Skip to main content
STI & HIV 2023 World Congress Main banner
Final Program


Icon Legend
Back

Epidemiology & Monitoring

Category: Gonorrhoea - AMR

(P60) Molecular antimicrobial resistance surveillance of Neisseria gonorrhoeae in Germany

Tuesday, July 25, 2023
16:00 – 18:00 CST


Introduction:

Increasing antimicrobial resistance (AMR) in Neisseria gonorrhoeae (NG) poses a major public health threat. Within the framework of the nationwide sentinel surveillance system for NG-AMR (Go-Surv-AMR), genomic data, phenotypic and epidemiological data are combined to investigate the emergence and distribution of NG-AMR determinants in Germany.





Methods:

Antimicrobial susceptibility (azithromycin, cefixime, ceftriaxone, ciprofloxacin, penicillin and tetracycline) of the NG isolates was determined using E-test. Minimum inhibitory concentrations (MICs) were interpreted following European Committee on Antimicrobial Susceptibility Testing (EUCAST) clinical breakpoints (version 12.0). The sequence types were assessed by Neisseria gonorrhoeae multiantigen sequence typing (NG-MAST). After extraction of DNA the genomes were sequenced using Illumina technology. Pathogenwatch was used to identify resistance genes and predict AMR.



Results:

Between 2016-2020, a total of 83 laboratories sent 2344 NG isolates. Whole genome analysis showed that reduced phenotypic susceptibility to azithromycin (increase from 2016 to 2020: 5% to 13%) could mainly be attributed to the mosaic-like mtr locus. Overall a high concordance between phenotypic AMR and molecular AMR determinants was found. However, phenotypic cephalosporin resistance did not correlate with the predicted resistance genotype. By combining AMR data with phylogenetic analysis genogroups were identified which are associated with decreased susceptibility to azithromycin, cefixime, or ceftriaxone. Results from 2021 and 2022 are currently in final analysis.





Discussion:

The increase of azithromycin-resistance in NG in Germany appears to be driven by globally distributed phylogenetic groups. Continued genotypic surveillance and correlation with genotypic results of NG-AMR is important in order to improve and further facilitate efficient AMR diagnostics and to ensure an efficient disease management.