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Fifteen years of a nationwide culture collection of Neisseria gonorrhoeae antimicrobial resistance in Portugal

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Abstract

Neisseria gonorrhoeae antimicrobial resistance (AMR) and gonorrhea disease burden remain major public health concerns worldwide. To contribute to the supranational demands to monitor and manage the spread of antimicrobial-resistant N. gonorrhoeae, the Portuguese NIH promoted the creation of the National Laboratory Network for Neisseria gonorrhoeae Collection (PTGonoNet). The present study reports the N. gonorrhoeae major AMR trends observed from 2003 up to 2018. All isolates described in the present study constitute the opportunistic ongoing N. gonorrhoeae isolate collection supported by the National Reference Laboratory for Sexually Transmitted Infections of the Portuguese NIH, enrolling strains isolated in 35 different public and private laboratories. Minimum inhibitory concentrations were determined using E-tests for azithromycin, benzylpenicillin, cefixime, ceftriaxone, ciprofloxacin, gentamicin, spectinomycin and tetracycline. Molecular typing was determined using NG-MAST. AMR data of 2596 country-spread isolates show that 87.67% of all N. gonorrhoeae isolates presented decreased susceptibility to at least one antimicrobial. A continuous decreased susceptibility and resistance to penicillin, tetracycline and ciprofloxacin can be observed along the years. However, no decreased susceptibility to cephalosporins was observed until 2018, while for azithromycin, this was always low. The most common observed NG-MAST genogroups were G1407, G7445, G225, G2, and G1034. This study evidences the advantages of a nationwide collection of isolates and of centralized AMR testing to respond to supranational (EURO-GASP) requirements while providing unprecedented data on AMR in the context of 15 years of surveillance.

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Ackowledgement

The author work like to acknowledge: 1) Cristina Furtado for her support in launching PTGonoNet (http://www.insa.min-saude.pt/category/areas-deatuacao/doencas-infeciosas/rede-nacional-de-vigilancia-laboratorial-de-estirpes-de-n-gonorrhoeae/); 2) the laboratory technicians Lúcia Reis, Maria Arminda Ferreira, Albertina Paulino, and Ana Isabel Salas; 3) the support staff of INSA, in particular Sandra Pimenta, Rute Nunes, Augusta Correia, Susana Melo, Gustavo Duque, Lúcia Vieira, Conceição Moreira, Paula Grilo, Fernanda Martins and Elsa Graça; and, 4) all technicians and pathologists of PTGonoNet participants, in particular to José Manuel Amorim. Thanks to Jacinta Azevedo and Cândida Fernandes for fruitful discussions concerning gonorrhea clinical presentation, epidemiology and therapeutics.

PTGonoNet work group

Filipa Alegria, Aqualab Laboratório Clínico e de Saúde Pública Lda

Ana Jacinta Piedade, Beatriz Godinho - Análises Clínicas

Maria Beatriz Tomaz, Beatriz Godinho - Análises Clínicas

Cristina Toscano, Centro Hospitalar de Lisboa Ocidental, E.P.E.

Mariana Pessanha, Centro Hospitalar de Lisboa Ocidental, E.P.E.

Eliana Costa, Centro Hospitalar de Trás-os-Montes e Alto Douro, E.P.E.

Agostinho Lira, Centro Hospitalar de Vila Nova de Gaia/Espinho, E.P.E.

Catarina Chaves, Centro Hospitalar e Universitário de Coimbra (CHUC)

Ana Cristina Silva, Centro Hospitalar Entre Douro e Vouga (Clinical Pathology Service)

Margarida Feijó Pinto, Centro Hospitalar Universitário de Lisboa Central, E.P.E. (CHULC)

Manuela Ribeiro, Centro Hospitalar Universitário de São João (CHUSJ)

Angélica Costa Ramos, Centro Hospitalar Universitário de São João (CHUSJ)

Hugo Cruz, Centro Hospitalar Universitário do Porto, E.P.E.

Maria Helena Ramos, Centro Hospitalar Universitário do Porto, E.P.E.

José Melo Cristino, Centro Hospitalar Universitário Lisboa Norte, E.P.E.

Maria Inês Stilwell, Cintramédica

Carlos Marques, Cintramédica

Mariana Garcez, Hormofuncional Affidea

Maritza Pereira, Hormofuncional Affidea

Vera Santos, Hemobiolab Affidea

Marco Amaral, Hemobiolab Affidea

Maria José Rego de Sousa, Grupo Germano de Sousa – Centro de Medicina Laboratorial

Maria Favila Menezes, Grupo Germano de Sousa – Centro de Medicina Laboratoria

Elsa Calado, Grupo Germano de Sousa – Centro de Medicina Laboratorial, Porto

Luís Dias, Grupo Germano de Sousa – Centro de Medicina Laboratorial, Porto

Florbela Pereira, Hospital da Cruz Vermelha

Idalina Rocha, Hospital da Cruz Vermelha

Paula Mota Vieira, Hospital da Senhora da Oliveira Guimarães, E.P.E.

Maria Alberta Faustino, Hospital de Braga, E.P.E.

Maria Carmen Iglesias, Hospital de Braga, E.P.E.

Rita Pinto, Hospital do Divino Espírito Santo de Ponta Delgada, E.P.E.

Lúcia Serpa, Hospital do Divino Espírito Santo de Ponta Delgada, E.P.E.

Adriana Coutinho, Hospital do Espírito Santo de Évora, E.P.E.

Filomena Caldeira, Hospital do Espírito Santo de Évora, E.P.E.

José Diogo, Hospital Garcia de Orta, E.P.E.

Luísa Sancho, Hospital Professor Doutor Fernando Fonseca, E.P.E.

Sandra Schafer, Hospital Professor Doutor Fernando Fonseca, E.P.E.

José Carlos Camisão, Imunolab - Centro Diagnóstico Imunológico SA

Graça Trigueiro, Joaquim Chaves Saúde (JCS)

Alexandra Costa, Joaquim Chaves Saúde (JCS)

Alda Campos, Laboratório Aeminium

Alexandra Pereira, Laboratório Bernardina Sancho

Ana Catarina Guerreiro, Laboratório de Análises Clínicas Dr. J. Leitão Santos, Lda.

Gizela Santos, Laboratório de Análises Clínicas Dr. J. Leitão Santos, Lda.

Mónica Cardoso, Laboratório de Análises Clínicas Noémia Igreja

Filomena Lencastre, Laboratório Virgílio M. Roldão, Lda.

Luísa Frazão, Laboratório de Análises Clínicas Dr. Joaquim Rodrigues, Lda.

Sofia Soares, Soares & Figueiredo, S.A. Laboratório de Análises Clínicas e Águas

Inês Figueiredo, Soares & Figueiredo, S.A. Laboratório de Análises Clínicas e Águas

Vitória Rodrigues, SYNLAB

Eugénio Corrêa, SYNLAB

Rui Campainha, UNILABS_Lisboa

Maria Rosário Barros, UNILABS_Porto

Sofia Botelho Moniz, UNILABS_Porto

Funding

M. Pinto was supported by the Portuguese Science and Technology Foundation (FCT) through grant SFRH/BD/109264/2015.

Author information

Authors and Affiliations

  1. Bioinformatics Unit, Department of Infectious Diseases, Instituto Nacional de Saúde Doutor Ricardo Jorge, INSA, Avenida Padre Cruz, 1649-016, Lisbon, Portugal

    Miguel Pinto & João Paulo Gomes

  2. Laboratory of Microbiology, Department of Infectious Diseases, Instituto Nacional de Saúde Doutor Ricardo Jorge, INSA, Avenida Padre Cruz, 1649-016, Lisbon, Portugal

    João Carlos Rodrigues, Rui Matias & Ivone Água-Doce

  3. National Reference Laboratory for Sexually Transmitted Infections, Department of Infectious Diseases, National Institute of Health, Avenida Padre Cruz, 1649-016, Lisbon, Portugal

    Dora Cordeiro, Cristina Correia & Maria José Borrego

Authors
  1. Miguel Pinto
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  2. João Carlos Rodrigues
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  3. Rui Matias
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  4. Ivone Água-Doce
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  5. Dora Cordeiro
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  6. Cristina Correia
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  7. João Paulo Gomes
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  8. Maria José Borrego
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Consortia

PTGonoNet

  • Filipa Alegria
  • , Ana Jacinta Piedade
  • , Maria Beatriz Tomaz
  • , Cristina Toscano
  • , Mariana Pessanha
  • , Eliana Costa
  • , Agostinho Lira
  • , Catarina Chaves
  • , Ana Cristina Silva
  • , Margarida Feijó Pinto
  • , Manuela Ribeiro
  • , Angélica Costa Ramos
  • , Hugo Cruz
  • , Maria Helena Ramos
  • , José Melo Cristino
  • , Maria Inês Stilwell
  • , Carlos Marques
  • , Mariana Garcez
  • , Maritza Pereira
  • , Vera Santos
  • , Marco Amaral
  • , Maria José Rego de Sousa
  • , Maria Favila Menezes
  • , Elsa Calado
  • , Luís Dias
  • , Florbela Pereira
  • , Idalina Rocha
  • , Paula Mota Vieira
  • , Maria Alberta Faustino
  • , Maria Carmen Iglesias
  • , Rita Pinto
  • , Lúcia Serpa
  • , Adriana Coutinho
  • , Filomena Caldeira
  • , José Diogo
  • , Luísa Sancho
  • , Sandra Schafer
  • , José Carlos Camisão
  • , Graça Trigueiro
  • , Alexandra Costa
  • , Alda Campos
  • , Alexandra Pereira
  • , Ana Catarina Guerreiro
  • , Gizela Santos
  • , Mónica Cardoso
  • , Filomena Lencastre
  • , Luísa Frazão
  • , Sofia Soares
  • , Inês Figueiredo
  • , Vitória Rodrigues
  • , Eugénio Corrêa
  • , Rui Campainha
  • , Maria Rosário Barros
  •  & Sofia Botelho Moniz

Contributions

JPG and MJB conceived and designed the study. PTGonoNet participants collected, performed diagnosis, isolated, and send all strains to the reference laboratory. MP, JCR, RM, IAD, DC, and CC performed the wet lab experiments. MP performed research and analyzed the data. MP, JPG, and MJB wrote the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Maria José Borrego.

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Pinto, M., Rodrigues, J.C., Matias, R. et al. Fifteen years of a nationwide culture collection of Neisseria gonorrhoeae antimicrobial resistance in Portugal. Eur J Clin Microbiol Infect Dis 39, 1761–1770 (2020). https://doi.org/10.1007/s10096-020-03907-7

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