Fig. 3

Distribution of minimum inhibitory concentration (MIC) values (mg/L) for the last-line antibiotics for N. gonorrhoeae azithromycin (a) and ceftriaxone (b) in a collection of 3987 N. gonorrhoeae isolates with different combinations of genetic antimicrobial resistance (AMR) mechanisms. Only combinations observed in at least 5 isolates are shown (see Additional file 3: Fig. S5-S10 for expanded plots for six antibiotics). Dashed horizontal lines on the violin plots mark the EUCAST epidemiological cut-off (ECOFF) for azithromycin and EUCAST clinical breakpoint for ceftriaxone. Point colours inside violins represent the genotypic AMR prediction by Pathogenwatch on each combination of mechanisms (indicated in the grid below by black circles connected vertically; horizontal thick grey lines connect combinations of mechanisms that share an individual determinant). Barplots on the top show the abundance of isolates with each combination of mechanisms. Bar colours represent the differences between the predicted (Pred SIR) and the observed SIR (Obs SIR), i.e. red for a predicted susceptible mechanism when the observed phenotype is resistant). c Radar plots comparing the sensitivity, specificity, positive and negative predictive values (PPV/NPV) for six antibiotics for the test and validation benchmark analyses. AZM = azithromycin, CFM = cefixime, CIP = ciprofloxacin, CRO = ceftriaxone, PEN = benzylpenicillin, TET = tetracycline