Projecting the development of antimicrobial resistance in Neisseria gonorrhoeae from antimicrobial surveillance data: a mathematical modelling study

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Projecting the development of antimicrobial resistance in Neisseria gonorrhoeae from antimicrobial surveillance data : a mathematical modelling study

Riou, Julien (author): Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland

Althaus, Christian L. (author): Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland

Allen, Hester (author): UK Health Security Agency, London, UK

Cole, Michelle J. (author): UK Health Security Agency, London, UK

Grad, Yonatan H. (author): Harvard T.H. Chan School of Public Health, Boston, USA

Heijne, Janneke C. M. (author): Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands; Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands

Unemo, Magnus, 1970- (author): Örebro universitet,Institutionen för medicinska vetenskaper,Region Örebro län

Low, Nicola (author): Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland

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BioMed Central (BMC), 2023
2023
English.
In: BMC Infectious Diseases. - : BioMed Central (BMC). - 1471-2334. ; 23:1

Related links:: https://doi.org/10.1...; show more...; https://urn.kb.se/re...; https://doi.org/10.1...; show less...

Journal article (peer-reviewed)

Abstract Subject headings

BACKGROUND: The World Health Organization recommends changing the first-line antimicrobial treatment for gonorrhoea when ≥ 5% of Neisseria gonorrhoeae cases fail treatment or are resistant. Susceptibility to ceftriaxone, the last remaining treatment option has been decreasing in many countries. We used antimicrobial resistance surveillance data and developed mathematical models to project the time to reach the 5% threshold for resistance to first-line antimicrobials used for N. gonorrhoeae.METHODS: We used data from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) in England and Wales from 2000-2018 about minimum inhibitory concentrations (MIC) for ciprofloxacin, azithromycin, cefixime and ceftriaxone and antimicrobial treatment in two groups, heterosexual men and women (HMW) and men who have sex with men (MSM). We developed two susceptible-infected-susceptible models to fit these data and produce projections of the proportion of resistance until 2030. The single-step model represents the situation in which a single mutation results in antimicrobial resistance. In the multi-step model, the sequential accumulation of resistance mutations is reflected by changes in the MIC distribution.RESULTS: The single-step model described resistance to ciprofloxacin well. Both single-step and multi-step models could describe azithromycin and cefixime resistance, with projected resistance levels higher with the multi-step than the single step model. For ceftriaxone, with very few observed cases of full resistance, the multi-step model was needed to describe long-term dynamics of resistance. Extrapolating from the observed upward drift in MIC values, the multi-step model projected ≥ 5% resistance to ceftriaxone could be reached by 2030, based on treatment pressure alone. Ceftriaxone resistance was projected to rise to 13.2% (95% credible interval [CrI]: 0.7-44.8%) among HMW and 19.6% (95%CrI: 2.6-54.4%) among MSM by 2030.CONCLUSIONS: New first-line antimicrobials for gonorrhoea treatment are needed. In the meantime, public health authorities should strengthen surveillance for AMR in N. gonorrhoeae and implement strategies for continued antimicrobial stewardship. Our models show the utility of long-term representative surveillance of gonococcal antimicrobial susceptibility data and can be adapted for use in, and for comparison with, other countries.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Infektionsmedicin (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Infectious Medicine (hsv//eng)

Keyword

Antimicrobial resistance
Mathematical model
Minimum inhibitory concentration
Neisseria gonorrhoeae
Surveillance

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By the author/editor: Riou, Julien; Althaus, Christi ...; Allen, Hester; Cole, Michelle J ...; Grad, Yonatan H.; Heijne, Janneke ...; show more...; Unemo, Magnus, 1 ...; Low, Nicola; show less...

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