Neisseria gonorrhoeae antimicrobial susceptibility in Barcelona: penA, ponA, mtrR, and porB mutations and NG-MAST sequence types associated with decreased susceptibility to cephalosporins.

Abstract

The aims of this study were to determine the antimicrobial susceptibility of Neisseria gonorrhoeae (NG) in our area, to analyze the molecular mechanisms involved in cephalosporins resistance, and to undertake molecular typing of our NG strains. Antimicrobial susceptibility was determined using the Etest. The genes penA, mtrR, penB, and ponA were studied. Molecular typing was performed by N. gonorrhoeae multiantigen sequence typing. Of 329 strains analyzed in 2013, none showed high-level cephalosporin resistance, but 8.2% had resistance to cefixime [minimum inhibitory concentration (MIC) > 0.125μg/mL] and 0.6% to ceftriaxone (MIC > 0.125μg/mL). Azithromycin resistance was documented in 4.3% and ciprofloxacin resistance in 49.2%. Among 48 strains with an MIC ≥ 0.125μg/mL to cefixime, 58.3% showed the penA mosaic pattern XXXIV, 98% a Leu → Pro substitution at position 421 of the ponA gene, 100% amino acid changes at positions 101 and 102 of the PorB1b porin, and 87.5% of strains an adenine deletion in the promoter region of the MtrC-D-E efflux pump. A significant difference between strains with and without decreased cephalosporin susceptibility (MIC ≥ 0.125μg/mL) was observed for these four genes. Of the 48 strains with an MIC ≥ 0.125μg/mL to cefixime, 43.8% belonged to the genogroup G1407 and 27.1% belonged to the genogroup G2400. A significant association of G1407 with decreased susceptibility (MIC ≥ 0.125μg/mL) and G2992 with susceptibility was found, and also between G1407 and mosaic pattern XXXIV and between G2400 and A501T substitution in penA. The NG resistance rate in our area is higher than the median of Europe. We have detected the emergence of G2400, which may be a source of antimicrobial resistance.