title: Risk factors for antimicrobial-resistant Neisseria gonorrhoeae in Europe.
abstract: BACKGROUND
  The European Gonococcal Antimicrobial Surveillance Programme performs antimicrobial resistance surveillance and is coordinated by the European Centre for Disease Prevention and Control. This study used epidemiological and behavioral data combined with the gonococcal susceptibility profiles to determine risk factors associated with harboring resistant gonococci in Europe.
  
  
  METHODS
  From 2009 to 2011, gonococcal isolates from 21 countries were submitted to the European Gonococcal Antimicrobial Surveillance Programme for antimicrobial susceptibility testing. Patient variables associated with resistance to azithromycin, cefixime, and ciprofloxacin were identified using univariate and multivariable logistic regression analyses of odds ratios. Geometric means for ceftriaxone and cefixime minimum inhibitory concentrations (MICs) were compared for patients of different sexual orientation and sex.
  
  
  RESULTS
  A total of 5034 gonococcal isolates were tested from 2009 to 2011. Isolates exhibiting resistance to cefixime (MIC > 0.125 mg/L) and ciprofloxacin (MIC > 0.5 mg/L) were significantly associated with infection in heterosexuals (males only for ciprofloxacin), older patients (>25 years of age), or those without a concurrent chlamydial infection in the multivariable analysis. The geometric mean of cefixime and ceftriaxone MICs decreased from 2009 to 2011, most significantly for men who have sex with men, and isolates from male heterosexuals exhibited the highest MICs in 2011.
  
  
  CONCLUSIONS
  The linking of epidemiological and behavioral data to the susceptibility profiles of the gonococcal isolates has allowed those at higher risk for acquiring antimicrobial resistant Neisseria gonorrhoeae to be identified. Improved data numbers and representativeness are required before evidence-based risk groups can be identified, and subsequent focused treatments or public health intervention strategies can be initiated with confidence.
authors.affiliation: From the *Public Health England, London, United Kingdom; †European Centre for Disease Prevention and Control, Stockholm, Sweden; ‡Örebro University Hospital, Örebro, Sweden; §Statens Serum Institut, Copenhagen, Denmark.
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Cole
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Spiteri
authors.forename: Katy
authors.initials: K
authors.lastname: Town
authors.forename: Magnus
authors.initials: M
authors.lastname: Unemo
authors.forename: Steen
authors.initials: S
authors.lastname: Hoffmann
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Chisholm
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Amato-Gauci
authors.forename: Marita
authors.initials: M
authors.lastname: van de Laar
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Ison
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage* / Q000494:pharmacology; D017963:Azithromycin / Q000494:pharmacology; D020682:Cefixime / Q000494:pharmacology; D002443:Ceftriaxone / Q000494:pharmacology; D004352:Drug Resistance, Microbial; D005060:Europe / Q000453:epidemiology; D005260:Female; D006069:Gonorrhea / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D009344:Neisseria gonorrhoeae / Q000187:drug effects*; D012307:Risk Factors; D018571:Sentinel Surveillance
chemical_list: D000890:Anti-Infective Agents; D002443:Ceftriaxone; D017963:Azithromycin; D020682:Cefixime