Paula Salmerón1,2,3, Belén Viñado1, Maider Arando1,2, Eva Alcoceba4, Beatriz Romero5, Blanca Menéndez2,6, Samuel Bernal2,7, Pedro Idigoras8, Javier Colomina9, Gloria Martin-Saco2,10, Álvaro Leal-Negredo2,11, Aurora Torreblanca2,12, Olalla Martinez13, Judit Serra-Pladevall*1,2,3

1 Vall d’Hebron University Hospital. Vall d’Hebron Research Institute. Barcelona. Spain.

2 Sexually Transmitted Infections Study Group (GEITS). Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC)

3 Autonomous University of Barcelona (UAB). Barcelona. Spain.

4 Son Espases University Hospital. Mallorca. Spain.

5 Ramón y Cajal University Hospital. Ramón y Cajal Institute for Health Research (IRYCIS). Madrid. Spain.

6 Sandoval Health Centre. San Carlos Clinical Hospital. San Carlos Institute for Health Research (IdISSC). Madrid. Spain.

7 Valme University Hospital. Sevilla. Spain.

8 Donostia University Hospital. San Sebastián. Spain

9 Valencia University Clinical Hospital. Valencia. Spain.

10 Miguel Servet University Hospital. Zaragoza. Spain.

11 Asturias Central University Hospital. Oviedo. Spain.

12 Cabueñes University Hospital. Gijón. Spain.

13 La Ribera University Hospital, Alzira, Valencia. Spain.

Background: Gonococcal infection is one of the most common sexually transmitted infections and the emergence of antimicrobial resistance is becoming a major public health concern globally. The aim of this article is to describe phenotypic antimicrobial resistance of Neisseria gonorrhoeae and epidemiological data from patients with gonococcal infection in eight different regions of Spain. With this approach, the study aims to explore the actual situation of this infection in Spain in order to update the local therapeutic guidelines.    

Methods: All N. gonorrhoeae isolates recovered from clinical specimens from April 1st 2018 to September 30th 2019 from ten hospitals in Spain were included. The minimum inhibitory concentrations (MICs) of ceftriaxone, cefixime, ciprofloxacin, azithromycin, gentamicin and fosfomycin were determined by gradient diffusion method. Results were interpreted following the European Committee on Antimicrobial Susceptibility Testing breakpoints (EUCAST).

Statistical analysis was performed using Stata (StataCorp, USA). Baseline characteristics were compared between men who have sex with other men (MSM), heterosexuals, and men who have sex with men and women (MSMW) using the Chi-squared test. Resistance determinants were identified using logistic regression analysis. Univariable and multivariable analyses were performed.

Results: Antimicrobial susceptibility testing was performed on 2571 gonococci isolated from 2429 patients. 44.5% (945/2124) of patients whose sexual behavior was known were men who have sex with men. Antimicrobial resistance rate to extended-spectrum cephalosporins were low, with 0.2% (6/2571) isolates showing resistance to ceftriaxone and 1.8% (44/2571) to cefixime. The overall azithromycin resistance rate was 12.1% (310/2571), although it greatly differed depending on the area. 56.4% of the strains studied were ciprofloxacin resistant. MIC50 and MIC90 values to gentamicin were 4 and 8 mg/L and to fosfomycin 24 and 48 mg/L, respectively.

Conclusions: Our study suggests that N. gonorrhoeae susceptibility to extended-spectrum cephalosporins remains high and stable in Spain. Azithromycin resistance rate could call into question the suitability of dual therapy. Antimicrobial surveillance programs of N. gonorrhoeae in a national level are essential to prevent the emergence and spread of resistant strains.

34 IUSTI Congress - European Congres on Sexually transmitted Infections and HIV/AIDS
Bucharest, September 3-5,