Antimicrobial-resistant Neisseria gonorrhoeae in Europe in 2020 compared with in 2013 and 2018: a retrospective genomic surveillance study
Authors: Daniel Golparian, Michelle J Cole, Leonor Sánchez-Busó, Michaela Day, Susanne Jacobsson, Thinushaa Uthayakumaran, Raquel Abad, Beatrice Bercot, Dominique A Caugant, Dagmar Heuer, Klaus Jansen, Sonja Pleininger, Paola Stefanelli, David M Aanensen, Benjamin Bluemel, Magnus Unemo, Sonja Pleininger, Silke Stadlbauer, Alexander Indra, Irith De Baetselier, Wim Vanden Berghe, Amaryl Lecompte, Blaženka Hunjak, Tatjana Nemeth Blažić, Panayiota Maikanti-Charalambous, Despo Pieridou, Hana Zákoucká, Helena Žemličková, Steen Hoffmann, Susan Cowan, Lasse Jessen Schwartz, Rita Peetso, Jevgenia Epstein, Jelena Viktorova, Beatrice Bercot, Cécile Bébéar, Florence Lot, Jukka Torvikoski, Suvi Korhonen, Susanne Buder, Klaus Jansen, Vivi Miriagou, Eirini Siatravani, Ioanna Magaziotou, Eleni Paparizou, Eszter Balla, Mária Dudás, Lena Rós Ásmundsdóttir, Guðrún Svanborg Hauksdóttir, Thorolfur Gudnason, Marianna Thordardottir, Aoife Colgan, Brendan Crowley, Sinéad Saab, Maeve Keane, Paola Stefanelli, Anna Carannante, Patrizia Parodi, Gatis Pakarna, Raina Nikiforova, Antra Bormane, Elina Dimina, Christopher Barbara, Francesca Mifsud, Robert Cassar, Julie Haider, Alje Van Dam, Birgit Van Benthem, Maartje Visser, Ineke Linde, Hilde Kløvstad, Dominique Caugant, Thea Bergheim, Beata Młynarczyk-Bonikowska, Jacinta Azevedo, Maria-José Borrego, Marina Lurdes Ramos Nascimento, Peter Pavlik, Irena Klavs, Andreja Murnik, Tanja Kustec, Polona Maver Vodičar, Julio Vázquez Moreno, Asuncion Diaz, Raquel Abad Torreblanca, Inga Velicko, Magnus Unemo
Journal: The Lancet Microbe (2024)

BackgroundRegular 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.MethodsIn 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.Findings1932 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.InterpretationAzithromycin-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.FundingEuropean Centre for Disease Prevention and Control and Örebro University Hospital.