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Antimicrobial Resistance Expressed by : A Major Global Public Health Problem in the 21st Century

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  • Authors: Magnus Unemo1, Carlos del Rio2, William M. Shafer3
  • Editors: W. Michael Scheld5, James M. Hughes6, Richard J. Whitley7
  • VIEW AFFILIATIONS HIDE AFFILIATIONS
    Affiliations: 1: WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Microbiology, Örebro University Hospital, SE-701 85 Örebro, Sweden; 2: Hubert Department of Global Health, Rollins School of Public Health of Emory University and Department of Medicine, Division of Infectious Diseases; 3: Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA 30322; 4: Veterans Affairs Medical Center (Atlanta), Decatur, GA 30033; 5: Department of Infectious Diseases, University of Virginia Health System, Charlottesville, VA; 6: Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA; 7: Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
  • Source: microbiolspec June 2016 vol. 4 no. 3 doi:10.1128/microbiolspec.EI10-0009-2015
  • Received 25 November 2015 Accepted 22 December 2015 Published 10 June 2016
  • William M. Shafer, wshafer@emory.edu
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  • Abstract:

    is a strictly human pathogen that is typically transmitted by sexual contact. The associated disease gonorrhea has plagued humankind for thousands of years, with a current estimated incidence of 78 million cases per year. Advances in antimicrobial discovery in the 1920s and 1930s leading to the discovery of sulfonamides and penicillin begun the era of effective antimicrobial treatment of gonorrhea. Unfortunately, the gonococcus developed decreased susceptibility or even resistance to these initially employed antibiotics, a trend that continued over subsequent decades with each new antibiotic that was brought into clinical practice. As this pattern of resistance has continued into the 21st century, there is now reason for great concern, especially in an era when few new antibiotics have prospects for use as treatment of gonorrhea. Here, we review the history of gonorrhea treatment regimens and gonococcal resistance to antibiotics, the mechanisms of resistance, resistance monitoring schemes that exist in different international settings, global responses to the challenge of resistance, and prospects for future treatment regimens in the 21st century.

  • Citation: Unemo M, del Rio C, Shafer W. 2016. Antimicrobial Resistance Expressed by : A Major Global Public Health Problem in the 21st Century. Microbiol Spectrum 4(3):EI10-0009-2015. doi:10.1128/microbiolspec.EI10-0009-2015.

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/content/journal/microbiolspec/10.1128/microbiolspec.EI10-0009-2015
2016-06-10
2017-09-26

Abstract:

is a strictly human pathogen that is typically transmitted by sexual contact. The associated disease gonorrhea has plagued humankind for thousands of years, with a current estimated incidence of 78 million cases per year. Advances in antimicrobial discovery in the 1920s and 1930s leading to the discovery of sulfonamides and penicillin begun the era of effective antimicrobial treatment of gonorrhea. Unfortunately, the gonococcus developed decreased susceptibility or even resistance to these initially employed antibiotics, a trend that continued over subsequent decades with each new antibiotic that was brought into clinical practice. As this pattern of resistance has continued into the 21st century, there is now reason for great concern, especially in an era when few new antibiotics have prospects for use as treatment of gonorrhea. Here, we review the history of gonorrhea treatment regimens and gonococcal resistance to antibiotics, the mechanisms of resistance, resistance monitoring schemes that exist in different international settings, global responses to the challenge of resistance, and prospects for future treatment regimens in the 21st century.

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Figures

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FIGURE 1

Gonococcal Isolate Surveillance Project (GISP) sentinel sites and regional laboratories in 2015. Courtesy of Centers for Diseases Control and Prevention (http://www.cdc.gov/std/gisp/gisp-map.htm).

Source: microbiolspec June 2016 vol. 4 no. 3 doi:10.1128/microbiolspec.EI10-0009-2015
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Image of FIGURE 2
FIGURE 2

Gonococcal Isolate Surveillance Project (GISP) antimicrobial testing panel with Clinical and Laboratory Standards Institute (CLSI) breakpoints in 2014. Gray = sensitive; yellow = Intermediate; orange/red = resistant.

Source: microbiolspec June 2016 vol. 4 no. 3 doi:10.1128/microbiolspec.EI10-0009-2015
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FIGURE 3

Prevalence of resistance in in the U.S. Gonococcal Isolate Surveillance Project (GISP) from 2000 to 2014. R, resistance; RS, reduced susceptibility.

Source: microbiolspec June 2016 vol. 4 no. 3 doi:10.1128/microbiolspec.EI10-0009-2015
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FIGURE 4

Antimicrobials used to treat gonorrhea in the United States from 1988 to 2013. Courtesy of Centers for Disease Control and Prevention (http://www.cdc.gov/std/gisp/gisp2013.htm).

Source: microbiolspec June 2016 vol. 4 no. 3 doi:10.1128/microbiolspec.EI10-0009-2015
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Tables

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TABLE 1

Main antimicrobial resistance determinants in for previously and currently recommended antimicrobials for treatment of gonorrhea (adapted from reference 12 )

Source: microbiolspec June 2016 vol. 4 no. 3 doi:10.1128/microbiolspec.EI10-0009-2015
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TABLE 2

Recommended treatments for uncomplicated infections of the urethra, cervix, rectum, and pharynx in adults and youth in the United States, Canada, Australia, and Europe

Source: microbiolspec June 2016 vol. 4 no. 3 doi:10.1128/microbiolspec.EI10-0009-2015
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TABLE 3

Key components of the WHO global action plan to control the spread and impact of antimicrobial resistance in

Source: microbiolspec June 2016 vol. 4 no. 3 doi:10.1128/microbiolspec.EI10-0009-2015

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