Prevalence of Cefixime-Resistant Neisseria gonorrhoeae in Melbourne, Australia, 2021-2022

Eric P F Chow; Kerrie Stevens; Vesna De Petra; Marcus Y Chen; Catriona S Bradshaw; Norelle L Sherry; Lindley A Barbee; Lenka A Vodstrcil; Ivette Aguirre; Kate L Seib; Kate Maddaford; Deborah A Williamson; Benjamin P Howden; Christopher K Fairley

doi:10.1093/infdis/jiae313

Prevalence of Cefixime-Resistant Neisseria gonorrhoeae in Melbourne, Australia, 2021-2022

J Infect Dis. 2024 Nov 15;230(5):e1121-e1125. doi: 10.1093/infdis/jiae313.

Authors

Eric P F Chow^{1

2

3}, Kerrie Stevens⁴, Vesna De Petra^{1

4}, Marcus Y Chen^{1

2}, Catriona S Bradshaw^{1

2

3}, Norelle L Sherry^{4

5}, Lindley A Barbee^{6

7}, Lenka A Vodstrcil^{1

2

3}, Ivette Aguirre¹, Kate L Seib⁸, Kate Maddaford^{1

2}, Deborah A Williamson^{9

10

11}, Benjamin P Howden^{4

5

12}, Christopher K Fairley^{1

2}

Affiliations

¹ Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.
² School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
³ Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
⁴ Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
⁵ Department of Infectious Diseases and Immunology, Austin Health, Heidelberg, Victoria, Australia.
⁶ Department of Medicine, University of Washington, Seattle, Washington, USA.
⁷ Public Health-Seattle and King County HIV/STD Program, Seattle, Washington, USA.
⁸ Institute for Glycomics, Griffith University, Southport, Queensland, Australia.
⁹ Victorian Infectious Disease Reference Laboratory, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
¹⁰ Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
¹¹ Department of Infectious Diseases and Immune Defence, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia.
¹² Centre for Pathogen Genomics, The University of Melbourne, Melbourne, Victoria, Australia.

Abstract

While ceftriaxone remains the first-line treatment for gonorrhea, the US Centers for Disease Control and Prevention recommended cefixime as a second-line treatment in 2021. We tested 1176 Neisseria gonorrhoeae isolates among clients attending the Melbourne Sexual Health Centre in 2021 and 2022. The prevalence of cefixime resistance was 6.3% (74/1176), azithromycin resistance was 4.9% (58/1176), and ceftriaxone resistance was 0% (0/1176). Cefixime resistance was highest among women (16.4%, 10/61), followed by men who have sex with women (6.4%, 7/109) and men who have sex with men (5.8%, 57/982). The prevalence of cefixime-resistant N gonorrhoeae exceeds the threshold of the 5% resistance level recommended by the World Health Organization; thus, cefixime treatment would have limited benefits in Australia.

Keywords: Neisseria gonorrhoeae; antimicrobial resistance; gonorrhea; resistance; treatment.

MeSH terms

Adolescent
Adult
Anti-Bacterial Agents* / pharmacology
Anti-Bacterial Agents* / therapeutic use
Australia / epidemiology
Azithromycin / pharmacology
Azithromycin / therapeutic use
Cefixime* / pharmacology
Cefixime* / therapeutic use
Ceftriaxone / pharmacology
Ceftriaxone / therapeutic use
Drug Resistance, Bacterial
Female
Gonorrhea* / drug therapy
Gonorrhea* / epidemiology
Gonorrhea* / microbiology
Humans
Male
Microbial Sensitivity Tests
Neisseria gonorrhoeae* / drug effects
Prevalence
Young Adult

Substances

Cefixime
Anti-Bacterial Agents
Ceftriaxone
Azithromycin

Abstract

MeSH terms

Substances

Grants and funding