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We present the Euro-GASP results from 2016 (25 countries), linked to patient epidemiological data, and compared with data from previous years.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Agar dilution and minimum inhibitory concentration (MIC) gradient strip methodologies were used to determine the antimicrobial susceptibility (using EUCAST breakpoints) of 2660\u2009\n                      <jats:italic>N. gonorrhoeae<\/jats:italic>\n                      isolates from 25 countries across the EU\/EEA. Significance of differences compared with Euro-GASP results in previous years was analysed using Z-tests.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      No isolates with resistance to ceftriaxone (MIC &gt;\u20090.125\u2009mg\/L) were detected in 2016 (one in 2015). However, the proportion of isolates with decreased susceptibility to ceftriaxone (MICs from 0.03\u2009mg\/L to 0.125\u2009mg\/L) increased significantly (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01) from 2015 to 2016. There were 14 (0.5%) isolates with ceftriaxone MICs 0.125\u2009mg\/L (on the resistance breakpoint), of which one isolate was resistant to azithromycin and four showed intermediate susceptibility to azithromycin. Cefixime resistance was detected in 2.1% of isolates in 2016 compared with 1.7% in 2015 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.26) and azithromycin resistance in 7.5% in 2016 compared with 7.1% in 2015 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.74). Seven (0.3%) isolates from five countries displayed high-level azithromycin resistance (MIC\u2265256\u2009mg\/L) in 2016 compared with five (0.2%) isolates in 2015. Resistance rate to ciprofloxacin was 46.5% compared with 49.4% in 2015 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.06). No isolates were resistant to spectinomycin and the MICs of gentamicin remained stable compared with previous years.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Overall AMR rates in gonococci in EU\/EEA remained stable from 2015 to 2016. However, the ceftriaxone MIC distribution shifted away from the most susceptible (\u22640.016\u2009mg\/L) and the proportion of isolates with decreased susceptibility to ceftriaxone increased significantly. This development is of concern as current European gonorrhoea management guideline recommends ceftriaxone 500\u2009mg plus azithromycin 2\u2009g as first-line therapy. With azithromycin resistance at 7.5%, the increasing ceftriaxone MICs might soon threaten the effectiveness of this therapeutic regimen and requires close monitoring.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12879-018-3528-4","type":"journal-article","created":{"date-parts":[[2018,12,3]],"date-time":"2018-12-03T04:14:15Z","timestamp":1543810455000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":76,"title":["Stably high azithromycin resistance and decreasing ceftriaxone susceptibility in Neisseria gonorrhoeae in 25 European countries, 2016"],"prefix":"10.1186","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5089-2321","authenticated-orcid":false,"given":"Michaela 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