Antimicrobial Susceptibility Profile of Neisseria gonorrhoeae from Patients Attending a Medical Laboratory, Institut Pasteur de Madagascar between 2014-2020: Phenotypic and Genomic characterization in a Subset of Neisseria gonorrhoeae Isolates.

The antimicrobial resistance of Neisseria gonorrhoea to all classes of current available antibiotics is a global concern. National surveillance programmes monitoring the susceptibility profiles of Neisseria gonorrhoeae hardly exist in resource constraint settings. Therefore, little is known about the antimicrobial susceptibility profile and associated genetic resistance mechanisms of N. gonorrhoeae in Madagascar. We report susceptibility data of N. gonorrhoeae isolates obtained by the medical laboratory of the Institut Pasteur de Madagascar, from 2014 -2020. In addition, we present data on the antimicrobial resistance mechanisms and antimicrobial resistance profile of a subset of isolates (N=46), including all isolates available of 2020. Over the study period, ceftriaxone resistant isolates exceeding the threshold of 5% in 2017 and 2020, were reported. Of the subset of re-tested isolates, all were found susceptible to ceftriaxone, azithromycin, and spectinomycin. Conversely, all isolates were resistant to ciprofloxacin and the majority was also resistant to penicillin and tetracycline. None of the isolates carried the mosaic penA gene and chromosomal mutations associated to the antibiotic resistance in gyrA, parC, penA, ponA, porB and mtrR genes were detected. The high rate of resistance to Penicillin and Tetracycline is explained by the presence of β-lactamase blaTEM and tetM genes, respectively, a plasmid mediated resistance. We found a high number of circulating multilocus sequence types. Almost half of them were new types, and one of them was among the four most predominant sequence types. Our report provides a detailed dataset obtained through phenotypic and genotypic methods which will serve as baseline for future surveillance of N. gonorrhoeae in our setting, and Madagascar. ### Competing Interest Statement The authors have declared no competing interest.