Antimicrobial resistance to Neisseria gonorrhoeae in Canada: 2009-2013
Bibliographic record
Abstract
Background: Gonorrhea is on the rise in Canada.Treatment has been complicated by the fact that Neisseria gonorrhoeae has acquired resistance to many antibiotics, including penicillin, tetracycline, erythromycin and ciprofloxacin.The emergence of isolates with decreased susceptibilities to the third generation cephalosporins and reports of treatment failures in Canada and around the world are cause for concern.Objective: To assess the resistance levels of common antibiotics to N. gonorrhoeae and to observe trends in resistance and/or decreased susceptibility to ciprofloxacin, third generation cephalosporins and azithromycin.Methods: Laboratory surveillance data for N. gonorrhoeae isolates submitted by provincial microbiology laboratories to the National Microbiology Laboratory (NML) from 2009-2013 were compared.Results: Since 2009, there has been an overall rise in antibiotic-resistant N. gonorrhoeae.In 2013, 24.3% of the isolates were resistant to erythromycin, 18.9% were resistant to penicillin, 33.0% were resistant to tetracycline, and 29.3% were resistant to ciprofloxacin.The percentage of isolates with decreased susceptibility to ceftriaxone (≥0.125 mg/L) and/or cefixime (≥0.25 mg/L) was 3.9% in 2013.This number represents a decrease from 5.9% in 2012 and 7.6% in 2011.The proportion of azithromycin resistant (MIC ≥2 mg/L) N. gonorrhoeae isolates increased from 0.4% in 2009 to 1.2% in 2013.Conclusion: Resistance to erythromycin, penicillin, tetracycline and ciprofloxacin is common.Decreased susceptibility to ceftriaxone and/or cefixime is now almost 4% and azithromycin resistance is emerging but remains low at 1.2%.These results have informed the gonococcal infection treatment recommendations in the Canadian Guidelines on Sexually Transmitted Infections.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.002 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".