Is the tide turning again for cephalosporin resistance in XXXX in Europe? Results from the 2013 European surveillance.

@entity1 @entity801 @entity2756 @entity6368 @entity2177 @entity4580 @entity2886 @entity6727 @entity6760 @entity7634
BACKGROUND: The emerging resistance to the extended-spectrum @entity2886 (ESCs) in @entity6368 together with increasing incidence of gonorrhoea cases in many countries have been global public health concerns. However, in recent years the levels of ESC resistance have decreased in several regions worldwide. We describe the European Gonococcal Antimicrobial Surveillance Programme ( @entity7634 -GASP) data from 2013, and compare them to corresponding data from 2009-2012. METHODS: During 2013, @entity6368 isolates from 21 participating countries were examined. Antimicrobial susceptibility testing (Etest or agar dilution) was performed for @entity6727 , @entity2756 , @entity2177 , @entity4580 , @entity6760 and @entity801 . Statistical analyses were performed to identify significant changes in resistance between years and to investigate associations between @entity1 with resistant gonococcal isolates and collected epidemiological variables. RESULTS: In total, 93 (4.7  %) of 1994 isolates displayed resistance to @entity6727 , representing an increase compared to the 3.9  % detected in 2012 (p   =   0.23). @entity6727 resistance was detected in 13 (61.9  %) of the 21 countries. @entity6727 resistance among @entity1 who have sex with @entity1 was only 1.2  %, compared to 5.6  % and 6.1  % in females and male heterosexuals, respectively. The univariate analysis confirmed that isolates resistant to @entity6727 were more likely to be from females (OR 4.87, p   <   0.01) or male heterosexuals (OR 5.32, p   <   0.01). Seven (0.4  %) isolates displayed @entity2756 resistance (in addition to @entity6727 resistance) compared to three and 10 isolates in 2012 and 2011, respectively. All 93 isolates with @entity6727 resistance were additionally resistant to @entity2177 and 16 (17.2  %) were also resistant to @entity4580 . Among all tested isolates (n   =   1994), the @entity2177 resistance level (52.9  %) was higher than in 2012 (50.1  %; p   =   0.08), and @entity4580 resistance (5.4  %) increased since 2012 (4.5  %; p   =   0.16). CONCLUSIONS: In 2013, the ESC resistance was again slightly increasing in Europe. This emphasises the importance of implementing the actions outlined in the European and additional response plans, particularly activities strengthening the surveillance of antimicrobial resistance. @entity2756 combined with @entity4580 remains a satisfactory option for the first-line treatment of gonorrhoea. However novel antimicrobials (new derivatives of previously developed antimicrobials or newly developed antimicrobials) for effective monotherapy or at least inclusion in new dual antimicrobial therapy regimens (combined with previously developed antimicrobials or novel antimicrobials) will likely be required.
