TY - JOUR
T1 - Antimicrobial Resistance of Neisseria Gonorrhoeae in a Newly Implemented Surveillance Program in Uganda
T2 - Surveillance Report
AU - Workneh, Meklit
AU - Hamill, Matthew M.
AU - Kakooza, Francis
AU - Mande, Emmanuel
AU - Wagner, Jessica
AU - Mbabazi, Olive
AU - Mugasha, Rodney
AU - Kajumbula, Henry
AU - Walwema, Richard
AU - Zenilman, Jonathan
AU - Musinguzi, Patrick
AU - Kyambadde, Peter
AU - Lamorde, Mohammed
AU - Manabe, Yukari C.
N1 - Funding Information:
The authors would like to acknowledge patients and clinicians at sentinel clinic sites for providing samples, the Centers for Disease Control and Prevention, Division of Sexually Transmitted Disease Prevention for sharing the original EGASP protocol as well as for providing Etest strips for the program, and in particular, John Papp, Emily Watson, and Mary Kamb at the Centers for Disease Control and Prevention and Theodora Wi at World Health Organization. The work was supported by the Centers for Disease Control Global Health Security grant. MW was supported by the National Institute of Health grant T32 AI007291-27. YCM was also supported by the National Institute of Biomedical Imaging and Bioengineering at the National Institutes of Health for the Johns Hopkins Center for Point of Care Technologies Research Network (U54EB007958). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or Centers for Disease Control and Prevention.
Publisher Copyright:
© Meklit Workneh, Matthew M Hamill, Francis Kakooza, Emmanuel Mande, Jessica Wagner, Olive Mbabazi, Rodney Mugasha, Henry Kajumbula, Richard Walwema, Jonathan Zenilman, Patrick Musinguzi, Peter Kyambadde, Mohammed Lamorde, Yukari C Manabe.
PY - 2020/4
Y1 - 2020/4
N2 - Background: Neisseria gonorrhoeae (commonly known as gonorrhea) has developed resistance to all first-line therapy in Southeast Asia. East Africa has historically had absent or rudimentary gonorrhea surveillance programs and, while the existence of antimicrobial-resistant gonorrhea is recognized, the extent of its resistance is largely unknown. In 2016, the World Health Organization’s Enhanced Gonococcal Antimicrobial Surveillance Program (EGASP) was initiated in Uganda to monitor resistance trends. Objective: This study characterizes gonorrhea and antibiotic resistance in a large surveillance program of men with urethral discharge syndrome from Kampala, Uganda. Methods: Men attending sentinel clinics with urethritis provided demographic information, behavior data, and a urethral swab in line with the World Health Organization’s EGASP protocols for culture, identification, and antibiotic-sensitivity testing using 2 methods—disk diffusion (Kirby-Bauer test) and Etest (BioMérieux Inc). A subset of samples underwent detailed antimicrobial resistance testing. Results: Of 639 samples collected from September 2016 to February 2018, 400 (62.6%) were culture-positive though 414 (64.8%) had microscopic evidence of gonorrhea. The mean age of the men from whom the samples were collected was 26.9 (SD 9.6) years and 7.2% (46/639) reported having HIV. There was high-level resistance to ciprofloxacin, tetracycline, and penicillin (greater than 90%) by Kirby-Bauer disk diffusion and 2.1% (4/188) had reduced azithromycin sensitivity by Etest. Of the early isolates that underwent detailed characterization, 60.3% (70/116) were culture-positive, 94% (66/69) isolates were either ciprofloxacin-resistant or ciprofloxacin-intermediate by Etest, 96% (65/68) were azithromycin-sensitive, and 96% (66/69) were gentamicin-sensitive. Resistance profiles were comparable between methods except for ceftriaxone (disk diffusion: 68/69, 99%; Etest: 67/69, 97%) and for gentamicin (disk diffusion: 2/8, 25%; Etest: 66/69, 96%) sensitivity. Conclusions: This is the first report from a systematic gonorrhea surveillance program in Uganda. Findings demonstrated resistance or increased minimum inhibitory concentration to all key antigonococcal antibiotics. There was evidence of poor antibiotic stewardship, near-universal resistance to several antibiotics, and emerging resistance to others. Individuals in the population sampled were at exceptionally high risk of STI and HIV infection requiring intervention. Ongoing surveillance efforts to develop interventions to curtail antimicrobial-resistant gonorrhea are needed.
AB - Background: Neisseria gonorrhoeae (commonly known as gonorrhea) has developed resistance to all first-line therapy in Southeast Asia. East Africa has historically had absent or rudimentary gonorrhea surveillance programs and, while the existence of antimicrobial-resistant gonorrhea is recognized, the extent of its resistance is largely unknown. In 2016, the World Health Organization’s Enhanced Gonococcal Antimicrobial Surveillance Program (EGASP) was initiated in Uganda to monitor resistance trends. Objective: This study characterizes gonorrhea and antibiotic resistance in a large surveillance program of men with urethral discharge syndrome from Kampala, Uganda. Methods: Men attending sentinel clinics with urethritis provided demographic information, behavior data, and a urethral swab in line with the World Health Organization’s EGASP protocols for culture, identification, and antibiotic-sensitivity testing using 2 methods—disk diffusion (Kirby-Bauer test) and Etest (BioMérieux Inc). A subset of samples underwent detailed antimicrobial resistance testing. Results: Of 639 samples collected from September 2016 to February 2018, 400 (62.6%) were culture-positive though 414 (64.8%) had microscopic evidence of gonorrhea. The mean age of the men from whom the samples were collected was 26.9 (SD 9.6) years and 7.2% (46/639) reported having HIV. There was high-level resistance to ciprofloxacin, tetracycline, and penicillin (greater than 90%) by Kirby-Bauer disk diffusion and 2.1% (4/188) had reduced azithromycin sensitivity by Etest. Of the early isolates that underwent detailed characterization, 60.3% (70/116) were culture-positive, 94% (66/69) isolates were either ciprofloxacin-resistant or ciprofloxacin-intermediate by Etest, 96% (65/68) were azithromycin-sensitive, and 96% (66/69) were gentamicin-sensitive. Resistance profiles were comparable between methods except for ceftriaxone (disk diffusion: 68/69, 99%; Etest: 67/69, 97%) and for gentamicin (disk diffusion: 2/8, 25%; Etest: 66/69, 96%) sensitivity. Conclusions: This is the first report from a systematic gonorrhea surveillance program in Uganda. Findings demonstrated resistance or increased minimum inhibitory concentration to all key antigonococcal antibiotics. There was evidence of poor antibiotic stewardship, near-universal resistance to several antibiotics, and emerging resistance to others. Individuals in the population sampled were at exceptionally high risk of STI and HIV infection requiring intervention. Ongoing surveillance efforts to develop interventions to curtail antimicrobial-resistant gonorrhea are needed.
KW - Antibiotic resistance
KW - Antimicrobial resistance
KW - EGASP
KW - Gonorrhea
KW - Neisseria Gonorrhoeae
KW - STD
KW - STI
KW - Sexually transmitted
KW - Surveillance
KW - Uganda
UR - http://www.scopus.com/inward/record.url?scp=85097850357&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85097850357&partnerID=8YFLogxK
U2 - 10.2196/17009
DO - 10.2196/17009
M3 - Article
C2 - 32519969
AN - SCOPUS:85097850357
SN - 2369-2960
VL - 6
JO - JMIR Public Health and Surveillance
JF - JMIR Public Health and Surveillance
IS - 2
M1 - e17009
ER -