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Die deutsche Laborlandschaft zu Diagnostik und Antibiotikaresistenztestung bei Neisseria gonorrhoeae

Laboratory practices: diagnostics and antibiotics resistance testing of Neisseria gonorrhoeae in Germany

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Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Aims and scope

Zusammenfassung

Weltweit sind zunehmende Antibiotikaresistenzen (AMR) bei Infektionen mit Neisseria gonorrhoeae (NG) zu beobachten. Aufgrund der fehlenden Meldepflicht in Deutschland stehen kaum epidemiologische und bevölkerungsbezogene Daten zur Verbreitung von NG-Infektionen und deren AMR zur Verfügung. Ziel der hier vorgestellten Erhebung war die Erfassung der NG-Diagnostikmethoden und AMR-Testungen von Laboren in Deutschland. Zwischen Juni und August 2013 wurde eine Querschnittserhebung in Deutschland über einen Online-Fragebogen durchgeführt. Labore mit NG-Diagnostik wurden identifiziert, um sie hinsichtlich der Diagnostikmethoden, des Probenumfangs, der getesteten Antibiotika, der beobachteten AMR sowie mit Blick auf allgemeine Laborangaben zu charakterisieren. Insgesamt führten 188 von 521 teilnehmenden Laboren eine NG-Diagnostik durch. Ihre Angaben waren somit Grundlage für die weiteren statistischen Auswertungen. 92,6 % der Labore führten einen Kulturnachweis durch. Im Median wurden 60 Proben pro Quartal (PpQ) (IQR 15–270) getestet. Der Positivenanteil unter Männern lag bei 4,1 % sowie 6,9 %. Die Mehrzahl (82,1 %) der 151 Labore mit Kulturnachweis führte eine AMR-Testung durch. Die hier am häufigsten getesteten Antibiotika waren Ciprofloxacin (94,8 %), Penicillin (93,1 %), Doxycyclin (70,0 %) und Ceftriaxon (67,2 %). Die Antibiotika gegen die am häufigsten jemals Resistenzen beobachtet wurden waren Ciprofloxacin (87,1 %), Penicillin (78,3 %), Doxycyclin (56,6 %) und Azithromycin (35,1 %; alle Angaben als Protzentsatz der Labore). Es wurden unterschiedliche AMR-Ablesestandards verwendet. Die weltweite Resistenzentwicklung weist darauf hin, dass eine regelmäßige Überwachung von AMR bei NG-Infektionen erforderlich ist. Die im Rahmen der Studie erhobenen Daten zur deutschen Laborlandschaft bei der NG-Diagnostik bieten hierfür eine wichtige Voraussetzung.

Abstract

Recent years have seen a world-wide increase in antimicrobial resistance (AMR) in cases of infection with Neisseria gonorrhoeae (NG). NG infection is not notifiable in Germany and there is a lack of information available about the spread and AMR of NG infections. The objective of the study was to provide information on diagnostic methods and AMR testing in cases of NG infections in German laboratories. A cross-sectional survey was undertaken in Germany between June and August 2013 using an online questionnaire. Laboratories performing NG diagnostics were identified and described with regard to the diagnostic methods used, the number of tests performed, the antibiotics tested and the AMR observed, in addition to general laboratory information. In total, 188 of the 521 participating laboratories performed NG diagnostics; these were included in the further statistical analysis. 92.6 % of the 188 laboratories performed culture. A median of 60 (IQR 15–270) samples per quarter (SPQ) were tested, with an overall positivity rate of 4.1 and 6.9 % among men. Most (82.1 %) of the 151 laboratories performing NG culture tested for AMR as well. The most frequently tested antibiotics were ciprofloxacin (94.8 %), penicillin (93.1 %), doxycycline (70.0 %) and ceftriaxone (67.2 %). The most frequently observed AMR ever were those against ciprofloxacin (87.1 %), penicillin (78.3 %), doxycycline (56.6 %) and azithromycin (35.1 %; all percentages refer to laboratories). The laboratories used different standards regarding susceptibility criteria. The emergence and spread of AMR shows that it is crucial to assess and monitor the scope and trends of multidrug-resistant gonorrhea. The data collected on diagnostic methods and AMR testing in cases of NG infections in German laboratories constitute an important basis for future monitoring.

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Danksagung

Wir möchten uns bei den zahlreichen Laboren bedanken, die an der Datenerhebung teilnahmen und diese Studie damit ermöglichten.

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Authors and Affiliations

  1. Abteilung für Infektionsepidemiologie, Fachgebiet HIV/AIDS und andere sexuell oder durch Blut übertragbare Infektionen, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland

    Anna Loenenbach M.A., M.Sc., S. Dudareva-Vizule, A. Sailer & V. Bremer

  2. Konsiliarlabor für Gonokokken, Vivantes Klinikum Neukölln, Rudower Straße 48, 12351 Berlin, Deutschland

    S. Buder & P.K. Kohl

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  1. Anna Loenenbach M.A., M.Sc.
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  2. S. Dudareva-Vizule
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  3. S. Buder
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  4. A. Sailer
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Correspondence to Anna Loenenbach M.A., M.Sc..

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A. Loenenbach, S. Dudavera-Vizule, S. Buder, A. Sailer, P.K. Kohl und V. Bremer geben an, dass kein Interessenkonflikt bestehen.

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Loenenbach, A., Dudareva-Vizule, S., Buder, S. et al. Die deutsche Laborlandschaft zu Diagnostik und Antibiotikaresistenztestung bei Neisseria gonorrhoeae . Bundesgesundheitsbl. 58, 866–874 (2015). https://doi.org/10.1007/s00103-015-2191-9

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