Is previous azithromycin treatment associated with azithromycin resistance in Neisseria gonorrhoeae ? A cross-sectional study using national surveillance data in England

Soazig Clifton*, Katy Town, Martina Furegato, Michelle Cole, Hamish Mohammed, Sarah C. Woodhall, J. Kevin Dunbar, Helen Fifer, Gwenda Hughes

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

14 Citations (Scopus)

Abstract

Objectives: It has been suggested that treatment of STIs with azithromycin may facilitate development of azithromycin resistance in Neisseria gonorrhoeae (NG) by exposing the organism to suboptimal doses. We investigated whether treatment history for non-rectal Chlamydia trachomatis (CT), non-gonococcal urethritis (NGU) or NG (proxies for azithromycin exposure) in sexual health (GUM) services was associated with susceptibility of NG to azithromycin. Methods: Azithromycin susceptibility data from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP 2013-2015, n=4606) and additional high-level azithromycin-resistant isolates (HL-AziR) identified by the Public Health England reference laboratory (2013-2016, n=54) were matched to electronic patient records in the national GUMCAD STI surveillance dataset (2012-2016). Descriptive and regression analyses were conducted to examine associations between history of previous CT/NGU/NG and subsequent susceptibility of NG to azithromycin. Results: Modal azithromycin minimum inhibitory concentration (MIC) was 0.25 mg/L (one dilution below the resistance breakpoint) in those with and without history of previous CT/NGU/NG (previous 1 month/6 months). There were no differences in MIC distribution by history of CT/NGU (P=0.98) or NG (P=0.85) in the previous 1 month/6 months or in the odds of having an elevated azithromycin MIC (>0.25 mg/L) (Adjusted OR for CT/NGU 0.97 (95% CI 0.76 to 1.25); adjusted OR for NG 0.82 (95% CI: 0.65 to 1.04)) compared with those with no CT/NGU/NG in the previous 6 months. Among patients with HL-AziR NG, 3 (4%) were treated for CT/NGU and 2 (3%) for NG in the previous 6 months, compared with 6% and 8%, respectively for all GRASP patients. Conclusions: We found no evidence of an association between previous treatment for CT/NGU or NG in GUM services and subsequent presentation with an azithromycin-resistant strain. As many CT diagnoses occur in non-GUM settings, further research is needed to determine whether azithromycin-resistant NG is associated with azithromycin exposure in other settings and for other conditions.

Original languageEnglish
Pages (from-to)421-426
Number of pages6
JournalSexually Transmitted Infections
Volume94
Issue number6
DOIs
Publication statusPublished - 1 Sep 2018

Bibliographical note

Funding Information:
GRASP has been funded totally (2000-2004) and partly (2005-2010) by the Department of Health (England) and by Public Health England. SC was funded to undertake independent research supported by the National Institute for Health Research (NIHR Research Methods Programme, Fellowships and Internships, NIHRRMFI-2014-05-28).

Funding Information:
Funding graSP has been funded totally (2000–2004) and partly (2005–2010) by the Department of Health (england) and by Public Health england. Sc was funded to undertake independent research supported by the national institute for Health research (niHr research Methods Programme, Fellowships and internships, niHr-rMFi-2014-05-28).

Publisher Copyright:
© 2018 Article author(s).

Keywords

  • antimicrobial resistance
  • azithromycin
  • neisseria gonorrhoea
  • surveillance

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