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Antimicrobial-resistant Neisseria gonorrhoeae in Europe in 2020 compared with in 2013 and 2018: a retrospective genomic surveillance study

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dc.contributor.authorGolparian, Daniel
dc.contributor.authorCole, Michelle J
dc.contributor.authorSánchez-Busó, Leonor
dc.contributor.authorDay, Michaela
dc.contributor.authorJacobsson, Susanne
dc.contributor.authorUthayakumaran, Thinushaa
dc.contributor.authorAbad, Raquel
dc.contributor.authorBercot, Beatrice
dc.contributor.authorCaugant, Dominique A
dc.contributor.authorHeuer, Dagmar
dc.contributor.authorJansen, Klaus
dc.contributor.authorPleininger, Sonja
dc.contributor.authorStefanelli, Paola
dc.contributor.authorAanensen, David M
dc.contributor.authorBluemel, Benjamin
dc.contributor.authorUnemo, Magnus
dc.contributor.authorEuro-GASP study group
dc.contributor.authorDiaz Franco, Asuncion
dc.contributor.authorVazquez-Moreno, Julio Alberto
dc.contributor.funderUnión Europea. European Centre for Disease Prevention and Control (ECDC)es_ES
dc.contributor.funderÖrebro University Hospital (Suecia)es_ES
dc.contributor.funderÖrebro County Council Research (Suecia)es_ES
dc.contributor.funderInstituto de Salud Carlos IIIes_ES
dc.contributor.funderGeneralitat Valenciana (España)es_ES
dc.contributor.funderMinisterio de Ciencia e Innovación (España)es_ES
dc.date.accessioned2024-07-02T13:05:12Z
dc.date.available2024-07-02T13:05:12Z
dc.date.issued2024-05
dc.description.abstractBackground: Regular quality-assured whole-genome sequencing linked to antimicrobial resistance (AMR) and patient metadata is imperative to elucidate the shifting gonorrhoea epidemiology, both nationally and internationally. We aimed to examine the gonococcal population in the European Economic Area (EEA) in 2020, elucidate emerging and disappearing gonococcal lineages associated with AMR and patient metadata, compare with 2013 and 2018 whole-genome sequencing data, and explain changes in gonococcal AMR and gonorrhoea epidemiology. Methods: In this retrospective genomic surveillance study, we analysed consecutive gonococcal isolates that were collected in EEA countries through the European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP) in 2020, and made comparisons with Euro-GASP data from 2013 and 2018. All isolates had linked AMR data (based on minimum inhibitory concentration determination) and patient metadata. We performed whole-genome sequencing and molecular typing and AMR determinants were derived from quality-checked whole-genome sequencing data. Links between genomic lineages, AMR, and patient metadata were examined. Findings: 1932 gonococcal isolates collected in 2020 in 21 EEA countries were included. The majority (81·2%, 147 of 181 isolates) of azithromycin resistance (present in 9·4%, 181 of 1932) was explained by the continued expansion of the Neisseria gonorrhoeae sequence typing for antimicrobial resistance (NG-STAR) clonal complexes (CCs) 63, 168, and 213 (with mtrD/mtrR promoter mosaic 2) and the novel NG-STAR CC1031 (semi-mosaic mtrD variant 13), associated with men who have sex with men and anorectal or oropharyngeal infections. The declining cefixime resistance (0·5%, nine of 1932) and negligible ceftriaxone resistance (0·1%, one of 1932) was largely because of the progressive disappearance of NG-STAR CC90 (with mosaic penA allele), which was predominant in 2013. No known resistance determinants for novel antimicrobials (zoliflodacin, gepotidacin, and lefamulin) were found. Interpretation: Azithromycin-resistant clones, mainly with mtrD mosaic or semi-mosaic variants, appear to be stabilising at a relatively high level in the EEA. This mostly low-level azithromycin resistance might threaten the recommended ceftriaxone-azithromycin therapy, but the negligible ceftriaxone resistance is encouraging. The decreased genomic population diversity and increased clonality could be explained in part by the COVID-19 pandemic resulting in lower importation of novel strains into Europe.es_ES
dc.description.peerreviewedSíes_ES
dc.description.sponsorshipThis study was supported by the European Centre for Disease Prevention and Control, the Örebro County Council Research Committee, and the Foundation for Medical Research at Örebro University Hospital, Sweden. Decentralised whole-genome sequencing for Spanish isolates was supported by the Spanish National Centre of Microbiology (ISCIII). LS-B was funded by Generalitat Valenciana (Conselleria de Sanitat Universal i Salut Pública [CDEI-06/20-B] and Conselleria d’Innovació, Universitats, Ciència i Societat Digital [CISEJI/2022/66]), Valencia, Spain; and the Ministry of Science and Innovation (PID2020-120113RA-I00), Madrid, Spain.es_ES
dc.format.number5es_ES
dc.format.pagee478-e488es_ES
dc.format.volume5es_ES
dc.identifier.citationLancet Microbe. 2024 May;5(5):e478-e488.es_ES
dc.identifier.doi10.1016/S2666-5247(23)00370-1es_ES
dc.identifier.e-issn2666-5247es_ES
dc.identifier.journalThe Lancet. Microbees_ES
dc.identifier.pubmedID38614111es_ES
dc.identifier.urihttp://hdl.handle.net/20.500.12105/19912
dc.language.isoenges_ES
dc.publisherElsevieres_ES
dc.relation.projectFECYTinfo:eu-repo/grantAgreement/ES/PID2020-120113RA-I00es_ES
dc.relation.publisherversionhttps://doi.org/10.1016/S2666-5247(23)00370-1es_ES
dc.repisalud.centroISCIII::Centro Nacional de Microbiologíaes_ES
dc.repisalud.institucionISCIIIes_ES
dc.rights.accessRightsopen accesses_ES
dc.rights.licenseAtribución 4.0 Internacional*
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/*
dc.subject.meshNeisseria gonorrhoeaees_ES
dc.subject.meshGonorrheaes_ES
dc.subject.meshAnti-Bacterial Agentses_ES
dc.subject.meshMicrobial Sensitivity Testses_ES
dc.subject.meshDrug Resistance, Bacteriales_ES
dc.subject.meshWhole Genome Sequencinges_ES
dc.subject.meshHumanses_ES
dc.subject.meshRetrospective Studieses_ES
dc.subject.meshEuropees_ES
dc.subject.meshMalees_ES
dc.subject.meshFemalees_ES
dc.subject.meshAdultes_ES
dc.subject.meshGenome, Bacteriales_ES
dc.subject.meshMiddle Agedes_ES
dc.subject.meshYoung Adultes_ES
dc.subject.meshGenomicses_ES
dc.subject.meshAzithromycines_ES
dc.subject.meshAdolescentes_ES
dc.titleAntimicrobial-resistant Neisseria gonorrhoeae in Europe in 2020 compared with in 2013 and 2018: a retrospective genomic surveillance studyes_ES
dc.typeresearch articlees_ES
dc.type.hasVersionVoRes_ES
dspace.entity.typePublication
relation.isAuthorOfPublicationae1b542d-e7ab-49ee-86bd-700209d166c1
relation.isAuthorOfPublication98ad881c-e9ea-43a8-ae35-fa4d295b628d
relation.isAuthorOfPublicationc5b6f138-e581-4216-b2ab-ee813c9e410d
relation.isAuthorOfPublication.latestForDiscoveryae1b542d-e7ab-49ee-86bd-700209d166c1
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