# Surveillance of Antimicrobial Resistance in Neisseria gonorrhoeae in Alberta from 2016–2022

## TL;DR

This study tracks antimicrobial resistance in gonorrhea in Alberta from 2016 to 2022, finding high susceptibility to key treatments but some concerning trends.

## Contribution

The study provides a seven-year retrospective analysis of gonorrhea resistance patterns and demographic trends in Alberta.

## Key findings

- All isolates were susceptible to ceftriaxone and cefixime, except one in 2018.
- Azithromycin susceptibility dropped from 99% to 88% during the study period, with the lowest in 2018.
- Males showed higher antimicrobial non-susceptibility than females for most drugs tested.

## Abstract

Background/Objectives: Neisseria gonorrhoeae can develop resistance to antimicrobial treatments, posing a challenge to effective management of patients. Alberta, Canada, monitors the antimicrobial susceptibility of gonorrhea isolates to track resistance trends. This study aims to retrospectively analyze susceptibility data and demographic trends from gonorrhea cases in the province over a seven-year period. Methods: Antimicrobial susceptibility testing was performed using gradient strip methodology on gonorrhea isolates from Alberta, evaluating both historical and currently recommended antimicrobials for treatment of gonorrhea. Susceptibility testing results were interpreted using Clinical and Laboratory Standards Institute (CLSI) breakpoints. Provincial antimicrobial susceptibility testing data were analyzed using STATA v.17, incorporating antimicrobial resistance patterns and demographic information from provincial databases. Results: Between 2016 and 2022, 4056 N. gonorrhoeae isolates were cultured from 3617 individuals. All isolates tested were susceptible to ceftriaxone and cefixime, except for a single resistant isolate in 2018. Azithromycin susceptibility ranged from 99% to 88%, with the lowest susceptibility observed in 2018. Males exhibited higher rates of antimicrobial non-susceptibility than females across all drugs tested, except for tetracycline. Conclusions: Ongoing antimicrobial susceptibility surveillance in Alberta is crucial for identifying resistance trends and informing the development of effective treatment strategies for gonorrhea.