Mandated Reporting of Neisseria Gonorrhoeae Antimicrobial Susceptibility Test Results to a Local Health Department to Surveil for the Emergence of Cephalosporin Resistance

Background: :  In 2008, the New York City (NYC) Department of Health and Mental Hygiene modified local health code to require clinical laboratories to report antimicrobial susceptibility testing (AST) results for Neisseria gonorrhoeae (Ng) within 24 hours of result. All clinical laboratory reporting in NYC is electronic. In 2010, a survey of clinical laboratories serving NYC residents found 25 laboratories performed Ng AST.

Objectives: To describe the frequency of elevated minimum inhibitory concentrations (MICs) to cephalosporins among Ng isolates in NYC.

Methods: Electronically submitted Ng AST results for specimens collected between January 2010 and June 2011 were characterized. For surveillance purposes, MICs of ­­> 0.125 ug/ml to Ceftriaxone or Cefixime, were considered elevated.

Results: During the 18 month period 21 labs reported AST results for 1129 Ng isolates from 1022 unique patients (143 female, 873 male, 1 transgender, 5 unknown sex). Most laboratories (18/21 (86%)) tested against  >1 cephalosporin. A single lab reported AST results for 1011/1060 (95%) of the isolates tested against cephalosporins.  Among 1017 GC isolates with AST MIC results for Ceftriaxone or Cefixime,  29/1017 (2.8%) had an MIC >0.125 (highest Ceftriaxone MIC = 0.250 ug/ml, n=2; highest Cefixime MIC =0.250 ug/ml, n=1); 93% (27/29) were from men (median age 28).

Conclusions: Mandated reporting of AST results for GC is feasible. In NYC, approximately 3% isolates with MICs reported for Ceftriaxone or Cefixime had an MIC> 0.125 ug/ml, however, none exceeded consensus thresholds for decreased susceptibility (>0.250 ug/ml). GC AST trends can be monitored for the emergence of local cephalosporin resistance.

Implications for Programs, Policy, and Research: Public health departments can monitor local antibiotic susceptibility patterns and can follow up on individual cases to assure adequate treatment and to ascertain clinical response to therapy. In NYC, Ng cases with elevated MICs to Ceftriaxone or Cefixime are followed up for partner notification.