To determine the accurate estimate of the rate of Neisseria gonorrhoeae antimicrobial resistance based on the provided options and the data from 2020, let's analyze each of the given statements:
1. Approximately 4% of isolates had elevated ceftriaxone MICs (20.125 μg/mL).
2. Approximately 7% of isolates had elevated cefixime MICs (20.25 μg/mL).
3. Approximately 18% of isolates had elevated azithromycin MICs (22.0 μg/mL).
4. Approximately 20% of isolates were resistant to tetracycline.
The correct rate of resistance based on 2020 data is the percentage given in option 4: 20% of isolates were resistant to tetracycline.
This means, in the year 2020, among the surveillance data collected, approximately 20% of Neisseria gonorrhoeae isolates were found to be resistant to tetracycline. The other options (4%, 7%, and 18% for ceftriaxone, cefixime, and azithromycin, respectively) are not the correct estimates based on the provided data.
So the final answer is:
Approximately 20% of isolates were resistant to tetracycline.