HPR volume 16 issue 12: news (12 December 2022)
Updated 30 December 2022
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GRASP annual report in summary
The UK Health Security Agency (UKHSA) has published its annual Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) report, presenting the latest data on antimicrobial resistance in Neisseria gonorrhoeae in England and Wales.
Between 2020 and 2021, Neisseria gonorrhoeae isolates collected through GRASP showed:
- a decrease in reduced susceptibility (minimum inhibitory concentration (MIC) >0.03 mg/L) to ceftriaxone, the current first-line therapy, from 1.4% in 2020 to 0.07% in 2021
- the modal ceftriaxone MIC increased to 0.015 mg/L after having remained stable at 0.008 mg/L since 2018
- the ceftriaxone MIC for isolates from gay, bisexual, and other men who have sex with men (GBMSM) remained higher (0.015 mg/L) than those from both women and heterosexual men (0.008 mg/L)
- although there were no cases of ceftriaxone resistance (MIC >0.125 mg/L) in the GRASP collection, there were 11 cases of ceftriaxone resistance confirmed by the UKHSA Antimicrobial resistance in sexually transmitted infections (STIs) (AMRSTI) national reference laboratory on direct referral from January 2021 to June 2022, compared to no cases in 2020 and 3 cases in 2019
- azithromycin resistance (MIC >0.5 mg/L) increased from 8.7% to 15.2%
- cefixime resistance (MIC >0.125 mg/L) decreased from 0.6% to 0.3%
- ciprofloxacin resistance (MIC >0.06 mg/L) increased from 44.3% to 46.9%
- penicillin resistance (MIC >1.0 mg/L) increased from 9.6% to 14.1%
- tetracycline resistance (MIC >1.0 mg/L) increased from 65.1% to 75.2%
Prescribing data demonstrated excellent adherence to the UK guideline for managing infection with N. gonorrhoeae, with 97.1% of individuals receiving the recommended first-line of ceftriaxone 1 g intramuscular (IM) monotherapy in 2021.
The effectiveness of first-line treatment for gonorrhoea continues to be threatened by the development of antimicrobial resistance. The ongoing decline in reduced ceftriaxone susceptibility and cefixime resistance are encouraging developments. However, increases in the ceftriaxone modal MIC and the number of referred resistant isolates to AMRSTI show that increases in susceptibility are not universal and require continual monitoring.
Sexual health services should report cases of suspected treatment failure to UKHSA via the online HIV and STI web portal.
Infection reports
Group A streptococcal infections: activity during the 2022 to 2023 season.
Travel-associated infections in London: 2020, 2021 and 2022.
Listeriosis in England and Wales: summary for 2020.
Laboratory confirmed cases of measles, rubella and mumps in England: July to September 2022.
Emerging infection hazards, outbreaks and incidents
Diphtheria: cases among asylum seekers in England, 2022.