SURVEILLANCE OF ANTIBIOTIC-RESISTANCE IN NEISSERIA-GONORRHOEAE IN THENETHERLANDS, 1977-95

Objective: To evaluate the prevalence and epidemiology of penicillinas e producing Neisseria gonorrhoeae (PPNG) and tetracycline resistant N gonorrhoeae (TRNG) in the period 1977-95 in the Netherlands. To compar e auxotypes, serovars, and antibiograms of PPNG, non-PPNG, and TRNG. T o identify determinants in patient characteristics for the epidemic sp read of TRNG/PPNG. Methods: With respect to the national gonococcal su rveillance all PPNG isolates from 30 laboratories over the country in 1977-90 and all gonococcal isolates from five sentinel laboratories (d uring 1 month per quarter) in 1991-5 were collected. Isolates were aux otyped and serotyped, the susceptibility for various antibiotics was t ested and plasmid contents were evaluated. Additional data on PPNG inf ected individuals were collected retrospectively during a microepidemi c of TRNG/PPNG. Univariate and multivariate analyses were performed to identify risk factors for TRNG/PPNG infections. Results: In 1995 an o verall high prevalence of PPNG infection (27%) and TRNG among PPNG inf ection (24%) was found in the Netherlands. Importantly, PPNG were foun d to have higher MICs for ceftriaxone and ciprofloxacin than non-PPNG; clinically relevant resistance to these antibiotics (or related agent s) may emerge first among these strains. The observed diversity of str ains (123 auxo/serovar classes since 1988) indicates a continuous intr oduction of new strains into the community. The epidemic increase of T RNG/PPNG was mainly caused by A/S classes NR/1B-6, PRO/1A-3, and PRO/1 A-6, suggesting a clonal spread of a few strains; the rapid spread was associated with transmission in high risk individuals (that is, prost itutes and their clients). Conclusion: The prevalence of PPNG in the N etherlands remains high and reduced sensitivity to other antimicrobial s was detected among the PPNG strains. This underlines the necessity f or a continuous national surveillance of resistance in gonococci inclu ding limited epidemiological information.