Antimicrobial resistance in Neisseria gonorrhoeae isolates and gonorrhoea treatment in the Republic of Belarus, Eastern Europe, 2009–2019

Abstract Background Limited antimicrobial resistance (AMR) data for Neisseria gonorrhoeae are available in Eastern Europe. We investigated AMR N. isolates the Republic of Belarus from 2009 to 2019, treatment recommended nationally, and given patients with gonorrhoea. Methods ( n = 522) cultured three regions 2009–2019 were examined. Determination minimum inhibitory concentrations (MICs) eight antimicrobials was performed using Etest. Resistance breakpoints European Committee on Antimicrobial Susceptibility Testing applied where available. A Nitrocefin test identified ?-lactamase production. Gonorrhoea 1652 also analysed. Statistical significance determined by Z-test, Fisher’s exact test, or Mann-Whitney U p -values < 0.05 indicating significance. Results In total, 27.8% resistant tetracycline, 24.7% ciprofloxacin, 7.0% benzylpenicillin, 2.7% cefixime, 0.8% azithromycin. No ceftriaxone, spectinomycin, gentamicin. However, 14 (2.7%) had a ceftriaxone MIC 0.125 mg/L, exactly at breakpoint (MIC > mg/L). Only one (0.2%) isolate, 2013, produced ?-lactamase. From levels ciprofloxacin tetracycline relatively high stable. cefixime not before 2013 but peaked 22.2% 2017. sporadic azithromycin found 1), 2012 (n 2018–2019 2). Overall, 862 (52.2%) received first-line according national guidelines (ceftriaxone 1 g). 154 (9.3%) nationally alternative (cefixime 400 mg ofloxacin mg), 636 (38.5%) non-recommended treatment. Conclusions The gonococcal high, however, low no identified. Ceftriaxone g can continuously be as empiric gonorrhoea therapy Belarus. Fluoroquinolones should prescribed if susceptibility has been confirmed testing. Timely updating compliance evidence-based based quality-assured imperative. need continued, improved enhanced surveillance is evident.