Temporal and geographic trends in extended-spectrum cephalosporins resistance among Neisseria gonorrhoeae isolates worldwide: a systematic review and meta-analysis

The global rise of antibiotic resistance in Neisseria gonorrhoeae presents a major public health threat. A systematic review and meta-analysis of 252 studies from 71 countries (1988–2025) found a weighted pooled resistance rate of ≤2.5% for extended-spectrum cephalosporins (ESCs), with significant temporal fluctuations in resistance. Resistance patterns varied notably across regions and depending on antimicrobial susceptibility testing methods. The study highlights the urgent need for robust antimicrobial stewardship, improved contact tracing, and comprehensive surveillance to effectively control resistant gonococcal infections.