Background: Gonorrhoea and widely spread antimicrobial resistance (AMR) in its etiological agent Neisseria\ngonorrhoeae are major public health concerns worldwide. Gonococcal AMR surveillance nationally and\ninternationally, to identify emerging resistance and inform treatment guidelines, is imperative for public health\npurposes. In 2009, AMR surveillance was initiated in Belarus, Eastern Europe because no gonococcal AMR data had\nbeen available for at least two decades. Herein, the prevalence and trends of gonococcal AMR and molecular\nepidemiological characteristics of N. gonorrhoeae strains from 2010 to 2013 in Belarus, are described.\nMethods: N. gonorrhoeae isolates (n=193) obtained in the Mogilev (n=142), Minsk (n=36) and Vitebsk (n=15)\nregions of Belarus in 2010 (n=72), 2011 (n=6), 2012 (n=75) and 2013 (n=40) were analyzed in regards to AMR using\nthe Etest method and for molecular epidemiology with N. gonorrhoeae multi-antigen sequence typing (NG-MAST).\nResults: During 2010ââ?¬â??2013, the proportions of resistant N. gonorrhoeae isolates were as follows: tetracycline 36%,\nciprofloxacin 28%, penicillin G 9%, azithromycin 5%, and cefixime 0.5%. Only one (0.5%) ?-lactamase producing\nisolate was detected. No isolates resistant to ceftriaxone and spectinomycin were identified. Overall, the resistance\nlevels to tetracycline, ciprofloxacin and penicillin G were relatively stable. Interestingly, the level of resistance to\nazithromycin declined from 12% in 2010 to 0% in 2013 (P < 0.05). In total, 70 NG-MAST STs were identified. The\npredominant STs were ST1993 (n=53), ST807 (n=13), ST285 (n=8) and ST9735 (n=8). Many novel STs (n=43, 61%),\nrepresenting 41% of all isolates, were found.\nConclusions: During 2010ââ?¬â??2013, the N. gonorrhoeae population in Belarus displayed high and relatively stable\nresistance levels to tetracycline, ciprofloxacin, and penicillin G, while the resistance to azithromycin declined. One\nisolate was resistant to cefixime, but no resistance to ceftriaxone or spectinomycin was found. The results of the\npresent surveillance initiated in 2009 were also used to replace penicillin G with ceftriaxone (1 g single dose\nintramuscularly) as the first-line drug for empiric treatment of gonorrhoea in the national treatment guidelines in\nBelarus in late 2009. It is essential to further strengthen the surveillance of gonococcal AMR and ideally survey also\ntreatment failures and molecular epidemiological genotypes in Belarus.
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