Antimicrobial Consumption and Susceptibility of Neisseria gonorrhoeae: A Global Ecological Analysis

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Aims The reasons why antimicrobial resistance in Neisseria gonorrhoeae has emerged explosively in certain populations but not others are poorly understood. We hypothesized that population level consumption of antimicrobials plays a role. Methods Using susceptibility data from the World Health Organizations Global Gonococcal Antimicrobial Surveillance Programme and antimicrobial consumption data from the IMS Health MIDAS database we built linear regression models with country-level cephalosporin, macrolide and fluoroquinolone consumption (standard doses/ 1000 population/ year) as the explanatory variable and 1-year lagged ceftriaxone, azithromycin and ciprofloxacin resistance as the outcome variables. These were performed at two time points 2008/2009 and 2013/2014. Results The association between antimicrobial resistance and consumption at the level of individual countries was positive in all 6 assessments. In four instances the positive associations were statistically significant (cephalosporins 2008: coefficient 0.0005 [95% confidence interval (CI) 0.0002-0.0007] and 2013: coefficient 0.0003 [95% CI 0.0002-0.0004]; macrolides 2013: coefficient 0.0005 [95% CI 0.00002-0.001]; fluoroquinolones 2013: coefficient 0.02 [95% CI 0.006-0.031]. Conclusions Differences in population level consumption of particular antimicrobials may play a role in explaining the variations in the emergence of antimicrobial resistance in N. gonorrhoeae.

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