Abstract：
OBJECTIVE: International travel combined with sex may contribute to dissemination of antimicrobial-resistant (AMR) Neisseria gonorrhoeae (Ng). To assess the role of travel in Ng strain susceptibility, we compared minimum inhibitory concentrations (MICs) for five antibiotics (ie, azithromycin, ceftriaxone, cefotaxime, cefixime and ciprofloxacin) in strains from clients with an exclusively Dutch sexual network and clients with an additional international sexual network.
METHODS: From 2013 to 2019, we recorded recent residence of sexual partners of clients (and of their partners) with Ng at the Center for Sexual Health of Amsterdam. We categorised clients as having: (1) exclusively sexual partners residing in the Netherlands (\'Dutch only\') or (2) at least one partner residing outside the Netherlands. We categorised the country of residence of sexual partners by World Bank/EuroVoc regions. We analysed the difference of log-transformed MIC of Ng strains between categories using linear or hurdle regression for each antibiotic.
RESULTS: We included 3367 gay and bisexual men who had sex with men (GBMSM), 516 women and 525 men who exclusively had sex with women (MSW) with Ng. Compared with GBMSM with a \'Dutch only\' network, GBMSM with: (1) a Western European network had higher MICs for ceftriaxone (β=0.19, 95% CI=0.08 to 0.29), cefotaxime (β=0.19, 95% CI=0.08 to 0.31) and cefixime (β=0.06, 95% CI=0.001 to 0.11); (2) a Southern European network had a higher MIC for cefixime (β=0.10, 95% CI=0.02 to 0.17); and (3) a sub-Saharan African network had a lower MIC for ciprofloxacin (β=-1.79, 95% CI=-2.84 to -0.74). In women and MSW, higher MICs were found for ceftriaxone in clients with a Latin American and Caribbean network (β=0.26, 95% CI=0.02 to 0.51).
CONCLUSIONS: For three cephalosporin antibiotics, we found Ng strains with slightly higher MICs in clients with partner(s) from Europe or Latin America and the Caribbean. International travel might contribute to the spread of Ng with lower susceptibility. More understanding of the emergence of AMR Ng is needed.
METHODS: From 2013 to 2019, we recorded recent residence of sexual partners of clients (and of their partners) with Ng at the Center for Sexual Health of Amsterdam. We categorised clients as having: (1) exclusively sexual partners residing in the Netherlands (\'Dutch only\') or (2) at least one partner residing outside the Netherlands. We categorised the country of residence of sexual partners by World Bank/EuroVoc regions. We analysed the difference of log-transformed MIC of Ng strains between categories using linear or hurdle regression for each antibiotic.
RESULTS: We included 3367 gay and bisexual men who had sex with men (GBMSM), 516 women and 525 men who exclusively had sex with women (MSW) with Ng. Compared with GBMSM with a \'Dutch only\' network, GBMSM with: (1) a Western European network had higher MICs for ceftriaxone (β=0.19, 95% CI=0.08 to 0.29), cefotaxime (β=0.19, 95% CI=0.08 to 0.31) and cefixime (β=0.06, 95% CI=0.001 to 0.11); (2) a Southern European network had a higher MIC for cefixime (β=0.10, 95% CI=0.02 to 0.17); and (3) a sub-Saharan African network had a lower MIC for ciprofloxacin (β=-1.79, 95% CI=-2.84 to -0.74). In women and MSW, higher MICs were found for ceftriaxone in clients with a Latin American and Caribbean network (β=0.26, 95% CI=0.02 to 0.51).
CONCLUSIONS: For three cephalosporin antibiotics, we found Ng strains with slightly higher MICs in clients with partner(s) from Europe or Latin America and the Caribbean. International travel might contribute to the spread of Ng with lower susceptibility. More understanding of the emergence of AMR Ng is needed.
摘要：
目的：国际旅行结合性别可能导致耐药淋病奈瑟菌（Ng）的传播。为了评估旅行在Ng菌株易感性中的作用，我们比较了五种抗生素的最低抑制浓度（MIC）（即，阿奇霉素,头孢曲松,头孢噻肟,头孢克肟和环丙沙星）来自具有荷兰性网络的客户和具有其他国际性网络的客户的菌株。
方法：从2013年到2019年，我们在阿姆斯特丹性健康中心记录了客户（及其伴侣）与Ng的性伴侣的最近住所。我们将客户分类为：（1）居住在荷兰的专有性伴侣（“仅限荷兰”）或（2）至少有一个居住在荷兰境外的伴侣。我们按世界银行/EuroVoc地区对性伴侣的居住国家进行了分类。我们使用每种抗生素的线性或障碍回归分析了类别之间Ng菌株的对数转化MIC的差异。
结果：我们包括3367名与男性发生性关系的男同性恋和双性恋男性（GBMSM），516名女性和525名男性与女性发生性关系（MSW）与Ng。与具有“仅荷兰”网络的GBMSM相比，GBMSM具有：（1）西欧网络对头孢曲松的MIC较高（β=0.19，95％CI=0.08至0.29），头孢噻肟（β=0.19，95％CI=0.08至0.31）和头孢克肟（β=0.06，95％CI=0.001至0.11）；（2）南欧网络对头孢克肟的MIC较高（β=0.10，95％CI=0.02至0.17）；（3）撒哈拉以南非洲网络对环丙沙星的MIC较低（β=-1.79至95％=0.84）。在女性和城市生活垃圾中，在拉丁美洲和加勒比网络的客户中发现头孢曲松的中等收入国家较高(β=0.26,95%CI=0.02~0.51).
结论：对于三种头孢菌素类抗生素，我们在与来自欧洲或拉丁美洲和加勒比地区的合作伙伴的客户中发现了具有稍高的MIC的Ng菌株。国际旅行可能会导致Ng的传播，而易感性较低。需要更多地了解AMRNg的出现。
方法：从2013年到2019年，我们在阿姆斯特丹性健康中心记录了客户（及其伴侣）与Ng的性伴侣的最近住所。我们将客户分类为：（1）居住在荷兰的专有性伴侣（“仅限荷兰”）或（2）至少有一个居住在荷兰境外的伴侣。我们按世界银行/EuroVoc地区对性伴侣的居住国家进行了分类。我们使用每种抗生素的线性或障碍回归分析了类别之间Ng菌株的对数转化MIC的差异。
结果：我们包括3367名与男性发生性关系的男同性恋和双性恋男性（GBMSM），516名女性和525名男性与女性发生性关系（MSW）与Ng。与具有“仅荷兰”网络的GBMSM相比，GBMSM具有：（1）西欧网络对头孢曲松的MIC较高（β=0.19，95％CI=0.08至0.29），头孢噻肟（β=0.19，95％CI=0.08至0.31）和头孢克肟（β=0.06，95％CI=0.001至0.11）；（2）南欧网络对头孢克肟的MIC较高（β=0.10，95％CI=0.02至0.17）；（3）撒哈拉以南非洲网络对环丙沙星的MIC较低（β=-1.79至95％=0.84）。在女性和城市生活垃圾中，在拉丁美洲和加勒比网络的客户中发现头孢曲松的中等收入国家较高(β=0.26,95%CI=0.02~0.51).
结论：对于三种头孢菌素类抗生素，我们在与来自欧洲或拉丁美洲和加勒比地区的合作伙伴的客户中发现了具有稍高的MIC的Ng菌株。国际旅行可能会导致Ng的传播，而易感性较低。需要更多地了解AMRNg的出现。
