Abstract
BackgroundIn the 1990s, azithromycin became the drug of choice for many infectious diseases but emerging resistance to the drug has only been reported in the last decade. In the last 5 years, the National Neisseria gonorrhoeae Reference Laboratory of Hungary (NNGRLH) has also observed an increased number of N. gonorrhoeae strains resistant to azithromycin. The aim of this study was to determine the most frequent sequence types (ST) of N. gonorrhoeae related to elevated levels of azithromycin MIC (minimal inhibitory concentration). Previously and currently isolated azithromycin-resistant strains have been investigated for the existence of molecular relationship.MethodsMaldi-Tof technic was applied for the identification of the strains isolated from outpatients attending the reference laboratory. Testing antibiotic susceptibility of azithromycin, cefixime, ceftriaxone, tetracycline, spectinomycin and ciprofloxacin was carried out for all the identified strains, using MIC strip test Liofilchem®. N. gonorrhoeae multiantigen sequence typing (NG-MAST) was performed exclusively on azithromycin-resistant isolates. A phylogenetic tree was drawn using MEGA6 (Molecular Evolutionary Genetics Analysis Version 6.0) Neighbour-Joining method.ResultsOut of 192 N. gonorrhoeae isolates, 30.0 % (58/192) proved resistant to azithromycin (MIC > 0.5 mg/L). Of the azithromycin-resistant isolates, ST1407, ST4995 and ST11064 were the most prevalent. Based on the phylogenetic analysis, the latter two STs are closely related.ConclusionsIn contrast to West-European countries, in our region, resistance to azithromycin has increased up to 30 % in the last 5 years, so the recommendation of the European Guideline −500 mg of ceftriaxone combined with 2 g of azithromycin as first choice therapy against N. gonorrhoeae- should be seriously considered in case of Hungary.Electronic supplementary materialThe online version of this article (doi:10.1186/s12941-016-0166-9) contains supplementary material, which is available to authorized users.
Highlights
In the 1990s, azithromycin became the drug of choice for many infectious diseases but emerging resistance to the drug has only been reported in the last decade
% in the last 5 years, so the recommendation of the European Guideline −500 mg of ceftriaxone combined with g of azithromycin as first choice therapy against N. gonorrhoeae- should be seriously considered in case of Hungary
In 2014, 192 N. gonorrhoeae strains were isolated at the STD Centre of the Department of Dermatology, Venerology and Dermatooncology of Semmelweis University, Budapest, Hungary
Summary
In the 1990s, azithromycin became the drug of choice for many infectious diseases but emerging resistance to the drug has only been reported in the last decade. It is necessary to enhance the surveillance of gonococcal antimicrobial resistance, especially for the drugs of first choice: ceftriaxone and azithromycin [2]. Of STDs, azithromycin is used to treat uncomplicated gonorrhoea in patients with cephalosporin allergy, Chlamydia trachomatis coinfection, Heamophilus ducreyii, Ureaplasma urealyticum, Mycoplasma genitalium infections. The Creative Commons Public Domain Dedication waiver
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