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We investigated AMR in\n                      <jats:italic>N. gonorrhoeae<\/jats:italic>\n                      isolates in the Republic of Belarus from 2009 to 2019, antimicrobial treatment recommended nationally, and treatment given to patients with gonorrhoea.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      <jats:italic>N. gonorrhoeae<\/jats:italic>\n                      isolates (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009522) cultured in three regions of Belarus in 2009\u20132019 were examined. Determination of minimum inhibitory concentrations (MICs) of eight antimicrobials was performed using Etest. Resistance breakpoints from the European Committee on Antimicrobial Susceptibility Testing were applied where available. A Nitrocefin test identified \u03b2-lactamase production. Gonorrhoea treatment for 1652 patients was also analysed. Statistical significance was determined by the Z-test, Fisher\u2019s exact test, or Mann-Whitney U test with\n                      <jats:italic>p<\/jats:italic>\n                      -values of &lt;\u20090.05 indicating significance.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In total, 27.8% of the\n                      <jats:italic>N. gonorrhoeae<\/jats:italic>\n                      isolates were resistant to tetracycline, 24.7% to ciprofloxacin, 7.0% to benzylpenicillin, 2.7% to cefixime, and 0.8% to azithromycin. No isolates were resistant to ceftriaxone, spectinomycin, or gentamicin. However, 14 (2.7%) isolates had a ceftriaxone MIC of 0.125\u2009mg\/L, exactly at the resistance breakpoint (MIC &gt;\u20090.125\u2009mg\/L). Only one (0.2%) isolate, from 2013, produced \u03b2-lactamase. From 2009 to 2019, the levels of resistance to ciprofloxacin and tetracycline were relatively high and stable. Resistance to cefixime was not identified before 2013 but peaked at 22.2% in 2017. Only sporadic isolates with resistance to azithromycin were found in 2009 (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u20091), 2012 (n\u2009=\u20091), and 2018\u20132019 (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u20092). Overall, 862 (52.2%) patients received first-line treatment according to national guidelines (ceftriaxone 1\u2009g). However, 154 (9.3%) patients received a nationally recommended alternative treatment (cefixime 400\u2009mg or ofloxacin 400\u2009mg), and 636 (38.5%) were given non-recommended treatment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The gonococcal resistance to ciprofloxacin and tetracycline was high, however, the resistance to azithromycin was low and no resistance to ceftriaxone was identified. Ceftriaxone 1\u2009g can continuously be recommended as empiric first-line gonorrhoea therapy in Belarus. Fluoroquinolones should not be prescribed for treatment if susceptibility has not been confirmed by testing. Timely updating and high compliance with national evidence-based gonorrhoea treatment guidelines based on quality-assured AMR data are imperative. The need for continued, improved and enhanced surveillance of gonococcal AMR in Belarus is evident.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12879-021-06184-7","type":"journal-article","created":{"date-parts":[[2021,6,2]],"date-time":"2021-06-02T08:11:34Z","timestamp":1622621494000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Antimicrobial resistance in Neisseria gonorrhoeae isolates and gonorrhoea treatment in the Republic of Belarus, Eastern Europe, 2009\u20132019"],"prefix":"10.1186","volume":"21","author":[{"given":"Aliaksandra","family":"Aniskevich","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iryna","family":"Shimanskaya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iryna","family":"Boiko","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tatyana","family":"Golubovskaya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Golparian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iryna","family":"Stanislavova","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susanne","family":"Jacobsson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aliaksandr","family":"Adaskevich","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1710-2081","authenticated-orcid":false,"given":"Magnus","family":"Unemo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,6,2]]},"reference":[{"issue":"5","key":"6184_CR1","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1071\/SH19061","volume":"16","author":"RD Kirkcaldy","year":"2019","unstructured":"Kirkcaldy RD, Weston E, Segurado AC, Hughes G. 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No patients were recruited only for the present study, and all patients were managed (diagnosed and treated) in accordance with standard care outside the present study from 2009 to 2019. Accordingly, no consent from the patients diagnosed and treated in routine practice (standard care) from 2009 to 2019 or any separate ethical approval for the present study was deemed necessary or required. Nevertheless, despite this an approval of the study protocol and publication of its results was obtained by the Expert Commission at the Belarusian Medical Academy of Postgraduate Education (BelMAPO), Minsk, Belarus (Date of final decision: July 6, 2020).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"520"}}