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Antimicrobial resistance for Neisseria gonorrhoeae in the United States, 1988 to 2003: The spread of fluoroquinolone resistance.
Annals of Internal Medicine 2007; 147(2):81-88.
Wang SA, Harvey AB, Conner SM, Zaidi
AA, Knapp JS, Whittington WLH, del Rio C, Judson
FN, Holmes KK.
Abstract
BACKGROUND: Over the past 60 years, Neisseria gonorrhoeae has acquired clinically
significant resistance to sulfonamides, tetracyclines, penicillins, and ciprofloxacin.
OBJECTIVE: To determine U.S. trends in the prevalence of antimicrobial resistance
of N. gonorrhoeae from 1988 to 2003. DESIGN: 16-year, multisite, sentinel
surveillance for gonococcal isolate susceptibility through the Gonococcal
Isolate Surveillance Project (GISP). SETTING: Sexually transmitted disease
clinics in 37 cities. PATIENTS: Male patients with a total of 82,064 episodes
of urethral gonorrhea. MEASUREMENTS: Primary outcome measures included percentage
of gonococcal isolates resistant to antimicrobials used to treat gonorrhea,
percentage of patients treated with specific antimicrobials for gonorrhea,
and trends of these measures over time. RESULTS: The median age of patients
was 26 years, and 74.1% of patients were African American. The proportion
of men treated with penicillins for gonorrhea declined from 39.5% in 1988
to 0% in 1994, while the proportion of those receiving fluoroquinolone treatment
increased from 0% in 1988 to 42.0% in 2003. Penicillin resistance peaked at
19.6% in 1991, then declined to 6.5% in 2003. Tetracycline resistance peaked
at 25.8% in 1997 and declined to 14.4% in 2003. The first fluoroquinolone-resistant
isolate was found in 1991. Nationally, 0.4% of isolates were fluoroquinolone-resistant
in 1999 and were identified in 39% of GISP cities. By 2003, 4.1% of isolates
were fluoroquinolone-resistant and were identified in 70% of GISP cities.
Isolates with decreased susceptibility to ceftriaxone, cefixime, azithromycin,
and spectinomycin remained rare. In 2001, 3 multidrug-resistant isolates with
decreased susceptibility to cefixime were identified. LIMITATION: Sentinel
surveillance may not fully reflect trends for all patients with gonorrhea
in the United States. CONCLUSIONS: Prevalence of penicillin resistance has
declined in the years since gonorrhea treatment with penicillin was discontinued.
Fluoroquinolone-resistant N. gonorrhoeae infections continue to increase at
a time when fluoroquinolone use has increased. Ongoing nationwide and local
antimicrobial susceptibility monitoring is crucial to ensure appropriate treatment
of gonorrhea.