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Genomic surveillance and antimicrobial resistance determinants in Neisseria gonorrhoeae isolates from Uganda, Malawi and South Africa, 2015-20

Kakooza, Francis (author)
Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
Golparian, Daniel, 1984- (author)
Örebro universitet,Institutionen för medicinska vetenskaper,Department of Laboratory Medicine, Faculty of Medicine and Health, WHO Collaborating Centre for Gonorrhoea and other STIs, National Reference Laboratory for STIs, Örebro University, Örebro, Sweden
Matoga, Mitch (author)
UNC Project Malawi, Lilongwe, Malawi
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Maseko, Venessa (author)
Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
Lamorde, Mohammed (author)
Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
Krysiak, Robert (author)
UNC Project Malawi, Lilongwe, Malawi
Manabe, Yuka C. (author)
Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda; Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Chen, Jane S. (author)
Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Kularatne, Ranmini (author)
Labtests Laboratory and Head Office, Mt Wellington, Auckland, New Zealand; Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Jacobsson, Susanne, 1974- (author)
Örebro universitet,Institutionen för medicinska vetenskaper,Region Örebro län,Department of Laboratory Medicine, Faculty of Medicine and Health, WHO Collaborating Centre for Gonorrhoea and other STIs, National Reference Laboratory for STIs
Godreuil, Sylvain (author)
Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Montpellier, and MIVEGEC, Université de Montpellier, CNRS, IRD, Montpellier, France
Hoffman, Irving (author)
UNC Project Malawi, Lilongwe, Malawi; Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Bercot, Beatrice (author)
Infectious Agents Department, French National Reference Centre for Bacterial STIs, Associated Laboratory for Gonococci, and APHP, Saint Louis Hospital, Paris, France
Wi, Teodora (author)
Department of the Global HIV, Hepatitis and STI Programmes, WHO, Geneva, Switzerland
Unemo, Magnus, 1970- (author)
Örebro universitet,Institutionen för medicinska vetenskaper,Region Örebro län,Department of Laboratory Medicine, Faculty of Medicine and Health, WHO Collaborating Centre for Gonorrhoea and other STIs, National Reference Laboratory for STIs, Örebro University, Örebro, Sweden; Institute for Global Health, University College London, London, UK
WGS Study Group, - (contributor)
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 (creator_code:org_t)
Oxford University Press, 2023
2023
English.
In: Journal of Antimicrobial Chemotherapy. - : Oxford University Press. - 0305-7453 .- 1460-2091. ; 78:8, s. 1982-1991
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https://doi.org/10.1...
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  • Journal article (peer-reviewed)
Abstract Subject headings
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  • OBJECTIVES: Global antimicrobial resistance (AMR) surveillance in Neisseria gonorrhoeae is essential. In 2017-18, only five (10.6%) countries in the WHO African Region reported to the WHO Global Gonococcal Antimicrobial Surveillance Programme (WHO GASP). Genomics enhances our understanding of gonococcal populations nationally and internationally, including AMR strain transmission; however, genomic studies from Africa are extremely scarce. We describe the gonococcal genomic lineages/sublineages, including AMR determinants, and baseline genomic diversity among strains in Uganda, Malawi and South Africa, 2015-20, and compare with sequences from Kenya and Burkina Faso.METHODS: Gonococcal isolates cultured in Uganda (n = 433), Malawi (n = 154) and South Africa (n = 99) in 2015-20 were genome-sequenced. MICs were determined using ETEST. Sequences of isolates from Kenya (n = 159), Burkina Faso (n = 52) and the 2016 WHO reference strains (n = 14) were included in the analysis.RESULTS: Resistance to ciprofloxacin was high in all countries (57.1%-100%). All isolates were susceptible to ceftriaxone, cefixime and spectinomycin, and 99.9% were susceptible to azithromycin. AMR determinants for ciprofloxacin, benzylpenicillin and tetracycline were common, but rare for cephalosporins and azithromycin. Most isolates belonged to the more antimicrobial-susceptible lineage B (n = 780) compared with the AMR lineage A (n = 141), and limited geographical phylogenomic signal was observed.CONCLUSIONS: We report the first multi-country gonococcal genomic comparison from Africa, which will support the WHO GASP and WHO enhanced GASP (EGASP). The high prevalence of resistance to ciprofloxacin (and empirical use continues), tetracycline and benzylpenicillin, and the emerging resistance determinants for azithromycin show it is imperative to strengthen the gonococcal AMR surveillance, ideally including genomics, in African countries.

Subject headings

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

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