TY - JOUR
T1 - Antimicrobial-resistant Neisseria gonorrhoeae in Europe in 2020 compared with in 2013 and 2018
T2 - a retrospective genomic surveillance study
AU - Golparian, Daniel
AU - Cole, Michelle J.
AU - Sánchez-Busó, Leonor
AU - Day, Michaela
AU - Jacobsson, Susanne
AU - Uthayakumaran, Thinushaa
AU - Abad, Raquel
AU - Euro-GASP study group
AU - Bercot, Beatrice
AU - Caugant, Dominique A.
AU - Heuer, Dagmar
AU - Jansen, Klaus
AU - Pleininger, Sonja
AU - Stefanelli, Paola
AU - Aanensen, David M.
AU - Bluemel, Benjamin
AU - Unemo, Magnus
AU - Stadlbauer, Silke
AU - Indra, Alexander
AU - de Baetselier, Irith
AU - Vanden Berghe, Wim
AU - Lecompte, Amaryl
AU - Hunjak, Blaženka
AU - Blažić, Tatjana Nemeth
AU - Maikanti-Charalambous, Panayiota
AU - Pieridou, Despo
AU - Zákoucká, Hana
AU - Žemličková, Helena
AU - Hoffmann, Steen
AU - Cowan, Susan
AU - Schwartz, Lasse Jessen
AU - Peetso, Rita
AU - Epstein, Jevgenia
AU - Viktorova, Jelena
AU - Bébéar, C. cile
AU - Lot, Florence
AU - Torvikoski, Jukka
AU - Korhonen, Suvi
AU - Buder, Susanne
AU - Miriagou, Vivi
AU - Siatravani, Eirini
AU - Magaziotou, Ioanna
AU - Paparizou, Eleni
AU - Balla, Eszter
AU - Dudás, M. ria
AU - Ásmundsdóttir, Lena R. s
AU - Hauksdóttir, Guðrún Svanborg
AU - Gudnason, Thorolfur
AU - Thordardottir, Marianna
AU - van Dam, Alje
AU - Visser, Maartje
N1 - Publisher Copyright: © 2023 The Author(s)
PY - 2024/5/1
Y1 - 2024/5/1
N2 - Background: Regular quality-assured whole-genome sequencing linked to antimicrobial resistance (AMR) and patient metadata is imperative to elucidate the shifting gonorrhoea epidemiology, both nationally and internationally. We aimed to examine the gonococcal population in the European Economic Area (EEA) in 2020, elucidate emerging and disappearing gonococcal lineages associated with AMR and patient metadata, compare with 2013 and 2018 whole-genome sequencing data, and explain changes in gonococcal AMR and gonorrhoea epidemiology. Methods: In this retrospective genomic surveillance study, we analysed consecutive gonococcal isolates that were collected in EEA countries through the European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP) in 2020, and made comparisons with Euro-GASP data from 2013 and 2018. All isolates had linked AMR data (based on minimum inhibitory concentration determination) and patient metadata. We performed whole-genome sequencing and molecular typing and AMR determinants were derived from quality-checked whole-genome sequencing data. Links between genomic lineages, AMR, and patient metadata were examined. Findings: 1932 gonococcal isolates collected in 2020 in 21 EEA countries were included. The majority (81·2%, 147 of 181 isolates) of azithromycin resistance (present in 9·4%, 181 of 1932) was explained by the continued expansion of the Neisseria gonorrhoeae sequence typing for antimicrobial resistance (NG-STAR) clonal complexes (CCs) 63, 168, and 213 (with mtrD/mtrR promoter mosaic 2) and the novel NG-STAR CC1031 (semi-mosaic mtrD variant 13), associated with men who have sex with men and anorectal or oropharyngeal infections. The declining cefixime resistance (0·5%, nine of 1932) and negligible ceftriaxone resistance (0·1%, one of 1932) was largely because of the progressive disappearance of NG-STAR CC90 (with mosaic penA allele), which was predominant in 2013. No known resistance determinants for novel antimicrobials (zoliflodacin, gepotidacin, and lefamulin) were found. Interpretation: Azithromycin-resistant clones, mainly with mtrD mosaic or semi-mosaic variants, appear to be stabilising at a relatively high level in the EEA. This mostly low-level azithromycin resistance might threaten the recommended ceftriaxone-azithromycin therapy, but the negligible ceftriaxone resistance is encouraging. The decreased genomic population diversity and increased clonality could be explained in part by the COVID-19 pandemic resulting in lower importation of novel strains into Europe. Funding: European Centre for Disease Prevention and Control and Örebro University Hospital.
AB - Background: Regular quality-assured whole-genome sequencing linked to antimicrobial resistance (AMR) and patient metadata is imperative to elucidate the shifting gonorrhoea epidemiology, both nationally and internationally. We aimed to examine the gonococcal population in the European Economic Area (EEA) in 2020, elucidate emerging and disappearing gonococcal lineages associated with AMR and patient metadata, compare with 2013 and 2018 whole-genome sequencing data, and explain changes in gonococcal AMR and gonorrhoea epidemiology. Methods: In this retrospective genomic surveillance study, we analysed consecutive gonococcal isolates that were collected in EEA countries through the European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP) in 2020, and made comparisons with Euro-GASP data from 2013 and 2018. All isolates had linked AMR data (based on minimum inhibitory concentration determination) and patient metadata. We performed whole-genome sequencing and molecular typing and AMR determinants were derived from quality-checked whole-genome sequencing data. Links between genomic lineages, AMR, and patient metadata were examined. Findings: 1932 gonococcal isolates collected in 2020 in 21 EEA countries were included. The majority (81·2%, 147 of 181 isolates) of azithromycin resistance (present in 9·4%, 181 of 1932) was explained by the continued expansion of the Neisseria gonorrhoeae sequence typing for antimicrobial resistance (NG-STAR) clonal complexes (CCs) 63, 168, and 213 (with mtrD/mtrR promoter mosaic 2) and the novel NG-STAR CC1031 (semi-mosaic mtrD variant 13), associated with men who have sex with men and anorectal or oropharyngeal infections. The declining cefixime resistance (0·5%, nine of 1932) and negligible ceftriaxone resistance (0·1%, one of 1932) was largely because of the progressive disappearance of NG-STAR CC90 (with mosaic penA allele), which was predominant in 2013. No known resistance determinants for novel antimicrobials (zoliflodacin, gepotidacin, and lefamulin) were found. Interpretation: Azithromycin-resistant clones, mainly with mtrD mosaic or semi-mosaic variants, appear to be stabilising at a relatively high level in the EEA. This mostly low-level azithromycin resistance might threaten the recommended ceftriaxone-azithromycin therapy, but the negligible ceftriaxone resistance is encouraging. The decreased genomic population diversity and increased clonality could be explained in part by the COVID-19 pandemic resulting in lower importation of novel strains into Europe. Funding: European Centre for Disease Prevention and Control and Örebro University Hospital.
UR - http://www.scopus.com/inward/record.url?scp=85190143936&partnerID=8YFLogxK
U2 - 10.1016/S2666-5247(23)00370-1
DO - 10.1016/S2666-5247(23)00370-1
M3 - Article
C2 - 38614111
SN - 2666-5247
VL - 5
SP - e478-e488
JO - The Lancet. Microbe
JF - The Lancet. Microbe
IS - 5
ER -