title: Antimicrobial susceptibility and molecular epidemiology of Neisseria gonorrhoeae in Germany.
abstract: Antimicrobial drug resistance in Neisseria gonorrhoeae has become an increasing public health problem. Hence, surveillance of resistance development is of crucial importance to implement adequate treatment guidelines. Data on the spread of antibiotic resistance among gonococcal isolates in Germany, however, is scarce. In a resistance surveillance study conducted by the Paul Ehrlich Society for Chemotherapy between October 2010 and December 2011, 23 laboratories all over Germany were requested to send N. gonorrhoeae isolates to the study laboratory in Frankfurt am Main. Species verification was performed biochemically using ApiNH and with Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS). Antimicrobial susceptibility testing was performed using the Etest method. For molecular epidemiological analysis, N. gonorrhoeae strains were genotyped by means of N. gonorrhoeae multi-antigen sequence typing. A total of 213 consecutive gonococcal isolates were analyzed in this nationwide study. Applying EUCAST breakpoints, high resistance rates were found for ciprofloxacin (74%) and tetracycline (41%). Penicillin non-susceptibility was detected in 80% of isolates. The rate of azithromycin resistance was 6%, while all strains were susceptible to spectinomycin, cefixime, and ceftriaxone. Molecular typing of gonococcal isolates revealed a great heterogeneity of 99 different sequence types (ST), but ST1407 predominated (n=39). This is the first comprehensive German multi-centre surveillance study on antibiotic susceptibility and molecular epidemiology of N. gonorrhoeae with implications for antibiotic choice for treatment of gonorrhoea. The World Health Organization supports the concept that an efficacious treatment of gonorrhoea results in at least 95% of infections being cured. Accordingly, as spectinomycin is not available on the German market, only the third generation cephalosporins cefixime and ceftriaxone are regarded as valuable drugs for empirical treatment of gonorrhoea in Germany.
authors.affiliation: Institute of Medical Microbiology and Infection Control, Hospital of Goethe-University, Frankfurt am Main, Germany.
authors.forename: Nicole Nari
authors.initials: NN
authors.lastname: Horn
authors.affiliation: Antiinfectives Intelligence GmbH, Campus of the University of Applied Sciences, Rheinbach, Germany; Rheinische Fachhochschule Köln, Cologne, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Kresken
authors.affiliation: Antiinfectives Intelligence GmbH, Campus of the University of Applied Sciences, Rheinbach, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Körber-Irrgang
authors.affiliation: Institute of Medical Microbiology and Infection Control, Hospital of Goethe-University, Frankfurt am Main, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Göttig
authors.affiliation: Institute of Applied Mathematics, University of Heidelberg, Germany.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Wichelhaus
authors.affiliation: Institute of Medical Microbiology and Infection Control, Hospital of Goethe-University, Frankfurt am Main, Germany. Electronic address: wichelhaus@em.uni-frankfurt.de.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Wichelhaus
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D005260:Female; D005838:Genotype; D005858:Germany / Q000453:epidemiology; D006069:Gonorrhea / Q000453:epidemiology* / Q000382:microbiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D017720:Molecular Epidemiology; D058885:Multilocus Sequence Typing; D009344:Neisseria gonorrhoeae / Q000145:classification* / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antimicrobial resistance; Gonorrhoea; NG-MAST; Neisseria gonorrhoeae