Antibiotic-resistant gonorrhoea drives bulk of rise in alerts

The number of antibiotic-resistant gonorrhoea samples reported to health authorities nearly trebled in the six months to September 2017, reinforcing worldwide concern over the spread of this and other types of dangerous drug-resistant bacteria.

The latest six-monthly report of the National Alert System for Critical Antimicrobial Resistance (CARAlert) reveals 742 reports of critically resistant bacteria were lodged in the system from 1 April to 30 September 2017, a 75% increase on the 423 cases reported in the same period a year earlier.

The bulk of the rise was caused by a sharp increase in the number of reports of gonorrhoea showing resistance to azithromycin, which is part of the recommended treatment for this infection. Reports of this strain of gonorrhoea rose by 182% over the same period, from 121 to 342.

The report, released today by the Australian Commission on Safety and Quality in Health Care, shows azithromycin non-susceptible gonorrhoea is now the most frequently reported ‘critical antimicrobial resistance’ (CAR) recorded in the CARAlert system, accounting for nearly 47% of all reports from 1 April to 30 September. CARs are defined as bacteria that cannot be treated by, or are a major threat to, last-line antibiotics.

Dual (two-drug) therapy for gonorrhoea was introduced in Australia in 2014 as part of a strategy to delay the appearance of gonorrhoea strains resistant to ceftriaxone, which is the main antibiotic used to treat gonorrhoea. This strategy appears to be working, as there are very few reports in Australia of Neisseria gonorrhoeae, the bacteria responsible for gonorrhoea, not being susceptible to ceftriaxone.

However, following the addition of azithromycin to ceftriaxone treatment in 2014, azithromycin non-susceptible N. gonorrhoeae have become increasingly more common in Australia, especially over the last two years. An increase was first seen in South Australia in 2016, then across all states and territories in 2017.

The spread of antibiotic resistance is causing authorities in Australia and globally to reinforce monitoring and programs designed to slow the spread of resistance. CARAlert collects information about highly resistant bacteria as they are confirmed, allowing trends to be identified and giving states and territories additional information to help containment efforts.

The CARAlert system was established by the Commission in March 2016, with funding from the Australian Government Department of Health and the Commission. The system is a core element of the Commission’s AURA (Antimicrobial Use and Resistance in Australia) Surveillance System.

Reports to CARAlert from 1 April to 30 September were made by 65 participating laboratories nationwide. At least one strain of bacteria with some type of critical antimicrobial resistance was reported from each state and territory.

After azithromycin-non-susceptible Neisseria gonorrhoeae, the bacteria responsible for gonorrhoea, the next most commonly reported CAR was a type of bacteria called carbepenemase-producing Enterobacteriaceae (CPE).

The Commission’s Senior Medical Advisor for the AURA Surveillance System, Professor John Turnidge, said the data showed that in its second year of operation CARAlert was providing regular and timely antimicrobial resistance data to states and territories and nationally.

‘We need to know which resistant bacteria are emerging so as to be best prepared to respond to outbreaks if and when they happen,’ Professor Turnidge said. ‘CARAlert is an incredibly powerful tool, because it gives unprecedented and timely information to public health authorities and clinicians.’

A second and smaller cause of the increase in CAR reports was an outbreak of OXA-48 producing Escherichia coli (a type of CPE) detected in Queensland, where 80 cases were reported between May 2017 and July 2017.

The outbreak was largely confined to a single facility, and was controlled within two months. The frequency of reporting of CPE, and the Queensland outbreak, highlight the importance of the implementation of the Commission’s Recommendations for the control of carbapenemase-producing Enterobacteriaceae: A guide for acute health facilities.

Other CARs remain at very low levels, providing reassurance that none has become established in Australia.

The Commission continues to monitor records from CARAlert, prepare summary reports and ensure regular discussion with state and territory health departments about trends and potential CAR outbreaks to inform quality improvement initiatives and policies to reduce antimicrobial resistance.

This report is available on the Commission’s website and complements a number of CARAlert updates and reports also published there.




The AURA Surveillance System
The Commission established the Antimicrobial Use and Resistance in Australia (AURA) Surveillance System to collect and analyse information and provide reports to inform policy and practice. The AURA National Coordination Unit (NCU) of the Commission works with a range of stakeholders to inform action at the local, state and territory, and national levels to prevent and contain the spread of antimicrobial resistance. CARAlert is a core component of the AURA Surveillance System.

The National Neisseria Network
The National Neisseria Network (NNN) was established in 1981. It is supported by the Australian Government Department of Health to provide the Australian Gonococcal Surveillance Programme. Private and public laboratories throughout Australia refer isolates to the NNN Reference Laboratories for testing for antimicrobial susceptibility.

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