Q
Li
Reference STD Lab, National Center for STD Control, Chinese CDC, Institute of Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, Jiangsu Province, China.
Guo-yi
GY
Zhang
Reference STD Lab, National Center for STD Control, Chinese CDC, Institute of Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, Jiangsu Province, China.
Xiangsheng
X
Chen
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D020682:Cefixime / Q000627:therapeutic use*; D015296:Ceftizoxime / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D006069:Gonorrhea / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D008297:Male; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification / Q000378:metabolism* / Q000472:pathogenicity; D000097623:Cefpodoxime
D000900:Anti-Bacterial Agents; D020682:Cefixime; D015296:Ceftizoxime; D000097623:Cefpodoxime