Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Infectious Diseases
Published in: BMC Infectious Diseases 1/2016

Open Access 01-12-2016 | Research article

Antimicrobial resistance in Neisseria gonorrhoeae in China: a meta-analysis

Authors: Yawen Chen, Yanhong Gong, Tingting Yang, Xingyue Song, Jing Li, Yong Gan, Xiaoxv Yin, Zuxun Lu

Published in: BMC Infectious Diseases | Issue 1/2016

Login to get access

Abstract

Background

Neisseria gonorrhoeae (N. gonorrhoeae) resistance to antimicrobial has been a major concern in China, and epidemiological data on N. gonorrhoeae resistance are not well understood. This meta-analysis was aimed at summarizing the evidence on N. gonorrhoeae resistance to penicillin, tetracycline, ciprofloxacin, ceftriaxone and spectinomycin in China.

Methods

Two researchers independently searched five databases to identify studies on N. gonorrhoeae resistance to antimicrobials from the databases’ inception to November 7, 2014. A random-effects model was used to estimate the antimicrobial resistance rates and their corresponding 95 % confidence intervals (CIs). Publication bias was assessed with the Begg rank correlation test and the Egger test.

Results

We included 127 studies in our synthesis reporting antimicrobial resistance. Our analyses demonstrated that N. gonorrhoeae resistance to penicillin and tetracycline respectively increased from 74.41 % (95 % CI: 64.1–84.7 %) and 68.3 % (95 % CI: 58.7–78.0 %) in 2000 to 84.2 % (95 % CI: 79.7–88.8 %) and 82.4 % (95 % CI: 79.9–84.7 %) in 2012. N. gonorrhoeae resistance to ciprofloxacin experienced a steady increase from 12.7 % (95 % CI, 8.6–16.7 %) in 1995 and reached 93.8 % (95 % CI: 91.9–95.7 %) in 2003. N. gonorrhoeae resistance to ceftriaxone was 1.7 % (95 % CI: 0.5–5.7 %) before 1995 and 0.5 % (95 % CI: 0.2–1.4 %) in 2012, and N. gonorrhoeae resistance to spectinomycin was less than 2 % from 1995 to 2012.

Conclusions

N. gonorrhoeae resistance rates to penicillin, tetracycline and ciprofloxacin were high in China. Ceftriaxone and spectinomycin remained effective therapy for the treatment of gonorrhea. It is essential to strengthen N. gonorrhoeae resistance surveillance and update treatment guidelines timely.
Appendix
Available only for authorised users
Literature
1.
Cohen MS. Classical sexually transmitted diseases drive the spread of HIV-1: back to the future. J Infect Dis. 2012;206(1):1–2.CrossRefPubMed
2.
3.
4.
5.
Zhang G, Su M, Zhu H, Gao Y. Analysis on human papilloma virus genotype in sex workers with condyloma acuminatum in Kunming. Int J Lab Med. 2015;02:211–2.
6.
Gerbase AC, Rowley JT, Heymann DH, Berkley SF, Piot P. Global prevalence and incidence estimates of selected curable STDs. Sex Transm Infect. 1998;74 Suppl 1:S12–6.PubMed
7.
Johnson SR, Morse SA. Antibiotic resistance in Neisseria gonorrhoeae: genetics and mechanisms of resistance. Sex Transm Dis. 1988;15(4):217–24.CrossRefPubMed
8.
Moodley P, Pillay C, Goga R, Kharsany AB, Sturm AW. Evolution in the trends of antimicrobial resistance in Neisseria gonorrhoeae isolated in Durban over a 5 year period: impact of the introduction of syndromic management. J Antimicrob Chemother. 2001;48(6):853–9.CrossRefPubMed
9.
Olsen B, Pham TL, Golparian D, Johansson E, Tran HK, Unemo M. Antimicrobial susceptibility and genetic characteristics of Neisseria gonorrhoeae isolates from Vietnam, 2011. BMC Infect Dis. 2013;13:40.CrossRefPubMedPubMedCentral
10.
Lebedzeu F, Golparian D, Titov L, Pankratava N, Glazkova S, Shimanskaya I, et al. Antimicrobial susceptibility/resistance and NG-MAST characterisation of Neisseria gonorrhoeae in Belarus, Eastern Europe, 2010–2013. BMC Infect Dis. 2015;15:29.
11.
Ye SZ. Survey on antibiotic sensitivity of Neisseria gonorrhoeae strains isolated in China, 1987–1992. Sex Transm Dis. 1994;21(4):237–40.CrossRefPubMed
12.
Ye S, Su X, Wang Q, Yin Y, Dai X, Sun H. Surveillance of antibiotic resistance of Neisseria gonorrhoeae isolates in China, 1993–1998. Sex Transm Dis. 2002;29(4):242–5.CrossRefPubMed
13.
Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283(15):2008–12.
14.
WHO. Sensitivity testing of Neisseria gonorrhoeae: Methodologies for use by participants in the WHO western Pacific regional surveillance programme. In: WHO/WPR Resignal Antimicrobial Surevillance Working Group Meeting Proceedings; 1992.
15.
WHO. Manual for the Laboratory Identification and Antimicrobial Susceptibility Testing of Bacterial Pathogens of Public Health Importance in the Developing World. 2003.
16.
Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58.CrossRefPubMed
17.
Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50(4):1088–101.CrossRefPubMed
18.
19.
Sethi S, Golparian D, Bala M, Dorji D, Ibrahim M, Jabeen K, et al. Antimicrobial susceptibility and genetic characteristics of Neisseria gonorrhoeae isolates from India, Pakistan and Bhutan in 2007–2011. BMC Infect Dis. 2013;13:35.
20.
Tapsall JW, Limnios EA, Abu BH, Darussalam B, Ping YY, Buadromo EM, et al. Surveillance of antibiotic resistance in Neisseria gonorrhoeae in the WHO Western Pacific and South East Asian regions, 2007–2008. Commun Dis Intell Q Rep. 2010;34(1):1–7.
21.
Surveillance of antibiotic resistance in Neisseria gonorrhoeae in the WHO Western Pacific Region, 2002. Commun Dis Intell Q Rep 2003 27(4):488–491.
22.
Surveillance of antibiotic resistance in Neisseria gonorrhoeae in the WHO Western Pacific Region, 2001. World Health Organization. Commun Dis Intell Q Rep 2002, 26(4):541–545.
23.
Surveillance of antibiotic resistance in Neisseria gonorrhoeae in the WHO Western Pacific Region, 2006. Commun Dis Intell Q Rep 2008, 32(1):48–51.
24.
Surveillance of antibiotic resistance in Neisseria gonorrhoeae in the WHO Western Pacific Region, 2005. Commun Dis Intell Q Rep 2006, 30(4):430–433.
25.
Surveillance of antibiotic resistance in Neisseria gonorrhoeae in the WHO Western Pacific Region, 2004. Commun Dis Intell Q Rep 2006, 30(1):129–132.
26.
Surveillance of antibiotic resistance in Neisseria gonorrhoeae in the WHO Western Pacific Region, 2000. Commun Dis Intell Q Rep 2001, 25(4):274–276.
27.
Lahra MM. Surveillance of antibiotic resistance in Neisseria gonorrhoeae in the WHO Western Pacific and South East Asian Regions, 2010. Commun Dis Intell Q Rep. 2012;36(1):95–100.PubMed
28.
Surveillance of antibiotic resistance in Neisseria gonorrhoeae in the WHO Western Pacific and South East Asian Regions, 2009. Commun Dis Intell Q Rep 2011, 35(1):2–7.
29.
WHO. Antimicrobial Resistance Global Report on Surveillance 2014. 2014.
30.
Shimuta K, Unemo M, Nakayama S, Morita-Ishihara T, Dorin M, Kawahata T, et al. Antimicrobial resistance and molecular typing of Neisseria gonorrhoeae isolates in Kyoto and Osaka, Japan, 2010 to 2012: intensified surveillance after identification of the first strain (H041) with high-level ceftriaxone resistance. Antimicrob Agents Chemother. 2013;57(11):5225–32.
31.
Lahra MM. Annual report of the Australian Gonococcal surveillance programme, 2011. Commun Dis Intell Q Rep. 2012;36(2):E166–73.PubMed
32.
Tanaka M, Shimojima M, Saika T, Iyoda T, Ikeda F, Kanayama A, et al. Nationwide antimicrobial susceptibility survey of Neisseria gonorrhoeae isolates in Japan. Kansenshogaku Zasshi. 2011;85(4):360–5.
33.
Tapsall JW. Implications of current recommendations for third-generation cephalosporin use in the WHO Western Pacific Region following the emergence of multiresistant gonococci. Sex Transm Infect. 2009;85(4):256–8.CrossRefPubMed
34.
Tapsall JW, Ndowa F, Lewis DA, Unemo M. Meeting the public health challenge of multidrug- and extensively drug-resistant Neisseria gonorrhoeae. Expert Rev Anti Infect Ther. 2009;7(7):821–34.CrossRefPubMed
35.
Arason VA, Gunnlaugsson A, Sigurdsson JA, Erlendsdottir H, Gudmundsson S, Kristinsson KG. Clonal spread of resistant pneumococci despite diminished antimicrobial use. Microb Drug Resist. 2002;8(3):187–92.CrossRefPubMed
36.
Melander E, Ekdahl K, Jonsson G, Molstad S. Frequency of penicillin-resistant pneumococci in children is correlated to community utilization of antibiotics. Pediatr Infect Dis J. 2000;19(12):1172–7.CrossRefPubMed
37.
Kahlmeter G, Menday P, Cars O. Non-hospital antimicrobial usage and resistance in community-acquired Escherichia coli urinary tract infection. J Antimicrob Chemother. 2003;52(6):1005–10.CrossRefPubMed
38.
Malhotra-Kumar S, Lammens C, Coenen S, Van Herck K, Goossens H. Effect of azithromycin and clarithromycin therapy on pharyngeal carriage of macrolide-resistant streptococci in healthy volunteers: a randomised, double-blind, placebo-controlled study. Lancet. 2007;369(9560):482–90.CrossRefPubMed
39.
Klausner JDAMMV. Correlates of gonococcal infection and of antimicrobial-resistant Neisseria gonorrhoeae among female sex workers, Republic of the Philippines, 1996–1997. J Infect Dis. 1999;3(179):729–33.CrossRef
40.
Cosgrove SE, Carmeli Y. The impact of antimicrobial resistance on health and economic outcomes. Clin Infect Dis. 2003;36(11):1433–7.CrossRefPubMed
41.
Zhao X. Analysis of the resistance of Neisseria gonorrhoeae to 6 common antimicrobials in Hebei region. J Pathogen Biol. 2014;7:637–41.
42.
Gong Y, Yu B, Huang H. Research of Neisseria gonorrhoeae to antibiotics resistance in Huizhou region. China Mod Med. 2013;22:167–9.
43.
Xie J, Chen H. Surveillance of antimicrobial susceptibilities of 233 Neisseria gonorrhoeae isolates. Med Innov China. 2011;17:121–2.
44.
Unemo M, Golparian D, Nicholas R, Ohnishi M, Gallay A, Sednaoui P. High-level cefixime- and ceftriaxone-resistant Neisseria gonorrhoeae in France: novel penA mosaic allele in a successful international clone causes treatment failure. Antimicrob Agents Chemother. 2012;56(3):1273–80.CrossRefPubMedPubMedCentral
45.
Ohnishi M, Golparian D, Shimuta K, Saika T, Hoshina S, Iwasaku K, et al. Is Neisseria gonorrhoeae initiating a future era of untreatable gonorrhea?: detailed characterization of the first strain with high-level resistance to ceftriaxone. Antimicrob Agents Chemother. 2011;55(7):3538–45.
46.
Camara J, Serra J, Ayats J, Bastida T, Carnicer-Pont D, Andreu A, et al. Molecular characterization of two high-level ceftriaxone-resistant Neisseria gonorrhoeae isolates detected in Catalonia. Spain J Antimicrob Chemother. 2012;67(8):1858–60.
47.
Su X, Jiang F, Qimuge, Dai X, Sun H, Ye S. Surveillance of antimicrobial susceptibilities in Neisseria gonorrhoeae in Nanjing, China, 1999–2006. Sex Transm Dis. 2007;34(12):995–9.PubMed
48.
Qin Y, Zhu D. In vitro susceptibility to 4 antinicrobial agents Neisseria Gonorrhoea. J Chongqing Med Univ. 1991;2:114–7.
49.
Gu K, Wu L, Zhu S. Analysis of 81 Neisseria gonorrhoeae isolates resistance to quinolones in Hefei. J Zhejiang Univ. 1992;04:164–6.
50.
Yu K, Yu Q, Mo B. Analysis of Neisseria gonorrhoeae resistance in Nanchang during 2006 to 2008. J Nanchang Univ (Med Sci). 2009; 1:134–135.
51.
Zhang L, He L, Wang F. Trend of drug resistance of Neisseria gonorrhoeae in Shenzhen area in 2008. China Trop Med. 2010;5:561–2.
52.
Dillon JA, Ruben M, Li H, Borthagaray G, Marquez C, Fiorito S, et al. Challenges in the control of gonorrhea in South America and the Caribbean: monitoring the development of resistance to antibiotics. Sex Transm Dis. 2006;33(2):87–95.
Metadata
Title
Antimicrobial resistance in Neisseria gonorrhoeae in China: a meta-analysis
Authors
Yawen Chen
Yanhong Gong
Tingting Yang
Xingyue Song
Jing Li
Yong Gan
Xiaoxv Yin
Zuxun Lu
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2016
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-016-1435-0

Other articles of this Issue 1/2016

BMC Infectious Diseases 1/2016 Go to the issue

Research article

Seroprevalence of hepatitis E virus differs in Dutch and first generation migrant populations in Amsterdam, the Netherlands: a cross-sectional study

Research article

Clinical relevance of molecular identification of microorganisms and detection of antimicrobial resistance genes in bloodstream infections of paediatric cancer patients

Research article

Inflammatory arthritis in HIV positive patients: A practical guide

Research article

Usefulness of Integrase resistance testing in proviral HIV-1 DNA in patients with Raltegravir prior failure

Study protocol

HealthMap: a cluster randomised trial of interactive health plans and self-management support to prevent coronary heart disease in people with HIV

Research article

Clinical illness and outcomes in Nigerian children with late-appearing anaemia after artemisinin-based combination treatments of uncomplicated falciparum malaria

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits