O11.2 - Global Surveillance for Antimicrobial Resistant Neisseria gonorrhoeae through the Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP), 2015-2022
Background: Infections due to antimicrobial resistant (AMR) Neisseria gonorrhoeae (NG) are a global public health threat. The Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP) started in 2015 to systematically monitor patterns of AMR in strains of NG, understand factors associated with AMR NG infection, and create globally comparable NG resistance monitoring data.
Methods: Sentinel surveillance was conducted among male patients presenting with urethral discharge at healthcare facilities in Thailand (2015-2022), the Philippines (2018-2022), and Cambodia (2021-2022). Urethral swabs were collected from symptomatic men for Gram stain and culture, along with demographic, behavioral, and clinical data. Antimicrobial susceptibility testing (AST) was performed on NG isolates to determine minimum inhibitory concentrations (MICs) for azithromycin, cefixime, ceftriaxone, gentamicin, and ciprofloxacin using gradient strip testing via ETEST® (bioMérieux). Definitions for resistance and elevated MICs are indicated in Table 1.
Results: During August 2015–October 2022, 4,690 urethral specimens were collected; 54.2% were Gram stain positive and 53.3% were culture confirmed NG. Among men with confirmed gonococcal infection (n=2,499), 58.5% reported having sex with women only, 33.8% reported only having sex with men, and 7.4% reported having sex with both men and women. The median age of men with NG infection was 28 years (range 12-81 years) and 21% reported antibiotic use in the last 2 weeks. Appropriate primary NG treatment was received by 93.5% as indicated by their countries’ national guidelines. AST results were available for 99.9% (n=2,496) of NG culture-confirmed EGASP specimens. Most specimens were susceptible to all tested antibiotics (98.3%), but 53 specimens (2.1%) had elevated MICs to some antibiotics (Table 1); 90% of elevated MICs to cephalosporins were reported from Cambodia.
Conclusion: EGASP enables collection of systematic and standardized epidemiologic and laboratory data across countries to increase knowledge about factors influencing AMR NG. Although the proportion of isolates with elevated MICs to cephalosporins is low, any elevated MIC is concerning as cephalosporins are the only remaining recommended gonorrhea treatment. Further global expansion of AMR NG surveillance through EGASP is important to monitor these trends worldwide, provide critical data for updating national and international treatment guidelines, and inform antibiotic stewardship policies.
