ArticleThe Journal of infectious diseases2026
The Influence of National Antibiotic Consumption on Neisseria Gonorrhoeae Antibiotic Resistance in Norway, 2003-2024.
Article in The Journal of infectious diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo investigate whether national population-level antibiotic consumption influences antimicrobial resistance (AMR) in Norwegian Neisseria gonorrhoeae isolates. To explore metrics suitable for ecological AMR studies.
methodsLongitudinal Norwegian gonococcal susceptibility data (2003-2024) were analysed alongside national antibiotic consumption. Temporal trends were examined graphically and associations assessed using one-tailed Spearman rank correlations. Novel metrics-The "Susceptible Isolate Pressure Indicator" (SIPI) and "Wild-Type Isolate Pressure Indicator" (WIPI) ratios were introduced to characterize shifts in minimum inhibitory concentration (MIC) distributions within susceptible or wild-type ranges.
resultsStrong positive, significant correlations were observed between consumption of the most widely used antibiotic classes in Norway-betalactamase-sensitive penicillins and tetracyclines-and gonococcal geometric mean MIC for benzylpenicillin (ρ = 0.776, P < .001) and tetracycline (ρ = 0.841, P < .001). Penicillin-class consumption was also significantly associated with betalactamase plasmid carriage (ρ = 0.637, P = .013), consistent with horizontal gene transfer from commensal flora.
conclusionsEven in a low-consumption European context, Norwegian antibiotic use appears to shape gonococcal resistance, possibly partly via gene uptake from commensal Neisseria. The SIPI and WIPI ratios describe susceptible-range MIC histogram shapes, and offer utility for AMR surveillance by capturing isolate flux.
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