ANTIMICROBIAL RESISTANCE
In 2014, the susceptibility of gonococci to two of the recommended antibiotics for gonorrhoea treatment showed signs of improvement, according to results from the European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP). At the same time, a significant increase in resistance to another antibiotic agent that is part of the suggested dual therapy of gonorrhoea was observed. On an annual basis, countries of the European Union and European Economic Area (EU/EEA) participate in Euro-GASP to test susceptibility of Neisseria gonorrhoeae to the antibiotics commonly used for gonorrhoea treatment. In 2014, 23 EU/EEA countries collected and tested more than 2,000 gonococcal isolates and found a significantly lower proportion with cefixime resistance (2%), compared with 2013 when 4.7% of the tested isolates were not susceptible to this drug. The 2014 results continue the trend of decreasing cefixime resistance that started in 2010 (8.7%) but was interrupted by a slight increase in 2013. The ECDC report Gonococcal antimicrobial susceptibility surveillance in Europe 2014 also showed that resistance to the antibiotic azithromycin has continued to rise across Europe since 2012 to a level of 8% of tested isolates in 2014. The highest resistance to this recommended drug was seen among isolates taken from men who have sex with men (10%) and male heterosexuals (9%) while the lowest levels were found among those from females (2%). “The observed drop in cefixime and
ceftriaxone resistance in Europe is encouraging,” said Andrew Amato, head of ECDC’s programme on HIV/AIDS, sexually transmitted infections and viral hepatitis. “But knowing the history of Neisseria gonorrhoeae and antimicrobial resistance, we can expect that resistance levels will rise again in future years, leading to treatment failures. This is particularly worrying should azithromycin resistance levels also continue to increase. If we want to ensure that
Escherichia coli.
gonorrhoea remains a manageable infection, we have to continue to implement ECDC’s European response plan to control the threat of multidrug-resistant gonorrhoea.”
Euro-GASP monitors emerging resistance trends
Since the European treatment guidelines for gonorrhoea recommend use of two antimicrobials (ceftriaxone or cefixime in combination with azithromycin), the surveillance of antimicrobial susceptibility of these agents – which is currently undertaken by ECDC’s Euro-GASP – is vital to guide clinical services to ensure that patients are successfully treated and the risk of complications are avoided. With more than 66,000 reported cases in 2014, and many more infections occurring but not reported, gonorrhoea is the second most frequently recorded sexually transmitted infection in Europe after chlamydia. ECDC launched a regional response plan to control multi-drug resistant gonorrhoea to minimise the threat of drug-resistant gonorrhoea in Europe. This plan argues
Concern over traces of airborne resistant bacteria
Polluted city air has now been identified as a possible means of transmission for resistant bacteria. Researchers in Gothenburg have shown that air samples from Beijing contain DNA from genes that make bacteria resistant to the most powerful antibiotics we have. The researchers looked for genes that make bacteria resistant to antibiotics in a total of 864 samples of DNA collected from humans, animals, and different environments worldwide.1
“Of particular concern is that we found a series of genes that provide resistance to carbapenems, a group of last resort
antibiotics taken for infections caused by bacteria that are often very difficult to treat,” said Joakim Larsson, a professor at Sahlgrenska Academy and director of the Centre for Antibiotic Resistance Research at the University of Gothenburg. “This may be a more important means of transmission than previously thought.”
Reference
1 Pal C, et al, ‘The structure and diversity of human, animal and environmental resistomes.’ Microbiome. 7 October 2016,
http://microbiomejournal.biomedcentral.com/ articles/10.1186/s40168-016-0199-5
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that countries need to ensure they have the minimum capacity for culture and susceptibility testing. They must also have strategies for rapid identification and reporting of failures to treatment with currently recommended antimicrobials. At the same time, antimicrobial resistance surveillance and awareness of this problem should be stepped up so that measures can be taken to ensure that options for successful treatment of gonorrhoea remain available in the EU.
Improvements in prescribing
There have also been some positive reports regarding antibiotic usage in the news. Sales of antibiotics for use in animals are at a four-year low, putting the UK on track to meet targets on tackling antibiotic resistance, according to a report by Defra. The report shows a drop in sales of the highest priority antibiotics that are critically important for humans. Sales of these made up just over 1% of all antibiotics sold for use in animals in 2015.
In healthcare, Public Health England (PHE) has also issued a report which shows that, for the first time, fewer antibiotics are being prescribed by GPs and clinicians, in the UK. A decline in the use of antibiotics has occurred across all healthcare settings, including in the community and hospitals. This is the first time a reduction has been seen in antibiotic use across the whole healthcare system. Safely reducing the amount of antibiotics that are inappropriately prescribed is a vital part of the work to tackle antibiotic resistance. In 2015, 2.2 million fewer antibiotic prescriptions were dispensed in the community compared to 2014. This equates to 6% of all prescriptions. Use of broad-spectrum antibiotics (which are effective against a wide range of bacteria and more likely to lead to resistance) has also decreased in primary care for the second year running.
Dr Susan Hopkins, lead author and healthcare epidemiologist at PHE, said: “The overall decrease in the number of
FEBRUARY 2017
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