Neisseria gonorrhoeae treatment failure to the recommended antibiotic regimen-Québec, Canada, 2015-19

• Published in: Journal of antimicrobial chemotherapy 2024-11, Vol.79 (11), p.3029-3040
• Main Authors: Blouin, Karine, Lefebvre, Brigitte, Trudelle, Annick, Defay, Fannie, Perrault-Sullivan, Gentiane, Gnimatin, Jean-Pierre, Labbé, Annie-Claude
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - therapeutic use; Azithromycin - administration & dosage; Azithromycin - therapeutic use; Cefixime - pharmacology; Cefixime - therapeutic use; Ceftriaxone - therapeutic use; Female; Gonorrhea - drug therapy; Gonorrhea - microbiology; Humans; Longitudinal Studies; Male; Microbial Sensitivity Tests; Middle Aged; Neisseria gonorrhoeae - drug effects; Quebec - epidemiology; Treatment Failure; Young Adult
• ISSN: 0305-7453; 1460-2091; 1460-2091
• DOI: 10.1093/jac/dkae327

To describe Neisseria gonorrhoeae treatment failure to the recommended antimicrobial regimens (azithromycin, cefixime and ceftriaxone). Our study was a longitudinal analysis of treatment failures from an observational open cohort of gonococcal infection cases collected in Québec, Canada (n = 2547) between September 2015 and December 2019. Epidemiological and clinical data were collected using a self-administered questionnaire, direct case interviews and chart reviews. Antimicrobial susceptibility testing was performed using the agar dilution method. To be retained as a treatment failure, cases must have had (i) a laboratory-confirmed gonococcal infection; (ii) a documented treatment; (iii) a positive test of cure (TOC) performed within a defined period and (iv) no sexual contact (vaginal, oral or anal), even protected with a condom, between the beginning of treatment and the positive TOC. A broader definition, including suspected cases, was also examined. Among 1593 cases where a TOC was performed, 83 had a positive TOC: 11 were retained as treatment failure, and 6 were considered suspected cases (overall = 17/1593; 1.1%). Possible explanations for retained or suspected treatment failure included resistance to the antibiotics used for treatment (n = 1), pharyngeal infection (n = 9, of which 5 had been treated with ceftriaxone and 4 with other regimens); and azithromycin monotherapy (n = 1). Some cases had more than one potential explanation. Treatment failure occurred in 1.1% of cases of Neisseria gonorrhoeae infection for which a TOC was performed, including some cases of pharyngeal infection treated with ceftriaxone.