CMAJ • February 3, 2009; 180 (3). doi:10.1503/cmaj.080222.
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Research

Prevalence of and risk factors for quinolone-resistant Neisseria gonorrhoeae infection in Ontario

Kaede V. Ota, MD, Frances Jamieson, MD, David N. Fisman, MD MPH, Karen E. Jones, MD MHSc, Itamar E. Tamari, MD, Lai-King Ng, PhD, Lynn Towns, MLT, Prasad Rawte, MS MLT, Alessandro Di Prima, BSc, Tom Wong, MD MPH and Susan E. Richardson, MD

From The Hospital for Sick Children (Ota, Fisman, Richardson); the University of Toronto (Ota, Jamieson, Fisman, Jones, Richardson); the Public Health Laboratory, Ontario Agency for Health Protection and Promotion, (Jamieson, Fisman, Towns, Rawte, Di Prima, Richardson); the Maple Leaf Medical Clinic (Jones); the Hassle Free Mens Clinic (Tamari), Toronto, Ont.; the Public Health Agency of Canada, National Microbiology Laboratory (Ng), Winnipeg, Man.; and the Public Health Agency of Canada, Community Acquired Infections Division (Wong), Ottawa, Ont.

Correspondence to: Dr. Susan E. Richardson, Division of Microbiology, Pediatric Laboratory Medicine, The Hospital for Sick Children, 555 University Ave., Toronto ON M5G 1X8; fax 416 813-6257; susan.richardson{at}sickkids.ca

Background: Quinolone-resistant Neisseria gonorrhoeae has swiftly emerged in Canada. We sought to determine its prevalence in the province of Ontario and to investigate risk factors for quinolone-resistant N. gonorrhoeae infection in a Canadian setting.

Methods: We used records from the Public Health Laboratory of the Ontario Agency for Health Protection and Promotion in Toronto, Ontario, and the National Microbiology Laboratory in Winnipeg, Manitoba, to generate epidemic curves for N. gonorrhoeae infection. We extracted limited demographic data from 2006 quinolone-resistant N. gonorrhoeae isolates and from a random sample of quinolone-susceptible isolates. We also extracted minimum inhibitory concentrations for commonly tested antibiotics.

Results: Between 2002 and 2006, the number of N. gonorrhoeae infections detected by culture decreased by 26% and the number of cases detected by nucleic acid amplification testing increased 6-fold. The proportion of N. gonorrhoeae isolates with resistance to quinolones increased from 4% to 28% over the same period. Analysis of 695 quinolone-resistant N. gonorrhoeae isolates and 688 quinolone-susceptible control isolates from 2006 showed a higher proportion of men (odds ratio [OR] 3.1, 95% confidence interval [CI] 2.3–4.1) and patients over 30 years of age (OR 3.1, 95% CI 2.4–3.8) in the quinolone-resistant group. The proportion of men who have sex with men appeared to be relatively similar in both groups (OR 1.4, 95% CI 1.1–1.8). Quinolone-resistant strains were more resistant to penicillin (p < 0.001), tetracycline (p < 0.001) and erythromycin (p < 0.001). All isolates were susceptible to cefixime, ceftriaxone, azithromycin and spectinomycin.

Interpretation: During 2006 in Ontario, 28% of N. gonorrhoeae isolates were resistant to quinolones. Infections in heterosexual men appear to have contributed significantly to the quinolone resistance rate. Medical practitioners should be aware of the widespread prevalence of quinolone-resistant N. gonorrhoeae and avoid quinolone use for empiric therapy.


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