Population level consumption of cephalosporins and macrolides may select for reduced antimicrobial susceptibility to unrelated antimicrobials in Neisseria gonorrhoeae: an ecological analysis

Abstract

AbstractAimsPrevious studies have found positive associations between population level consumption of macrolides/cephalosporins/floroquinolones and Neisseria gonorrhoeae sensitivity to the same class of antimicrobial. We hypothesized that these associations may also apply to different classes of antimicrobials.MethodsUsing susceptibility data from 24 countries in the European Gonococcal Antimicrobial Surveillance Programme and antimicrobial consumption data from the IMS Health MIDAS database we built mixed effects linear regression models with country-level cephalosporin, quinolone and macrolide consumption (standard doses/ 1000 population/ year) as the explanatory variables (from 2009 to 2015) and 1-year lagged ceftriaxone, azithromycin and ciprofloxacin geometric mean minimum inhibitory concentrations and percent resistance as the outcome variables (2010 to 2016).ResultsPositive associations were found between the consumption of cephalosporins and geometric mean MIC ceftriaxone, cefixime and ciprofloxacin. Macrolide consumption was associated with cefixime and ciprofloxacin geometric mean MIC as well as the prevalence of antimicrobial resistance to ciprofloxacin and cefixime.ConclusionsPopulation level consumption of cephalosporins and macrolides may select for reduced antimicrobial susceptibility to unrelated antimicrobials.