Risk factors of multidrug-resistant gonococcal infections: an analysis of data from the sentinel surveillance network- Québec, Canada, 2017–2019
Neisseria gonorrhoeae MDR correlates
DOI:
https://doi.org/10.54103/2282-0930/30018Keywords:
Gonococcal infections, Multidrug resistance, Québec, SurveillanceAbstract
The emergence of antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a worrying global phenomenon, with major implications for public health. This study, a cross-sectional analysis of an open cohort, explored the risk factors associated with multidrug-resistant (MDR) gonococcal infections in the province of Québec, Canada, using data from the sentinel surveillance network from 2017 to 2019. The data comprised sociodemographic, epidemiological, and clinical information, collected through self-administered questionnaires, direct case interviews and chart reviews coupled with laboratory AMR data for five antibiotics: azithromycin, tetracycline, ciprofloxacin, cefixime, and ceftriaxone. Missing data were handled using multiple imputation with chain equations (MICE); generalized estimating equations (GEE) were used to assess correlates of MDR. The analysis included 714 participants with a total of 775 cases. We observed very frequent resistance to ciprofloxacin (74.3%), while resistance to tetracycline and azithromycin was 19.9% and 21.3%, respectively. MDR was found in 12.5% of cases. Multivariate analysis indicated that having five or more sexual partners in the past two months (aPR=1.61, 95%CI: 1.07-2.41) was associated with MDR. In conclusion, our results show an association between the number of sexual partners and MDR, supporting the hypothesis that resistance can develop more rapidly in dense sexual networks. It is crucial to address the issue of circulating resistant strains through ongoing surveillance, research, and targeted interventions to manage and contain them before they become widespread.
Downloads
References
World Health Organization (WHO). Gonorrhoea: Latest Antimicrobial Global Surveillance Results and Guidance for Vaccine Development Published.
Kirkcaldy, R. D., Weston, E., Segurado, A. C. & Hughes, G. Epidemiology of gonorrhoea: a global perspective. Sex. Health 16, 401 (2019).
Unemo, M. et al. World Health Organization Global Gonococcal Antimicrobial Surveillance Program (WHO GASP): review of new data and evidence to inform international collaborative actions and research efforts. Sex. Health 16, 412 (2019).
Choudhri, Y., Miller, J., Sandhu, J., Leon, A. & Aho, J. Gonorrhea in Canada, 2010–2015. Can. Commun. Dis. Rep. 44, 37–42 (2018).
Public Health Agency of Canada. Reported Cases from 1991 to 2021 in Canada - Notifiable Diseases on-Line. https://diseases.canada.ca/notifiable/charts?c=yl.
Blouin, K., Lambert, G. & Perrault Sullivan, G. Portrait Des Infections Transmissibles Sexuellement et Par Le Sang (ITSS) Au Québec : Année 2021 et Projections 2022. https://www.inspq.qc.ca/publications/3364 (2023).
Blouin, K. et al. Correlates of Neisseria gonorrhoeae antimicrobial resistance: cross-sectional results from an open cohort sentinel surveillance network in Québec, Canada, 2016–2019. BMJ Open 13, e073849 (2023).
Sawatzky, P. et al. Antimicrobial susceptibilities of Neisseria gonorrhoeae in Canada, 2021. Can. Commun. Dis. Rep. 49, 388–397 (2023).
Lefebvre, B. et al. Ceftriaxone-Resistant Neisseria gonorrhoeae , Canada, 2017. Emerg. Infect. Dis. 24, 381–383 (2018).
Sommaire des résultats d’antibiorésistance des souches de Neisseria gonorrhoeae au Québec en 2022. (Institut national de santé publique du Québec, Québec, 2023).
Defay, F. et al. Réseau Sentinelle de Surveillance de l’infection Gonococcique, de l’antibiorésistance et Des Échecs de Traitement Au Québec : Résultats Du 1er Septembre 2015 Au 31 Décembre 2017. https://www.inspq.qc.ca/publications/3331 (2023).
Martin, I. et al. Multidrug-resistant and extensively drug-resistant Neisseria gonorrhoeae in Canada, 2012–2016. Can. Commun. Dis. Rep. 45, 45–53 (2019).
Sullivan Pepe, M. & Anderson, G. L. A cautionary note on inference for marginal regression models with longitudinal data and general correlated response data. Commun. Stat. - Simul. Comput. 23, 939–951 (1994).
Pan, W., Louis, T. A. & Connett, J. E. A Note on Marginal Linear Regression with Correlated Response Data. Am. Stat. 54, 191–195 (2000).
White, I. R., Royston, P. & Wood, A. M. Multiple imputation using chained equations: Issues and guidance for practice. Stat. Med. 30, 377–399 (2011).
Austin, P. C., White, I. R., Lee, D. S. & Van Buuren, S. Missing Data in Clinical Research: A Tutorial on Multiple Imputation. Can. J. Cardiol. 37, 1322–1331 (2021).
Pedersen, A. et al. Missing data and multiple imputation in clinical epidemiological research. Clin. Epidemiol. Volume 9, 157–166 (2017).
Unemo, M. et al. WHO global antimicrobial resistance surveillance for Neisseria gonorrhoeae 2017–18: a retrospective observational study. Lancet Microbe 2, e627–e636 (2021).
Karymbaeva, S. et al. Antimicrobial resistance and molecular epidemiological typing of Neisseria gonorrhoeae isolates from Kyrgyzstan in Central Asia, 2012 and 2017. BMC Infect. Dis. 21, 559 (2021).
Lee, D. Y. J. et al. Reflex Detection of Ciprofloxacin Resistance in Neisseria gonorrhoeae by Use of the SpeeDx ResistancePlus GC Assay. J. Clin. Microbiol. 59, e00089-21 (2021).
Yahara, K. et al. Emergence and evolution of antimicrobial resistance genes and mutations in Neisseria gonorrhoeae. Genome Med. 13, 51 (2021).
Williamson, D. A. et al. Trends and Risk Factors for Antimicrobial-Resistant Neisseria gonorrhoeae, Melbourne, Australia, 2007 to 2018. Antimicrob. Agents Chemother. 63, e01221-19 (2019).
Herrero, M. et al. Epidemiology and antimicrobial resistance profile of Neisseria gonorrhoeae in Catalonia, Spain, 2016–2019. Eur. J. Clin. Microbiol. Infect. Dis. 42, 883–893 (2023).
Clifton, S. et al. Prevalence of and factors associated with MDR Neisseria gonorrhoeae in England and Wales between 2004 and 2015: analysis of annual cross-sectional surveillance surveys. J. Antimicrob. Chemother. 73, 923–932 (2018).
Sundbeck, M., Agardh, A. & Östergren, P.-O. Travel abroad increases sexual health risk-taking among Swedish youth: a population-based study using a case-crossover strategy. Glob. Health Action 10, 1330511 (2017).
Beauté, J. et al. Travel-associated gonorrhoea in four Nordic countries, 2008 to 2013. Eurosurveillance 22, (2017).
Vivancos, R., Abubakar, I. & Hunter, P. R. Foreign travel, casual sex, and sexually transmitted infections: systematic review and meta-analysis. Int. J. Infect. Dis. 14, e842–e851 (2010).
Korzeniewski, K. & Juszczak, D. Travel-related sexually transmitted infections. Int. Marit. Health 66, 238–246 (2015).
Gareau, E. & Phillips, K. P. Key informant perspectives on sexual health services for travelling young adults: a qualitative study. BMC Health Serv. Res. 22, 145 (2022).
Vicente De La Cruz, M. D. L. M., Giesen, C. & Díaz-Menéndez, M. International travels and transmission of multidrug resistant Neisseria gonorrhoeae in Europe: A systematic review. Travel Med. Infect. Dis. 49, 102401 (2022).
CLSI. Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Seven Informational Supplement (M100–S31). (2021).
Thorington, R. et al. Antimicrobial susceptibilities of Neisseria gonorrhoeae in Canada, 2020. Can. Commun. Dis. Rep. 48, 571–579 (2022).
World Health Organization. Global action plan to control the spread and impact of antimicrobial resistance in Neisseria gonorrhoeae. (2012).
Bell, S. F. E., Ware, R. S., Lewis, D. A., Lahra, M. M. & Whiley, D. M. Antimicrobial susceptibility assays for Neisseria gonorrhoeae: a proof-of-principle population-based retrospective analysis. Lancet Microbe 4, e544–e551 (2023).
CLSI. M100 Performance Standards for Antimicrobial Susceptibility Testing. (2023).
Downloads
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2025 Jean-Pierre Gnimatin, Annick Trudelle, Annie-Claude Labbé, Karine Blouin
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Funding data
-
Institute of Infection and Immunity
Grant numbers 402759 -
Nature et technologies
Grant numbers 2023-2024-V3-337176
