Antimicrobial Resistance in Clinical Neisseria gonorrhoeae Isolates at Regional and National Referral Hospitals in Uganda

Abstract

Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a growing global health challenge, particularly in sub-Saharan Africa yet data in Uganda remain limited. This cross-sectional study analyzed 54 clinical isolates of N. gonorrhoeae collected between July 2019 and June 2021 from three referral hospitals in Uganda. Phenotypic resistance patterns were determined using the Kirby-Bauer disc diffusion method, while genotypic analysis employed PCR to detect resistance-associated mutations in the penA, gyrA, and parC genes. Resistance was highest to Penicillin (100%) and Tetracycline (98.15%), followed by Ciprofloxacin (87.04%). In contrast, lower resistance rates were observed for Cefixime (33.33%) and Cefoxitin (28.26%). Genotypic analysis revealed the penA gene in 66.7% of isolates, making it the predominant genetic determinant of resistance, while gyrA and parC were detected in 35.3% and 25.5% of isolates, respectively. Statistical analysis indicated that older adults (≥ 45 years) had the highest odds of infection (OR = 2.88, p = 0.045). These findings underscore the need for enhanced AMR surveillance and updates to treatment guidelines prioritizing Ceftriaxone and Cefixime for gonorrhea management.