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Retrospective Analysis of Antimicrobial Susceptibility Trends (2000–2009) in Neisseria gonorrhoeae Isolates from Countries in Latin America and the Caribbean Shows Evolving Resistance to Ciprofloxacin, Azithromycin and Decreased Susceptibility to Ceftriaxone

Starnino, Stefania PhD*†; Galarza, Patricia MSc, MPH§; Carvallo, María Elena Trigoso BSc; Benzaken, Adele Schwartz MD, PhD; Ballesteros, Aurora Maldonado RT, BSc**; Cruz, Olga Marina Sanabria BSc††; Hernandez, Alina Llop MD, PhD‡‡; Carbajal, José Luis Portilla MSc§§; Borthagaray, Graciela Dr. Q.F.¶¶; Payares, Daisy BSc∥∥; Dillon, Jo-Anne R. PhD*†GASP-LAC Working Group

Erratum

The article that appears on page 813 of the October 2012 issue of the journal has a correction in Table 3 for the Antibiotic and Dose Recommended in Peru. Ciprofloxacin DOSE 500 mg (s. d.) and; as alternatives azithromycin 1 g (s. d.) coupled with ciprofloxacin 500 mg (s. d.) or ceftriaxone 125 mg (s. d.).

Sexually Transmitted Diseases. 41(9):571, September 2014.

doi: 10.1097/OLQ.0b013e3182631c9f
Original Study

Background The emergence of resistance and treatment failures to third generation cephalosporins prompted the revitalization of the global Gonococcal Antimicrobial Surveillance Program (GASP) to ensure that information regarding trends of the antimicrobial susceptibility of Neisseria gonorrhoeae isolates is up-to-date. Accordingly, former and potential GASP participants in Latin America and the Caribbean were contacted to reinitiate the GASP network in the region and to undertake a retrospective analysis of the antimicrobial susceptibility of N. gonorrhoeae isolates between 2000 and 2009.

Methods Eleven countries participated in this retrospective analysis reporting on the susceptibility of N. gonorrhoeae isolates to up to 6 antibiotics as well as national treatment guidelines over the period. Antimicrobial susceptibility determination was carried out using combination of agar dilution and disk diffusion (Clinical Laboratory and Standards Institute) or Etest. Antimicrobial susceptibility data from each country were aggregated and analyzed for antimicrobial resistance trends in the region.

Results More than 11,400 N. gonorrhoeae isolates were tested for antimicrobial susceptibility: 6 countries tested N. gonorrhoeae over the entire period and 5 countries tested sporadically. Decreased susceptibility to ceftriaxone was reported from 1 country (7 isolates, MICs >0.25 μg/ml) in 2007. No resistance to spectinomycin was reported. From 2000 to 2009, aggregated ciprofloxacin resistance increased from 2% (19/784) to 31% (311/1015) in 9 countries and azithromycin resistance increased from 6% (39/646) to 23% (225/962) in 4/6 reporting countries. Overall, resistance to penicillin and tetracycline decreased from 35% (441/1241) to 26% (258/975) and from 60% (476/792) to 35% (323/931), respectively.

In 2009, resistance to gentamicin (3%, 4/122), chloramphenicol (5%, 6/120), and ofloxacin (2%, 6/120) was reported from 1 country.

Conclusions The report of ceftriaxone-resistant isolates coupled with the emergence and spread of resistance to ciprofloxacin and azithromycin in Latin America and the Caribbean in the 2000s indicates the importance of active surveillance of N. gonorrhoeae antimicrobial susceptibility to determine antimicrobial resistance emerging trends so as to promptly inform and guide the development of effective treatment options for gonococcal infections.

Trends in the antimicrobial susceptibility of N. gonorrhoeae isolates from 11 countries in Latin America and the Caribbean between 2000 and 2009 showed increasing resistance to ciprofloxacin and azithromycin and emerging resistance to ceftriaxone. A review of treatment guidelines is needed.Supplemental Digital Content is available in the article.

From the *Vaccine and Infectious Diseases Organization, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; †Co-ordinating Centre for the Gonococcal Antimicrobial Surveillance Program (GASP) in Latin America and the Caribbean (LAC), University of Saskatchewan, Saskatoon, Saskatchewan, Canada; ‡The GASP-LAC Working Group: Irene Pagano, MD (Centro Nacional de Referencia en ITS INEI-ANLIS “Dr. Carlos G. Malbrán”, Buenos Aires, Argentina); Valdir Monteiro Pinto, MD, MSc (Division STD Control, Hepatitis and Aids departamiento National ITS/SIDA, Brasilia Brasil. Current address STD/AIDS State Program - Sao Paulo, Brazil); María Elena Realpe (Instituto Nacional de Salud, Bogotá, Colombia); Rafael Llanes MD, MSc, and Onelquis Feliciano MSc (Instituto de Medicina Tropical “Pedro Kourí”, Ministerio Salud Publica, Habana, Cuba); Eduardo Aguilar Jarrin (Ministerio de Salud Publica del Ecuador, Quito, Ecuador); Nicolas Aguayo (Ministerio de Salud de Paraguay, Asuncion, Paraguay); Ana Acevedo, PhD (Facultad de Química, Universidad de la Republica, Montevideo, Uruguay); Mingmin Liao, MD, PhD (Vaccine and Infectious Diseases Organization, University of Saskatchewan, Saskatoon, Saskatchewan, Canada); §Centro Nacional de Referencia en ITS INEI-ANLIS “Dr. Carlos G. Malbrán”, Buenos Aires, Argentina; ¶Centro Departamental de Vigilancia, Información y Referencia, La Paz, Bolivia; ∥Fundção Alfredo da Matta, Manaus – Amazonas, Brazil; **Instituto de Salud Publica, Santiago, Chile; ††Instituto Nacional de Salud, Bogotá, Colombia; ‡‡Instituto de Medicina Tropical “Pedro Kourí”, Ministerio Salud Publica, Habana, Cuba;§§Instituto Nacional de Salud, Lima, Perú; ¶¶Facultad de Química, Universidad de la Republica, Montevideo, Uruguay; and ∥∥Instituto Nacional de Higiene “Rafael Rangel” Caracas, Venezuela

The authors thank Claudia Oviedo (Argentina), Rita Revollo (Bolivia), Gerson Fernando Pereira, Denis Ribeiro, Marcelo Barbosa (Brazil), Ana Ingold (Uruguay) for their contributions to these studies.

Studies from Brazil were funded by the Department of STD, AIDS, and Viral Hepatitis, Ministry of Health, Brazil. Venezuelan studies were funded by the Programa Venezolano de Vigilancia de la Resistencia a los Antimicrobianos. This study was also partially supported by the World Health Organization (HQRHR1003664, WHO Registration: 2010/80420–1), and the International Development Research Centre-Canada (IDRC) (grant # G13179). S. S. was partially funded by the Research Alliance for the Prevention of Infectious Diseases (RAPID), (grant #9,127), and by the Saskatchewan Health Research Foundation (SHRF) (grant # G16518), University of Saskatchewan (Saskatoon, Saskatchewan, Canada).

Preliminary data were presented at the first Latin America and Caribbean (ALAC) IUSTI conference [Curitiba, Brazil, May 18 to 21, 2011 (Patricia Galarza)] and at the 19th conference for the International Society for STD Research (ISSTDR), Quebec City, Canada, July 10 to 13, 2011, abstracts [P1-S4.28] and [P1-S1.45].

Conflict of interests: None declared.

Correspondence: Jo-Anne R Dillon, Room A218, 120 Veterinary Road, Saskatoon, Saskatchewan S7N 5E3, Canada. E-mail: j.dillon@usask.ca.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (http://www.stdjournal.com).

Received for publication March 14, 2012, and accepted May 10, 2012.

© Copyright 2012 American Sexually Transmitted Diseases Association