Abstract
In South Korea, surveillance of antimicrobial drug resistance in Neisseria gonorrhoeae is extremely limited. We describe the emergence and subsequent national spread of N. gonorrhoeae strains with mosaic penA alleles associated with decreased susceptibility and resistance to extended-spectrum cephalosporins. From 2012 through 2017, the proportion of mosaic penA alleles in gonococcal-positive nucleic acid amplification test (NAAT) specimens across South Korea increased from 1.1% to 23.9%. Gonococcal strains with mosaic penA alleles emerged in the international hubs of Seoul in Gyeonggi Province and Busan in South Gyeongsang Province and subsequently spread across South Korea. Most common was mosaic penA-10.001 (n = 572 isolates; 94.7%), which is associated with cefixime resistance. We also identified mosaic penA-34.001 and penA-60.001, both of which are associated with multidrug-resistant gonococcal strains and spread of cefixime and ceftriaxone resistance. Implementation of molecular resistance prediction from N. gonorrhoeae–positive nucleic acid amplification test specimens is imperative in South Korea and internationally.
Highlights
In South Korea, surveillance of antimicrobial drug resistance in Neisseria gonorrhoeae is extremely limited
We describe the emergence and subsequent national spread of N. gonorrhoeae strains with mosaic penA alleles in gonococcal-positive nucleic acid amplification test (NAAT) specimens across South Korea from 2012 through 2017
N. gonorrhoeae–Positive NAAT Specimens and Corresponding Patients The collection of DNA extracts we examined consisted of 3,884 N. gonorrhoeae–positive NAAT specimens collected across South Korea from 2012 through 2017 (Table 1)
Summary
In South Korea, surveillance of antimicrobial drug resistance in Neisseria gonorrhoeae is extremely limited. We describe the emergence and subsequent national spread of N. gonorrhoeae strains with mosaic penA alleles associated with decreased susceptibility and resistance to extended-spectrum cephalosporins. Implementation of molecular resistance prediction from N. gonorrhoeae–positive nucleic acid amplification test specimens is imperative in South Korea and internationally. During the past 2 decades, N. gonorrhoeae strains with resistance to extended-spectrum cephalosporins (ESCs), including ceftriaxone, the last remaining option for empiric first-line gonorrhea treatment, have emerged and spread internationally, which is a serious concern worldwide [2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23]. Molecular prediction of AMR directly from N. gonorrhoeae–positive NAAT samples is imperative for large-scale screening and prediction of the level and spread of ESC resistance in Korea
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