The European gonococcal antimicrobial surveillance programme (Euro-GASP) appropriately reflects the antimicrobial resistance situation for Neisseria gonorrhoeae in the European Union/European Economic Area

Michelle J. Cole; Chantal Quinten; Susanne Jacobsson; Michaela Day; Andrew J. Amato-Gauci; Neil Woodford; Gianfranco Spiteri; Magnus Unemo; Angelika Stary; Maria Haller; Ruth Verbrugge; Tania Crucitti; Soteroulla Soteriou; Despo Pieridou; Susan Cowan; Steen Hoffmann; Jevgenia Epstein; Jelena Viktorova; Ndeindo Ndeikoundam; Agathe Goubard; Peter Kohl; Susanne Buder; Viviane Bremer; Eva Tzelepi; Vasileia Konte; Eszter Balla; M. ria Dudás; Guðrún Sigmundsdóttir; Guðrún Svanborg Hauksdóttir; Derval Igoe; Brendan Crowley; Barbara Suligoi; Paola Stefanelli; Gatis Pakarna; Violeta Mavcutko; Christopher Barbara; Jackie Maistre Melillo; Alje van Dam; Birgit van Benthem; Ineke Linde; Hilde Kløvstad; Thea Bergheim; Slawomir Majewski; Beata Mlynarczyk-Bonikowska; Jacinta Azevedo; Maria José Borrego; Peter Pavlik; Peter Truska; Irena Klavs; Samo Jeverica; Julio Vazquez; Mercedes Diez; Inga Velicko; Magnus Unemo; Gwenda Hughes; Kirstine Eastick

doi:https://doi.org/10.1186/s12879-019-4631-x

The European gonococcal antimicrobial surveillance programme (Euro-GASP) appropriately reflects the antimicrobial resistance situation for Neisseria gonorrhoeae in the European Union/European Economic Area

Michelle J. Cole, Chantal Quinten, Susanne Jacobsson, Michaela Day, Andrew J. Amato-Gauci, Neil Woodford, Gianfranco Spiteri, Magnus Unemo, Angelika Stary, Maria Haller, Ruth Verbrugge, Tania Crucitti, Soteroulla Soteriou, Despo Pieridou, Susan Cowan, Steen Hoffmann, Jevgenia Epstein, Jelena Viktorova, Ndeindo Ndeikoundam, Agathe GoubardPeter Kohl, Susanne Buder, Viviane Bremer, Eva Tzelepi, Vasileia Konte, Eszter Balla, M. ria Dudás, Guðrún Sigmundsdóttir, Guðrún Svanborg Hauksdóttir, Derval Igoe, Brendan Crowley, Barbara Suligoi, Paola Stefanelli, Gatis Pakarna, Violeta Mavcutko, Christopher Barbara, Jackie Maistre Melillo, Alje van Dam, Birgit van Benthem, Ineke Linde, Hilde Kløvstad, Thea Bergheim, Slawomir Majewski, Beata Mlynarczyk-Bonikowska, Jacinta Azevedo, Maria José Borrego, Peter Pavlik, Peter Truska, Irena Klavs, Samo Jeverica, Julio Vazquez, Mercedes Diez, Inga Velicko, Magnus Unemo, Gwenda Hughes, Kirstine Eastick

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Abstract

Background: European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP) antimicrobial resistance (AMR) data are used to inform gonorrhoea treatment guidelines; therefore the data need to be robust and representative. We assessed the extent to which Euro-GASP reflects national measures of the AMR situation for Neisseria gonorrhoeae across the European Union/European Economic Area (EU/EEA). Methods: We compared data from Euro-GASP with published national gonococcal AMR data from 15 countries for azithromycin, cefixime and ciprofloxacin for the period 2009 to 2013 and performed Poisson regression to identify differences (p < 0.05) between the proportions of resistant isolates. The 2014 Euro-GASP AMR data for each country (n = 19) were weighted to account for differences in the distribution of patient characteristics between Euro-GASP and EU/EEA epidemiological gonorrhoea surveillance data. Data were compared to determine whether estimates of resistance levels differed with regards to the 5% threshold used to assess the clinical utility of first-line gonorrhoea treatments. We assessed the quality of decentralised testing by comparing AMR data for isolates tested both centrally and in the participating laboratories, and by evaluating external quality assessment (EQA) performance. Results: There was no significant difference for azithromycin, cefixime and ciprofloxacin resistance when Euro-GASP country data were compared with data from national reports. Weighting slightly altered the Euro-GASP AMR estimates (by between - 4.7 and 4.7% from the unweighted estimates). Weighting resulted in greater changes in estimates of resistance to azithromycin (from - 9.5 to 2.7%) and ciprofloxacin (from - 14.8 to 17.9%) in countries with low isolate numbers and low completeness of reporting (n = 3). Weighting caused AMR levels to fall below or above the 5% threshold for cefixime or azithromycin, respectively in only two countries. Susceptibility category data submitted from the decentralised Euro-GASP laboratories were concordant with the Euro-GASP data (> 90%). EQA performance was also good; < 5% of the minimum inhibitory concentration (MIC) results differed by > 4-fold from the modal MIC of the EQA isolate. Conclusions: The overall prevalence of AMR reported by Euro-GASP reflects closely the AMR situation for N. gonorrhoeae in the EU/EEA. Euro-GASP data can be used to provide robust AMR estimates to inform the European guideline for the management of gonorrhoea.

Original language	English
Article number	1040
Journal	BMC Infectious Diseases
Volume	19
Issue number	1
DOIs	https://doi.org/10.1186/s12879-019-4631-x
Publication status	Published - 2019

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Cole, M. J., Quinten, C., Jacobsson, S., Day, M., Amato-Gauci, A. J., Woodford, N., Spiteri, G., Unemo, M., Stary, A., Haller, M., Verbrugge, R., Crucitti, T., Soteriou, S., Pieridou, D., Cowan, S., Hoffmann, S., Epstein, J., Viktorova, J., Ndeikoundam, N., ... Eastick, K. (2019). The European gonococcal antimicrobial surveillance programme (Euro-GASP) appropriately reflects the antimicrobial resistance situation for Neisseria gonorrhoeae in the European Union/European Economic Area. BMC Infectious Diseases, 19(1), Article 1040. https://doi.org/10.1186/s12879-019-4631-x

@article{9ce5e1dbadf94c318a60e8a4d2c1a575,

title = "The European gonococcal antimicrobial surveillance programme (Euro-GASP) appropriately reflects the antimicrobial resistance situation for Neisseria gonorrhoeae in the European Union/European Economic Area",

abstract = "Background: European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP) antimicrobial resistance (AMR) data are used to inform gonorrhoea treatment guidelines; therefore the data need to be robust and representative. We assessed the extent to which Euro-GASP reflects national measures of the AMR situation for Neisseria gonorrhoeae across the European Union/European Economic Area (EU/EEA). Methods: We compared data from Euro-GASP with published national gonococcal AMR data from 15 countries for azithromycin, cefixime and ciprofloxacin for the period 2009 to 2013 and performed Poisson regression to identify differences (p < 0.05) between the proportions of resistant isolates. The 2014 Euro-GASP AMR data for each country (n = 19) were weighted to account for differences in the distribution of patient characteristics between Euro-GASP and EU/EEA epidemiological gonorrhoea surveillance data. Data were compared to determine whether estimates of resistance levels differed with regards to the 5% threshold used to assess the clinical utility of first-line gonorrhoea treatments. We assessed the quality of decentralised testing by comparing AMR data for isolates tested both centrally and in the participating laboratories, and by evaluating external quality assessment (EQA) performance. Results: There was no significant difference for azithromycin, cefixime and ciprofloxacin resistance when Euro-GASP country data were compared with data from national reports. Weighting slightly altered the Euro-GASP AMR estimates (by between - 4.7 and 4.7% from the unweighted estimates). Weighting resulted in greater changes in estimates of resistance to azithromycin (from - 9.5 to 2.7%) and ciprofloxacin (from - 14.8 to 17.9%) in countries with low isolate numbers and low completeness of reporting (n = 3). Weighting caused AMR levels to fall below or above the 5% threshold for cefixime or azithromycin, respectively in only two countries. Susceptibility category data submitted from the decentralised Euro-GASP laboratories were concordant with the Euro-GASP data (> 90%). EQA performance was also good; < 5% of the minimum inhibitory concentration (MIC) results differed by > 4-fold from the modal MIC of the EQA isolate. Conclusions: The overall prevalence of AMR reported by Euro-GASP reflects closely the AMR situation for N. gonorrhoeae in the EU/EEA. Euro-GASP data can be used to provide robust AMR estimates to inform the European guideline for the management of gonorrhoea.",

author = "Cole, {Michelle J.} and Chantal Quinten and Susanne Jacobsson and Michaela Day and Amato-Gauci, {Andrew J.} and Neil Woodford and Gianfranco Spiteri and Magnus Unemo and Angelika Stary and Maria Haller and Ruth Verbrugge and Tania Crucitti and Soteroulla Soteriou and Despo Pieridou and Susan Cowan and Steen Hoffmann and Jevgenia Epstein and Jelena Viktorova and Ndeindo Ndeikoundam and Agathe Goubard and Peter Kohl and Susanne Buder and Viviane Bremer and Eva Tzelepi and Vasileia Konte and Eszter Balla and Dud{\'a}s, {M. ria} and Gu{\dh}r{\'u}n Sigmundsd{\'o}ttir and Hauksd{\'o}ttir, {Gu{\dh}r{\'u}n Svanborg} and Derval Igoe and Brendan Crowley and Barbara Suligoi and Paola Stefanelli and Gatis Pakarna and Violeta Mavcutko and Christopher Barbara and Melillo, {Jackie Maistre} and {van Dam}, Alje and {van Benthem}, Birgit and Ineke Linde and Hilde Kl{\o}vstad and Thea Bergheim and Slawomir Majewski and Beata Mlynarczyk-Bonikowska and Jacinta Azevedo and Borrego, {Maria Jos{\'e}} and Peter Pavlik and Peter Truska and Irena Klavs and Samo Jeverica and Julio Vazquez and Mercedes Diez and Inga Velicko and Magnus Unemo and Gwenda Hughes and Kirstine Eastick",

year = "2019",

doi = "https://doi.org/10.1186/s12879-019-4631-x",

language = "English",

volume = "19",

journal = "BMC Infectious Diseases",

issn = "1471-2334",

publisher = "BioMed Central",

number = "1",

}

Cole, MJ, Quinten, C, Jacobsson, S, Day, M, Amato-Gauci, AJ, Woodford, N, Spiteri, G, Unemo, M, Stary, A, Haller, M, Verbrugge, R, Crucitti, T, Soteriou, S, Pieridou, D, Cowan, S, Hoffmann, S, Epstein, J, Viktorova, J, Ndeikoundam, N, Goubard, A, Kohl, P, Buder, S, Bremer, V, Tzelepi, E, Konte, V, Balla, E, Dudás, MR, Sigmundsdóttir, G, Hauksdóttir, GS, Igoe, D, Crowley, B, Suligoi, B, Stefanelli, P, Pakarna, G, Mavcutko, V, Barbara, C, Melillo, JM, van Dam, A, van Benthem, B, Linde, I, Kløvstad, H, Bergheim, T, Majewski, S, Mlynarczyk-Bonikowska, B, Azevedo, J, Borrego, MJ, Pavlik, P, Truska, P, Klavs, I, Jeverica, S, Vazquez, J, Diez, M, Velicko, I, Unemo, M, Hughes, G & Eastick, K 2019, 'The European gonococcal antimicrobial surveillance programme (Euro-GASP) appropriately reflects the antimicrobial resistance situation for Neisseria gonorrhoeae in the European Union/European Economic Area', BMC Infectious Diseases, vol. 19, no. 1, 1040. https://doi.org/10.1186/s12879-019-4631-x

The European gonococcal antimicrobial surveillance programme (Euro-GASP) appropriately reflects the antimicrobial resistance situation for Neisseria gonorrhoeae in the European Union/European Economic Area. / Cole, Michelle J.; Quinten, Chantal; Jacobsson, Susanne et al.
In: BMC Infectious Diseases, Vol. 19, No. 1, 1040, 2019.

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

TY - JOUR

T1 - The European gonococcal antimicrobial surveillance programme (Euro-GASP) appropriately reflects the antimicrobial resistance situation for Neisseria gonorrhoeae in the European Union/European Economic Area

AU - Cole, Michelle J.

AU - Quinten, Chantal

AU - Jacobsson, Susanne

AU - Day, Michaela

AU - Amato-Gauci, Andrew J.

AU - Woodford, Neil

AU - Spiteri, Gianfranco

AU - Unemo, Magnus

AU - Stary, Angelika

AU - Haller, Maria

AU - Verbrugge, Ruth

AU - Crucitti, Tania

AU - Soteriou, Soteroulla

AU - Pieridou, Despo

AU - Cowan, Susan

AU - Hoffmann, Steen

AU - Epstein, Jevgenia

AU - Viktorova, Jelena

AU - Ndeikoundam, Ndeindo

AU - Goubard, Agathe

AU - Kohl, Peter

AU - Buder, Susanne

AU - Bremer, Viviane

AU - Tzelepi, Eva

AU - Konte, Vasileia

AU - Balla, Eszter

AU - Dudás, M. ria

AU - Sigmundsdóttir, Guðrún

AU - Hauksdóttir, Guðrún Svanborg

AU - Igoe, Derval

AU - Crowley, Brendan

AU - Suligoi, Barbara

AU - Stefanelli, Paola

AU - Pakarna, Gatis

AU - Mavcutko, Violeta

AU - Barbara, Christopher

AU - Melillo, Jackie Maistre

AU - van Dam, Alje

AU - van Benthem, Birgit

AU - Linde, Ineke

AU - Kløvstad, Hilde

AU - Bergheim, Thea

AU - Majewski, Slawomir

AU - Mlynarczyk-Bonikowska, Beata

AU - Azevedo, Jacinta

AU - Borrego, Maria José

AU - Pavlik, Peter

AU - Truska, Peter

AU - Klavs, Irena

AU - Jeverica, Samo

AU - Vazquez, Julio

AU - Diez, Mercedes

AU - Velicko, Inga

AU - Unemo, Magnus

AU - Hughes, Gwenda

AU - Eastick, Kirstine

PY - 2019

Y1 - 2019

N2 - Background: European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP) antimicrobial resistance (AMR) data are used to inform gonorrhoea treatment guidelines; therefore the data need to be robust and representative. We assessed the extent to which Euro-GASP reflects national measures of the AMR situation for Neisseria gonorrhoeae across the European Union/European Economic Area (EU/EEA). Methods: We compared data from Euro-GASP with published national gonococcal AMR data from 15 countries for azithromycin, cefixime and ciprofloxacin for the period 2009 to 2013 and performed Poisson regression to identify differences (p < 0.05) between the proportions of resistant isolates. The 2014 Euro-GASP AMR data for each country (n = 19) were weighted to account for differences in the distribution of patient characteristics between Euro-GASP and EU/EEA epidemiological gonorrhoea surveillance data. Data were compared to determine whether estimates of resistance levels differed with regards to the 5% threshold used to assess the clinical utility of first-line gonorrhoea treatments. We assessed the quality of decentralised testing by comparing AMR data for isolates tested both centrally and in the participating laboratories, and by evaluating external quality assessment (EQA) performance. Results: There was no significant difference for azithromycin, cefixime and ciprofloxacin resistance when Euro-GASP country data were compared with data from national reports. Weighting slightly altered the Euro-GASP AMR estimates (by between - 4.7 and 4.7% from the unweighted estimates). Weighting resulted in greater changes in estimates of resistance to azithromycin (from - 9.5 to 2.7%) and ciprofloxacin (from - 14.8 to 17.9%) in countries with low isolate numbers and low completeness of reporting (n = 3). Weighting caused AMR levels to fall below or above the 5% threshold for cefixime or azithromycin, respectively in only two countries. Susceptibility category data submitted from the decentralised Euro-GASP laboratories were concordant with the Euro-GASP data (> 90%). EQA performance was also good; < 5% of the minimum inhibitory concentration (MIC) results differed by > 4-fold from the modal MIC of the EQA isolate. Conclusions: The overall prevalence of AMR reported by Euro-GASP reflects closely the AMR situation for N. gonorrhoeae in the EU/EEA. Euro-GASP data can be used to provide robust AMR estimates to inform the European guideline for the management of gonorrhoea.

AB - Background: European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP) antimicrobial resistance (AMR) data are used to inform gonorrhoea treatment guidelines; therefore the data need to be robust and representative. We assessed the extent to which Euro-GASP reflects national measures of the AMR situation for Neisseria gonorrhoeae across the European Union/European Economic Area (EU/EEA). Methods: We compared data from Euro-GASP with published national gonococcal AMR data from 15 countries for azithromycin, cefixime and ciprofloxacin for the period 2009 to 2013 and performed Poisson regression to identify differences (p < 0.05) between the proportions of resistant isolates. The 2014 Euro-GASP AMR data for each country (n = 19) were weighted to account for differences in the distribution of patient characteristics between Euro-GASP and EU/EEA epidemiological gonorrhoea surveillance data. Data were compared to determine whether estimates of resistance levels differed with regards to the 5% threshold used to assess the clinical utility of first-line gonorrhoea treatments. We assessed the quality of decentralised testing by comparing AMR data for isolates tested both centrally and in the participating laboratories, and by evaluating external quality assessment (EQA) performance. Results: There was no significant difference for azithromycin, cefixime and ciprofloxacin resistance when Euro-GASP country data were compared with data from national reports. Weighting slightly altered the Euro-GASP AMR estimates (by between - 4.7 and 4.7% from the unweighted estimates). Weighting resulted in greater changes in estimates of resistance to azithromycin (from - 9.5 to 2.7%) and ciprofloxacin (from - 14.8 to 17.9%) in countries with low isolate numbers and low completeness of reporting (n = 3). Weighting caused AMR levels to fall below or above the 5% threshold for cefixime or azithromycin, respectively in only two countries. Susceptibility category data submitted from the decentralised Euro-GASP laboratories were concordant with the Euro-GASP data (> 90%). EQA performance was also good; < 5% of the minimum inhibitory concentration (MIC) results differed by > 4-fold from the modal MIC of the EQA isolate. Conclusions: The overall prevalence of AMR reported by Euro-GASP reflects closely the AMR situation for N. gonorrhoeae in the EU/EEA. Euro-GASP data can be used to provide robust AMR estimates to inform the European guideline for the management of gonorrhoea.

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UR - https://www.ncbi.nlm.nih.gov/pubmed/31822275

U2 - https://doi.org/10.1186/s12879-019-4631-x

DO - https://doi.org/10.1186/s12879-019-4631-x

M3 - Article

C2 - 31822275

SN - 1471-2334

VL - 19

JO - BMC Infectious Diseases

JF - BMC Infectious Diseases

IS - 1

M1 - 1040

ER -

The European gonococcal antimicrobial surveillance programme (Euro-GASP) appropriately reflects the antimicrobial resistance situation for Neisseria gonorrhoeae in the European Union/European Economic Area

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