Markedly decreasing azithromycin susceptibility of Neisseria gonorrhoeae, Germany, 2014 to 2021

We monitored antimicrobial susceptibility develop-ments of Neisseria gonorrhoeae in Germany from January 2014 to May 2021. The proportion of isolates with azithromycin minimum inhibitory concentrations above the epidemiological cut-off increased substantially, from 1.3% in 2014 to 12.2% in 2020. Preliminary data from 2021 showed a further rise (January to May: 20.7%). Therefore, azithromycin as part of the recommended dual therapy in Germany for non-adherent patients is challenged. Antimicrobial susceptibility testing in clinical practice is crucial and continuous susceptibility surveillance indispensable.

Automated summary

The study found a concerning increase in Neisseria gonorrhoeae isolates with elevated azithromycin minimum inhibitory concentrations in Germany from 2014 to 2021, suggesting a challenge to the recommended dual therapy for non-adherent patients in the country. These findings highlight the importance of antimicrobial susceptibility testing in clinical practice and continuous surveillance of susceptibility trends.