First description of a cefixime- and ciprofloxacin-resistant Neisseria gonorrhoeae isolate with mutations in key antimicrobial susceptibility-determining genes from the country of Georgia.

M A Washington,T Akhvlediani,N Rahman,E C Garges,N H Latif,A E Jerse,M Pilligua-Lucas

doi:10.1016/j.nmni.2018.04.004

Abstract

Antimicrobial resistance in Neisseria gonorrhoeae is a global health problem. Enhanced international collaborative surveillance and disease control are needed to reduce the global burden of this important pathogen. Currently the antimicrobial resistance properties and molecular mechanisms of multidrug-resistant N. gonorrhoeae in the Republic of Georgia represent a significant knowledge gap. Here we report the isolation of a strain of N. gonorrhoeae exhibiting resistance to cefixime and ciprofloxacin with reduced susceptibility to penicillin and tetracycline from a patient being treated at a Georgian medical centre. Notably, this isolate was found to contain a mosaic penA allele and to harbour mutations in genes conferring susceptibility to the β-lactam, cephalosporin, fluoroquinolone, macrolide and penicillin classes of antibiotic. To our knowledge, this is the first report to describe the key mutations conferring the antimicrobial resistance properties of an isolate of N. gonorrhoeae from Georgia.

Highlights

Neisseria gonorrhoeae has been associated with a high rate of morbidity in military populations [1,2]
A collaborative study was initiated between the Georgian Ministry of Defense military hospital in Gori, the US Army Medical Research Directorate in Georgia (USAMRD-G) and the Uniformed Services University of the Health Sciences in Bethesda, Maryland, with the goal of characterizing N. gonorrhoeae isolates derived from men being treated for urethritis at the Gori facility
Targeted biochemical analysis using a Neisseria- and Haemophilus-specific panel (API NH; bioMérieux) designed to interrogate bacterial metabolism indicated that the genus and species specific reactions of the isolate were consistent with N. gonorrhoeae [18]

Summary

Introduction

Neisseria gonorrhoeae has been associated with a high rate of morbidity in military populations [1,2]. Accurate data regarding the prevalence of sexually transmitted infections in the Georgian military population is currently lacking The acquisition of such data is essential for the development and deployment of rational intervention strategies [6]. To this end, a collaborative study was initiated between the Georgian Ministry of Defense military hospital in Gori, the US Army Medical Research Directorate in Georgia (USAMRD-G) and the Uniformed Services University of the Health Sciences in Bethesda, Maryland, with the goal of characterizing N. gonorrhoeae isolates derived from men being treated for urethritis at the Gori facility. An unusual isolate of N. gonorrhoeae was recovered from a urethral swab taken from a 23-year-old soldier. The N. gonorrhoeae multiantigen sequence type (NG-MAST) was determined, and the nucleotide sequence of genes associated with vulnerability to the cephalosporins and the fluoroquinolones were determined [7,8]

Methods

Results

Conclusion