National Reference Centre for Neisseria gonorrhoeae (NRCNG)
Nominated National conduct point for ECDC
In the context of the activities of the Laboratory of Bacteriology and based on the expertise in the research field of bacterial resistance to antibiotics, the National Reference Centre for Neisseria gonorrhoeae (NRCNG) is functioning under authorization of the Greek Ministry of Health (Decision Α1/5755/15-6-1987). The NRCNG carries out continuous surveillance of the epidemiological trends and microbiological characteristics of gonorrhoea in Greece. The NRCNG further characterizes resistant strains and the mechanisms responsible for the emergence and spread of antimicrobial resistance among gonococci circulating in the Greek community.
The aforementioned activities are conducted in order to notify the emergence and spread of resistant strains. The NRCNG has been appointed as the national contact point for European Centre for Disease Prevention and Control (ECDC) and participates in the Microbiology Project of the European Network for Surveillance of Sexually Transmitted Infections and the related European Gonococcal Antimicrobial Susceptibility Surveillance Program (Euro-GASP).
Activities of the NRCNG for the years 2018-2021, as summarized in the Table below, include:
- Systematic collection of gonococcal isolates and data for gonorrhoea cases diagnosed throughout Greece;
- Susceptibility testing against the antibiotics that are clinically available for gonorrhoea therapy;
- Typing of gonococci using conventional, molecular and sequence-based molecular methodologies;
- Investigation of resistance mechanisms in selected isolates exhibiting new or rare patterns of resistance;
- Since 2019 Next Generation Sequencing techniques (WGS) were implemented for the molecular typing of gonorrhoeae isolates and the determination of resistance genes;
- Analysis of epidemiological, microbiological and genomic data for gonorrhoeae population;
- Participation in the External Quality Assurance Programme (EQA) organized and supervised by ECDC for the intra-European evaluation and quality assurance of laboratory methods for antibiotic susceptibility testing for Neisseria gonorrhoeae.
- Annual reports to the national (Greek Ministry of Health) and international (ECDC) Health Authorities;
- Results of the NRCNG are disseminated to the scientific community through publications and presentations;
- Simplified versions of the reports of the NRCNG are on the website of the HPI and are available to the public.
- Isolates/clones of interest are also reported in the Epidemic Intelligence Information System for Sexually Transmitted Infections (EPIS-STI) –a web-based communication platform that allows members of the Euro-GASP network to report unusual events related to gonococcal resistance.
On the basis of surveillance data for antimicrobial susceptibility of gonococcal population in Greece, provided by the NRCNG, the empirical treatment of gonorrhoea patients is guided at national level.
Table: Sample size and Activities of the NRCNG during the period 2018-2021
Hadad R, Cole MJ, Ebeyan S, Jacobsson S, Tan LY, Golparian D, Erskine S, Day M, Whiley D, Unemo M*; European collaborative group. Evaluation of the SpeeDx ResistancePlus® GC and SpeeDx GC 23S 2611 (beta) molecular assays for prediction of antimicrobial resistance/ susceptibility to ciprofloxacin and azithromycin in Neisseria gonorrhoeae. Journal of Αntimicrobial Chemotherapy 2021 Jan 1; 76(1):84-90. [http://doi.org/10.1093/jac/dkaa381].
Unemo M*, Ahlstrand J, Sánchez-Busó L, Day M, Aanensen D, Golparian D, Jacobsson S, Cole MJ; European Collaborative Group. High susceptibility to zoliflodacin and conserved target (GyrB) for zoliflodacin among 1209 consecutive clinical Neisseria gonorrhoeae isolates from 25 European countries, 2018. Journal of Antimicrobial Chemotherapy 2021 Apr 13; 76(5):1221-1228 [http://doi.org/10.1093/jac/dkab024].
Jacobsson S*, Cole MJ*, Spiteri G, Day M, Unemo M; Euro-GASP Network. Associations between antimicrobial susceptibility/resistance of Neisseria gonorrhoeae isolates in European Union/European Economic Area and patients’ gender, sexual orientation and anatomical site of infection, 2009-2016. BMC Infectious Diseases 2021 Mar 18; 21(1):273. [http://doi.org/10.1186/s12879-021-05931-0].
Cole MJ, Quaye N, Jacobsson S, Day M, Fagan E, Ison C, Pitt R, Seaton S, Woodford N, Stary A, Pleininger S, Crucitti T, Hunjak B, Maikanti P, Hoffmann S, Viktorova J, Buder S, Kohl P, Tzelepi E, Siatravani E, Balla E, Hauksdóttir GS, Rose L, Stefanelli P, Carannante A, Pakarna G, Mifsud F, Cassar RZ, Linde I, Bergheim T, Steinbakk M, Mlynarczyk-Bonikowska B, Borrego MJ, Shepherd J, Pavlik P, Jeverica S, Vazquez J, Abad R, Weiss S, Spiteri G, Unemo M. Ten years of external quality assessment (EQA) of Neisseria gonorrhoeae antimicrobial susceptibility testing in Europe elucidate high reliability of data. BMC Infectious Diseases 2019, 19(1), 281 [http://dx.doi.org/10.1186/s12879-019-3900-z].
Cole MJ*, Quinten C, Jacobsson S, Day M, Amato-Gauci AJ, Woodford N, Spiteri G, Unemo M; Euro-GASP network. The European gonococcal antimicrobial surveillance programme (Euro-GASP) appropriately reflects the antimicrobial resistance situation for Neisseria gonorrhoeae in the European Union/European Economic Area. BMC Infectious Diseases 2019 Dec 10; 19(1), 1040 [http://doi.org/10.1186/s12879-019-4631-x].
Day MJ, Spiteri G, Jacobsson S, Woodford N, Amato-Gauci AJ, Cole MJ, Unemo M; Euro-GASP network. Stably high azithromycin resistance and decreasing ceftriaxone susceptibility in Neisseria gonorrhoeae in 25 European countries, 2016. BMC Infectious Diseases 2018, 18(1), 609 [http://dx.doi.org/10.1186/s12879-018-3528-4].
Harris SR, Cole MJ, Spiteri G, Sánchez-Busó L, Golparian D, Jacobsson S, Goater R, Abudahab K, Yeats CA, Bercot B, Borrego M-J, Crowley B, Stefanelli P, Tripodo F, Abad R, Aanensen DM, Unemo M, Euro-GASP study group. Public health surveillance of multidrug-resistant clones of Neisseria gonorrhoeae in Europe: a genomic survey. The Lancet Infectious Diseases 2018, 18(7), 758-768 [http://dx.doi.org/10.1016/S1473-3099(18)30225-1].
Cole MJ, Spiteri G, Jacobsson S, Woodford N, Tripodo F, Amato-Gauci AJ, Unemo M, and Euro-GASP netowork. Overall low extended-spectrum cephalosporin resistance but high azithromycin resistance in Neisseria gonorrhoeae in 24 European countries, 2015. BMC Infectious Diseases 2017, 17:617 [doi: http://dx.doi.org/10.1186/s12879-017-2707-z].