The number of antibiotic-resistant gonorrhoea samples reported to health authorities skyrocketed in the six months to September 2017

The Australian Commission on Safety and Quality in Health Care says the near tripling of antibiotic-resistant gonorrhoea rates highlights worldwide concern over the spread of this and other types of dangerous drug-resistant bacteria.

The latest six-monthly report of the National Alert System for Critical Antimicrobial Resistance (CARAlert) reveals 742 reports of critically resistant bacteria were lodged in the system from 1 April to 30 September 2017, a 75% increase on the 423 cases reported in the same period a year earlier.

The rise was largely caused by a jump in the number of reports of gonorrhoea showing resistance to azithromycin. Reports of this strain of gonorrhoea rose by 182% over the same period, from 121 to 342.

The report, released by the Australian Commission on Safety and Quality in Health Care, shows azithromycin non-susceptible gonorrhoea is now the most frequently reported ‘critical antimicrobial resistance’ (CAR) recorded in the CARAlert system, accounting for nearly 47% of all reports from 1 April to 30 September. CARs are defined as bacteria that cannot be treated by, or are a major threat to, last-line antibiotics.

Dual (two-drug) therapy for gonorrhoea was introduced in Australia in 2014 as part of a strategy to delay the appearance of gonorrhoea strains resistant to ceftriaxone, which is the main antibiotic used to treat gonorrhoea. The Commission says the strategy appears to be having an impact, as there are very few reports in Australia of Neisseria gonorrhoeae not being susceptible to ceftriaxone.

However, following the addition of azithromycin to ceftriaxone treatment in 2014, azithromycin non-susceptible N. gonorrhoeae have become increasingly more common in Australia, especially over the last two years. An increase was first seen in South Australia in 2016, then across all states and territories in 2017.

The spread of antibiotic resistance is causing authorities in Australia and globally to reinforce monitoring and programs designed to slow the spread of resistance. CARAlert collects information about highly resistant bacteria as they are confirmed, allowing trends to be identified and giving states and territories additional information to help containment efforts.

Reports to CARAlert from 1 April to 30 September were made by 65 participating laboratories nationwide. At least one strain of bacteria with some type of critical antimicrobial resistance was reported from each state and territory.

After azithromycin-non-susceptible Neisseria gonorrhoeae, the next most commonly reported CAR was carbepenemase-producing Enterobacteriaceae (CPE).

The Commission’s Senior Medical Advisor for the AURA Surveillance System, Professor John Turnidge, says the data shows that in its second year of operation CARAlert is providing regular and timely antimicrobial resistance data to states and territories and nationally.

“We need to know which resistant bacteria are emerging so as to be best prepared to respond to outbreaks if and when they happen,” Professor Turnidge said.

A second and smaller cause of the increase in CAR reports was an outbreak of OXA-48 producing Escherichia coli detected in Queensland, where 80 cases were reported between May 2017 and July 2017.

The outbreak was largely confined to a single facility, and was controlled within two months. The frequency of reporting of CPE, and the Queensland outbreak, highlight the importance of the implementation of the Commission’s Recommendations for the Control of Carbapenemase-Producing Enterobacteriaceae: A guide for acute health facilities.

Other CARs remain at very low levels.