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Abstract：
BACKGROUND: Does the emergence of antimicrobial resistance in Neisseria gonorrhoeae include the erasure of highly susceptible strains or does it merely involve a stretching of the MIC distribution? If it was the former this would be important to know as it would increase the probability that the loss of susceptibility is irreversible.
METHODS: We conducted a historical analysis based on a literature review of changes of N. gonorrhoeae MIC distribution over the past 75 years for 3 antimicrobials (benzylpenicillin, ceftriaxone and azithromycin) in five countries (Denmark, Japan, South Africa, the United Kingdom and the United States).
RESULTS: Changes in MIC distribution were most marked for benzylpenicillin and showed evidence of a right shifting of MIC distribution that was associated with a reduction/elimination of susceptible strains in all countries. In the case of ceftriaxone and azithromycin, where only more recent data was available, right shifting was also found in all countries but the extent of right shifting varied and the evidence for the elimination of susceptible strains was more mixed.
CONCLUSIONS: The finding of right shifting of MIC distribution combined with reduction/elimination of susceptible strains is of concern since it suggests that this shifting may not be reversible. Since excess antimicrobial consumption is likely to be responsible for this right shifting, this insight provides additional impetus to promote antimicrobial stewardship.
METHODS: We conducted a historical analysis based on a literature review of changes of N. gonorrhoeae MIC distribution over the past 75 years for 3 antimicrobials (benzylpenicillin, ceftriaxone and azithromycin) in five countries (Denmark, Japan, South Africa, the United Kingdom and the United States).
RESULTS: Changes in MIC distribution were most marked for benzylpenicillin and showed evidence of a right shifting of MIC distribution that was associated with a reduction/elimination of susceptible strains in all countries. In the case of ceftriaxone and azithromycin, where only more recent data was available, right shifting was also found in all countries but the extent of right shifting varied and the evidence for the elimination of susceptible strains was more mixed.
CONCLUSIONS: The finding of right shifting of MIC distribution combined with reduction/elimination of susceptible strains is of concern since it suggests that this shifting may not be reversible. Since excess antimicrobial consumption is likely to be responsible for this right shifting, this insight provides additional impetus to promote antimicrobial stewardship.
摘要：
背景：淋病奈瑟菌耐药性的出现是否包括对高度易感菌株的消除，还是仅仅涉及MIC分布的延伸？如果是前者，这将是重要的，因为这将增加敏感性丧失是不可逆的可能性。
方法：我们根据过去75年中3种抗菌剂（苄青霉素，头孢曲松和阿奇霉素)在五个国家(丹麦，Japan,南非,联合王国和美国)。
结果：MIC分布的变化在苄青霉素中最为明显，并显示MIC分布右移的证据，这与所有国家易感菌株的减少/消除有关。在头孢曲松和阿奇霉素的情况下，只有最新的数据可用，在所有国家也发现了右移，但右移的程度各不相同，消除易感菌株的证据更加复杂。
结论：MIC分布的右移与易感菌株的减少/消除相结合的发现值得关注，因为它表明这种转移可能是不可逆的。由于过量的抗菌药物消费可能是这种右移的原因，这一见解为促进抗菌药物管理提供了额外的动力。
方法：我们根据过去75年中3种抗菌剂（苄青霉素，头孢曲松和阿奇霉素)在五个国家(丹麦，Japan,南非,联合王国和美国)。
结果：MIC分布的变化在苄青霉素中最为明显，并显示MIC分布右移的证据，这与所有国家易感菌株的减少/消除有关。在头孢曲松和阿奇霉素的情况下，只有最新的数据可用，在所有国家也发现了右移，但右移的程度各不相同，消除易感菌株的证据更加复杂。
结论：MIC分布的右移与易感菌株的减少/消除相结合的发现值得关注，因为它表明这种转移可能是不可逆的。由于过量的抗菌药物消费可能是这种右移的原因，这一见解为促进抗菌药物管理提供了额外的动力。
