Molecular antimicrobial resistance surveillance for Neisseria gonorrhoeae, Northern Territory, Australia

David M. Whiley; Ella Trembizki; Cameron Buckley; Kevin Freeman; Robert W. Baird; Miles Beaman; Marcus Chen; Basil Donovan; Ratan L. Kundu; Christopher K. Fairley; Rebecca Guy; Tiffany Hogan; John M. Kaldor; Mahdad Karimi; Athena Limnios; David G. Regan; Nathan Ryder; Jiunn Yih Su; James Ward; Monica M. Lahra

doi:10.3201/eid2309.170427

Molecular antimicrobial resistance surveillance for Neisseria gonorrhoeae, Northern Territory, Australia

David M. Whiley^*, Ella Trembizki, Cameron Buckley, Kevin Freeman, Robert W. Baird, Miles Beaman, Marcus Chen, Basil Donovan, Ratan L. Kundu, Christopher K. Fairley, Rebecca Guy, Tiffany Hogan, John M. Kaldor, Mahdad Karimi, Athena Limnios, David G. Regan, Nathan Ryder, Jiunn Yih Su, James Ward, Monica M. Lahra

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

22 Citations (Scopus)

Abstract

Neisseria gonorrhoeae antimicrobial resistance (AMR) is a globally recognized health threat; new strategies are needed to enhance AMR surveillance. The Northern Territory of Australia is unique in that 2 different first-line therapies, based primarily on geographic location, are used for gonorrhea treatment. We tested 1,629 N. gonorrhoeae nucleic acid amplification test–positive clinical samples, collected from regions where ceftriaxone plus azithromycin or amoxicillin plus azithromycin are recommended first-line treatments, by using 8 N. gonorrhoeae AMR PCR assays. We compared results with those from routine culture-based surveillance data. PCR data confirmed an absence of ceftriaxone resistance and a low level of azithromycin resistance (0.2%), and that penicillin resistance was <5% in amoxicillin plus azithromycin regions. Rates of ciprofloxacin resistance and penicillinase-producing N. gonorrhoeae were lower when molecular methods were used. Molecular methods to detect N. gonorrhoeae AMR can increase the evidence base for treatment guidelines, particularly in settings where culture-based surveillance is limited.

Original language	English
Pages (from-to)	1478-1485
Number of pages	8
Journal	Emerging Infectious Diseases
Volume	23
Issue number	9
DOIs	https://doi.org/10.3201/eid2309.170427
Publication status	Published - Sept 2017
Externally published	Yes

Bibliographical note

Funding Information:
This study was conducted as part of the Gonorrhoea Resistance Assessment by Nucleic Acid Detection study funded by the National Health and Medical Research Council (APP1025517), and the reference work of the National Neisseria Network, Australia, which is funded by the Australian Government Department of Health. Funding was also provided by the Australian Infectious Diseases Research Centre. D.W. is a recipient of a National Health and Medical Research Council fellowship.

Funding Information:
D.W. reports research funding from SpeeDx Pty Ltd. M.C. is principal investigator on a gonorrhoea treatment trial funded by Cempra.

Publisher Copyright:
© 2017, Centers for Disease Control and Prevention (CDC). All rights reserved.

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10.3201/eid2309.170427

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Whiley, D. M., Trembizki, E., Buckley, C., Freeman, K., Baird, R. W., Beaman, M., Chen, M., Donovan, B., Kundu, R. L., Fairley, C. K., Guy, R., Hogan, T., Kaldor, J. M., Karimi, M., Limnios, A., Regan, D. G., Ryder, N., Su, J. Y., Ward, J., & Lahra, M. M. (2017). Molecular antimicrobial resistance surveillance for Neisseria gonorrhoeae, Northern Territory, Australia. Emerging Infectious Diseases, 23(9), 1478-1485. https://doi.org/10.3201/eid2309.170427

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title = "Molecular antimicrobial resistance surveillance for Neisseria gonorrhoeae, Northern Territory, Australia",

abstract = "Neisseria gonorrhoeae antimicrobial resistance (AMR) is a globally recognized health threat; new strategies are needed to enhance AMR surveillance. The Northern Territory of Australia is unique in that 2 different first-line therapies, based primarily on geographic location, are used for gonorrhea treatment. We tested 1,629 N. gonorrhoeae nucleic acid amplification test–positive clinical samples, collected from regions where ceftriaxone plus azithromycin or amoxicillin plus azithromycin are recommended first-line treatments, by using 8 N. gonorrhoeae AMR PCR assays. We compared results with those from routine culture-based surveillance data. PCR data confirmed an absence of ceftriaxone resistance and a low level of azithromycin resistance (0.2%), and that penicillin resistance was <5% in amoxicillin plus azithromycin regions. Rates of ciprofloxacin resistance and penicillinase-producing N. gonorrhoeae were lower when molecular methods were used. Molecular methods to detect N. gonorrhoeae AMR can increase the evidence base for treatment guidelines, particularly in settings where culture-based surveillance is limited.",

author = "Whiley, {David M.} and Ella Trembizki and Cameron Buckley and Kevin Freeman and Baird, {Robert W.} and Miles Beaman and Marcus Chen and Basil Donovan and Kundu, {Ratan L.} and Fairley, {Christopher K.} and Rebecca Guy and Tiffany Hogan and Kaldor, {John M.} and Mahdad Karimi and Athena Limnios and Regan, {David G.} and Nathan Ryder and Su, {Jiunn Yih} and James Ward and Lahra, {Monica M.}",

note = "Funding Information: This study was conducted as part of the Gonorrhoea Resistance Assessment by Nucleic Acid Detection study funded by the National Health and Medical Research Council (APP1025517), and the reference work of the National Neisseria Network, Australia, which is funded by the Australian Government Department of Health. Funding was also provided by the Australian Infectious Diseases Research Centre. D.W. is a recipient of a National Health and Medical Research Council fellowship. Funding Information: D.W. reports research funding from SpeeDx Pty Ltd. M.C. is principal investigator on a gonorrhoea treatment trial funded by Cempra. Publisher Copyright: {\textcopyright} 2017, Centers for Disease Control and Prevention (CDC). All rights reserved.",

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Whiley, DM, Trembizki, E, Buckley, C, Freeman, K, Baird, RW, Beaman, M, Chen, M, Donovan, B, Kundu, RL, Fairley, CK, Guy, R, Hogan, T, Kaldor, JM, Karimi, M, Limnios, A, Regan, DG, Ryder, N, Su, JY, Ward, J & Lahra, MM 2017, 'Molecular antimicrobial resistance surveillance for Neisseria gonorrhoeae, Northern Territory, Australia', Emerging Infectious Diseases, vol. 23, no. 9, pp. 1478-1485. https://doi.org/10.3201/eid2309.170427

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AU - Buckley, Cameron

AU - Freeman, Kevin

AU - Baird, Robert W.

AU - Beaman, Miles

AU - Chen, Marcus

AU - Donovan, Basil

AU - Kundu, Ratan L.

AU - Fairley, Christopher K.

AU - Guy, Rebecca

AU - Hogan, Tiffany

AU - Kaldor, John M.

AU - Karimi, Mahdad

AU - Limnios, Athena

AU - Regan, David G.

AU - Ryder, Nathan

AU - Su, Jiunn Yih

AU - Ward, James

AU - Lahra, Monica M.

N1 - Funding Information: This study was conducted as part of the Gonorrhoea Resistance Assessment by Nucleic Acid Detection study funded by the National Health and Medical Research Council (APP1025517), and the reference work of the National Neisseria Network, Australia, which is funded by the Australian Government Department of Health. Funding was also provided by the Australian Infectious Diseases Research Centre. D.W. is a recipient of a National Health and Medical Research Council fellowship. Funding Information: D.W. reports research funding from SpeeDx Pty Ltd. M.C. is principal investigator on a gonorrhoea treatment trial funded by Cempra. Publisher Copyright: © 2017, Centers for Disease Control and Prevention (CDC). All rights reserved.

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N2 - Neisseria gonorrhoeae antimicrobial resistance (AMR) is a globally recognized health threat; new strategies are needed to enhance AMR surveillance. The Northern Territory of Australia is unique in that 2 different first-line therapies, based primarily on geographic location, are used for gonorrhea treatment. We tested 1,629 N. gonorrhoeae nucleic acid amplification test–positive clinical samples, collected from regions where ceftriaxone plus azithromycin or amoxicillin plus azithromycin are recommended first-line treatments, by using 8 N. gonorrhoeae AMR PCR assays. We compared results with those from routine culture-based surveillance data. PCR data confirmed an absence of ceftriaxone resistance and a low level of azithromycin resistance (0.2%), and that penicillin resistance was <5% in amoxicillin plus azithromycin regions. Rates of ciprofloxacin resistance and penicillinase-producing N. gonorrhoeae were lower when molecular methods were used. Molecular methods to detect N. gonorrhoeae AMR can increase the evidence base for treatment guidelines, particularly in settings where culture-based surveillance is limited.

AB - Neisseria gonorrhoeae antimicrobial resistance (AMR) is a globally recognized health threat; new strategies are needed to enhance AMR surveillance. The Northern Territory of Australia is unique in that 2 different first-line therapies, based primarily on geographic location, are used for gonorrhea treatment. We tested 1,629 N. gonorrhoeae nucleic acid amplification test–positive clinical samples, collected from regions where ceftriaxone plus azithromycin or amoxicillin plus azithromycin are recommended first-line treatments, by using 8 N. gonorrhoeae AMR PCR assays. We compared results with those from routine culture-based surveillance data. PCR data confirmed an absence of ceftriaxone resistance and a low level of azithromycin resistance (0.2%), and that penicillin resistance was <5% in amoxicillin plus azithromycin regions. Rates of ciprofloxacin resistance and penicillinase-producing N. gonorrhoeae were lower when molecular methods were used. Molecular methods to detect N. gonorrhoeae AMR can increase the evidence base for treatment guidelines, particularly in settings where culture-based surveillance is limited.

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Molecular antimicrobial resistance surveillance for Neisseria gonorrhoeae, Northern Territory, Australia

Abstract

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