Penicillinase-producing Neisseria Gonorrhoeae Research Articles

Activity of cefixime against Neisseria gonorrhoeae

AbstractBackground In most gonococcal populations, penicillin‐resistant strains have increased dramatically and penicillin can no longer be recommended for the treatment of gonorrhoea. Cefixime is the first oral third generation cephalosporin and represents an alternative therapeutical approach.Objective To evaluate the in vitro activity of cefixime against a gonococcal population in Germany.Material 203 Neisseria gonorrhoeae strains, isolated in the area of Heidelberg between 1986 and 1990, including 14 penicillinase‐producing Neisseria gonorrhoeae (PPNG) strains and five strains with chromosomally mediated penicillin resistance (CMPR).Methods Determination of minimal inhibitory concentration (MIC) of cefixime was performed by standard agar dilution technique. Auxotype/serovar (A/S) classification was performed by using Neisseria defined agar and 12 gonococcal outer membrane porin specific monoclonal antibodies in a coagglutination assay.Results The MIC range reached from 0.00025 μg/ml to 0.125 μg/ml cefixime. For both penicillin sensitive‐ and penicillin‐resistant strains, the geometric mean MIC was 0.0048 μg/ml, MIC 50 0.002 μg/ml and MIC 90 0.008 μg/ml. Among gonococcal strains with an MIC of 0.001 μg/ml cefixime strains belonging to A/S class (P)AH(U)/1A‐1/2 were significantly more frequent (p < 0.0001) than among strains having an MIC of > 0.001 μg/ml.Conclusion Cefixime showed very high antimicrobial activity against Neisseria gonorrhoeae. All tested gonococcal strains were susceptible to cefixime. The A/S class composition of a tested gonococcal population influences very strongly the range of MICs.

Activity of cefixime against Neisseria gonorrhoeae

Background In most gonococcal populations, penicillin-resistant strains have increased dramatically and penicillin can no longer be recommended for the treatment of gonorrhoea. Cefixime is the first oral third generation cephalosporin and represents an alternative therapeutical approach.Objective To evaluate the in vitro activity of cefixime against a gonococcal population in Germany.Material 203 Neisseria gonorrhoeae strains, isolated in the area of Heidelberg between 1986 and 1990, including 14 penicillinase-producing Neisseria gonorrhoeae (PPNG) strains and five strains with chromosomally mediated penicillin resistance (CMPR).Methods Determination of minimal inhibitory concentration (MIC) of cefixime was performed by standard agar dilution technique. Auxotype/serovar (A/S) classification was performed by using Neisseria defined agar and 12 gonococcal outer membrane porin specific monoclonal antibodies in a coagglutination assay.Results The MIC range reached from ≤ 0.00025 μg/ml to 0.125 μg/ml cefixime. For both penicillin sensitive- and penicillin-resistant strains, the geometric mean MIC was 0.0048 μg/ml, MIC 50 0.002 μg/ml and MIC 90 0.008 μg/ml. Among gonococcal strains with an MIC of ≤ 0.001 μg/ml cefixime strains belonging to A/S class (P)AH(U)/IA-1/2 were significantly more frequent (p < 0.0001) than among strains having an MIC of > 0.001 μg/ml.Conclusion Cefixime showed very high antimicrobial activity against Neisseria gonorrhoeae. All tested gonococcal strains were susceptible to cefixime. The A/S class composition of a tested gonococcal population influences very strongly the range of MICs.

A one-year survey of Neisseria gonorrhoeae isolated from patients attending an east London genitourinary medicine clinic: antibiotic susceptibility patterns and patients' characteristics.

To collect epidemiological data on gonococcal infection in an east London genitourinary medicine (GUM) clinic; to perform antibiotic susceptibility testing on Neisseria gonorrhoeae isolates and relate results to patient data; to assess the efficacy of current first-line antibiotic therapy for treating gonorrhoea. Gonococcal isolates were collected from 113 patients attending the GUM clinic at Newham General Hospital over a one year period. Isolates (104) were tested for susceptibility to various antibiotics. Plasmid profiles were obtained for penicillinase producing gonococci (PPNG) and isolates exhibiting high-level tetracycline resistance (TRNG). Epidemiological information was collected from clinic attenders by routine note-taking. PPNG (16) accounted for 15% of isolates tested, only three being acquired outside the United Kingdom (U.K.). Plasmid typing showed three types of beta-lactamase-encoding plasmids were represented (2.9 MDa, 3.2 MDa and 4.4 MDa). Amongst the non-PPNG isolates, high-level chromosomal resistance to penicillin (CMRNG) was found in 3.5%, intermediate resistance in 57.5% and full susceptibility in 39%. One isolate showed decreased susceptibility to ciprofloxacin (MIC = 0.06 mg/l). Three PPNG isolates also possessed a 25.2 MDa plasmid and expressed high-level tetracycline resistance encoded by tetM. All isolates were susceptible to cefixime, cefotaxime, azithromycin and spectinomycin. Most gonorrhoea (90%) was seen in local residents. The male:female case ratio was 2:1 with homosexually-acquired gonorrhoea accounting for only 3.5% of the total. Most patients (96%) had acquired gonorrhoea in the U.K.. A past history of gonorrhoea was more frequent in male patients. Concurrent chlamydial infection was seen in 31% females and 16% males. The high PPNG rate supports a previous decision to change first-line therapy from amoxycillin with probenecid to ciprofloxacin. There was no evidence of clinical treatment failure with ciprofloxacin. Cefixime, cefotaxime, azithromycin and spectinomycin all appear to be suitable alternative therapies. Acquisition of gonorrhoea abroad was associated with isolates exhibiting penicillin resistance but such isolates were also obtained from patients infected locally and without a history of foreign travel.

Hyperendemic penicillinase-producing Neisseria gonorrhoeae genital infections in an inner city population

To determine: 1) the proportion of Neisseria gonorrhoeae caused by penicillinase-producing Neisseria gonorrhoeae (PPNG) in our inner-city population; 2) any difference in the isolation rates of PPNG between adolescents and adults; 3) co-infection rates with Chlamydia trachomatis in this adolescent population; and 4) the appropriateness of current CDC recommendations for initial treatment of patients with suspected gonococcal infection. Genital cultures for GC were obtained from 1990 patients seen in the emergency room or primary care clinics. Of these, 285 were adolescents between 12 and 19 years of age. All adolescent patients were tested for chlamydial infection. Comparisons of gonococcal infection rates were made between adults and adolescents and between males and females. The rates of symptomatic versus asymptomatic adolescents were compared. Genital cultures were positive for GC in 13% of the patients tested. Of these, 51% were identified as being caused by PPNG. Among the adolescents, cultures were positive in 25%, and 63% of these were identified as PPNG. The rate of PPNG was significantly higher in adolescents than in adults. The rate of PPNG was highest in adolescent females and lowest in adult males. There was no difference in the rate of PPNG between adolescents and adult males. Of the 71 adolescents with GC, 58% were coinfected with C. trachomatis. Adolescents with PPNG had a higher rate of concomitant infection with C. trachomatis than those with a penicillin-sensitive strain. Adolescents with N. gonorrhoeae were more likely to be infected with PPNG if they had GU symptoms. Our data supports the most recent CDC recommendations that the initial treatment for suspected N. gonorrhoeae be effective against PPNG. Furthermore, chlamydia screening and treatment is warranted in patients suspected of having an STD.

Antimicrobial Susceptibility of Neisseria Gonorrhoeae, the Essential Drug List, and HIV/AIDS Control

A study of the susceptibility of Neisseria gonorrhoeae to nine drugs (penicillin tetracycline cotrimoxazole chloramphenicol erythromycin norfloxacin cefuroxime ceftriaxone and spectinomycin) was conducted in Kumasi Ghana from January to December of 1992. Sensitivity was between 2% and 10% for the first five antibiotics listed; 97% for the sixth; 95% for the seventh; 100% for the eighth; and 78% for the ninth. The first five are listed on the essential drug list (EDL) of many developing countries partly because of their cost. The others are recommended by the World Health Organization for use in countries where the incidence of penicillinase producing Neisseria gonorrhoeae (PPNG) exceeds 20%; however they are not listed on the EDL because of their prohibitive cost. Because of these results and the relationship between adequate treatment and control of sexually transmitted disease (STD) and prevention and control of human immunodeficiency virus (HIV) infection EDLs should be revised; the indiscriminate use of antibiotics should be discouraged; and donor agencies should tackle STD clinical support.

The Use of Fluoroquinolones in Sexually Transmitted Diseases in Southeast Asia

This paper reviews the use of the fluoroquinolone antibiotics in the management of sexually transmitted diseases (STD) in Southeast Asia. Numerous clinical trials performed in the region have shown that the quinolones are highly effective for treating uncomplicated gonorrhoea. Norfloxacin 800 mg, ofloxacin 400 mg, ciprofloxacin 250 mg, and pefloxacin 400 mg in single oral doses have yielded excellent clinical results. Overall cure rates were greater than 95%, with full eradication of penicillinase-producing Neisseria gonorrhoeae in all studies. Strains of gonococci resistant to the quinolones have already emerged and should be closely monitored. However, this has not become a serious problem to date, as large scale evaluation has shown that the quinolones remain highly efficacious for the treatment of gonorrhoea. These antibiotics in single doses are not effective for postgonococcal urethritis (PGU); therefore, concomitant use of an antichlamydial regimen for all patients with gonorrhoea is recommended. The quinolones are also highly effective for chancroid. Excellent results, with cure rates approaching 100%, were achieved with single oral doses of ciprofloxacin 500 mg, norfloxacin 800 mg, and ofloxacin 400 mg. Widespread use of these drugs in STD treatment regimens may be one of the main factors causing a dramatic decline in the number of cases of chancroid seen in recent years. Ofloxacin in variable dosages for a period of 10 to 21 days was found to be effective in nongonococcal urethritis (NGU). However, when compared with the tetracyclines, it is less cost effective and can thus be regarded as an alternative treatment for NGU.

Diversity of isolates of penicillinase-producing Neisseria gonorrhoeae (PPNG) in Honolulu, Hawaii: 1982-1991.

Gonococcal infections caused by penicillinase-producing Neisseria gonorrhoeae (PPNG) isolates have increased in geographic distribution and prevalence. It was postulated that PPNG strains would become endemic in Honolulu and that, in turn, this city would serve as a reservoir for the introduction of PPNG strains into the continental United States. To assess the role of Honolulu as a reservoir for PPNG strains by assessing the diversity and persistence of PPNG strains between 1982 and 1991. A total of 432 PPNG strains were characterized by auxotype/serovar (A/S) class and plasmid content, and their distribution during the 10-year period was studied. Of 432 isolates, 373 (86.4%) possessed a 4.4-Mdal beta-lactamase plasmid; 39 (9.0%) possessed a 3.2-Mdal beta-lactamase plasmid; and 20 (4.6%) possessed a 3.05-Mdal beta-lactamase plasmid. A total of 53 A/S classes were identified. Asian, African, and Toronto PPNG strains belonged to 49 (92.5%), 15 (28.3%), and 11 (20.7%) A/S classes, respectively. Though all Toronto PPNG strains possessed a 24.5-Mdal conjugative plasmid, these plasmids could not be transferred by conjugation. Although some apparent microepidemics of PPNG strains were identified, most strains were isolated sporadically. A large number of different strains have been associated with PPNG infections in Honolulu, but there was no evidence that any strain persisted endemically during the study period. These observations have important implications for the design and assessment of community gonorrhea control strategies.

Determinants of penicillinase producing Neisseria gonorrhoeae infections in heterosexuals in Amsterdam.

At the STD clinic of the Municipal Health Service in Amsterdam, the annual number of infections with penicillinase-producing Neisseria gonorrhoeae (PPNG) strains remained relatively stable from 1983 until 1990, while the number of non-PPNG infections declined dramatically. To investigate the PPNG and non-PPNG epidemic, a cross sectional study was conducted in 1989 and 1990. The purpose of this study was to assess determinants of PPNG infections among heterosexuals diagnosed with gonorrhoeae. In addition to routinely collected data in new consultations for STDs, information on alcohol use, drug use and sexual behaviour was obtained from patients diagnosed with gonorrhoea. The diagnosis of gonorrhoea was based on a positive culture and isolates were screened for PPNG. Logistic regression analysis was used to assess independent predictors of PPNG infection. Additional information was available of 328 women and 995 heterosexual men diagnosed with gonorrhoea. PPNG was diagnosed in 86/328 (26%) women and in 329/995 (33%) men. Logistic regression analysis identified a Central/South American nationality (odds ratio(OR) = 2.46) and older age (OR = 1.04 per year) as positively associated with PPNG infection in female patients. An inverse relation was found with use of hard drugs (OR = 0.29). Among men diagnosed with gonorrhoea, sexual contacts with window prostitutes (mainly women from Central/South America) (OR = 1.98) and a foreign nationality (OR = 1.78) were positively associated with PPNG infection, and sexual contact with drug using prostitutes (OR = 0.47) inversely. PPNG infections were especially common among Central and South American window prostitutes and their clients, but not among hard-drug addicted prostitutes and their clients. Since window prostitutes originating from Central and South American countries are transient in Amsterdam, prevention activities targeted at these prostitutes and their clients should be continued to limit the spread of PPNG and other STDs within these groups.

Survey on Antibiotic Sensitivity of Neisseria gonorrhoeae Strains Isolated in China, 1987–1992

The appearance and the endemic of penicillinase-producing Neisseria gonorrhoeae (PPNG) and other resistant strains cause much difficulty in the treatment of gonorrhea. To keep surveillance of the strains is important for the control of gonorrhea nationwide. To know the resistance to antibiotics of Neisseria gonorrhoeae strains isolated in China. The minimum inhibitory concentration (MIC) to penicillin, spectinomycin, and cephalosporins was determined by the agar plate dilution test in strains of N. gonorrhoeae submitted from six cities in various areas of the country during the period 1987-1992, and the prevalence of penicillinase-producing N. gonorrhoeae strains were examined by the rapid idometric method. The resistant strains to penicillin (MIC > or = 1.0 microgram/ml) accounted for 57.5% of all isolates. The resistant strains to spectinomycin (MIC > or = 128 micrograms/ml) made up 1.3% and the strains which had a MIC closing resistance (MIC = 64 micrograms/ml) accounted for 4%. There were 18 PPNG strains (4.3%) in 419 isolates from Nanjing and Nanning city. The resistant strains to ceftrixone and cefotaxime accounted for 2.6% and 4.2%, respectively. The situation of N. gonorrhoeae resistance to penicillin is rather serious in the country and relevant measures should be taken in the choice of therapeutic drugs, the follow-up of patients and the surveillance of gonorrhea.

Detection of cryptic plasmid and TEM-1 gene of Neisseria gonorrhoeae in clinical samples by PCR

A simultaneous detection of penicillinase-producing Neisseria gonorrhoeae (PPNG) and non-penicillinase-producing N. gonorrhoeae (NNPNG) from 100 clinical swab samples was evaluated in a four-primer polymerase chain reaction (PCR). Target sequences were the cryptic plasmid and the TEM-1 gene, a β-lactamase coding gene. Compared with conventional gonococcal tests, results indicated that the PCR-based test is more sensitive and should play an important role as an alternative or adjunct to culture particularly in asymptomatic patients. It correctly identified four samples out of 100 which were positive by both microscopy and culture. It detected accurately penicillinase-producing from non-penicillinase-producing strains.

Antibiotic chemotherapy of bacterial sexually transmitted diseases in adults: a review.

Treatment regimens for sexually transmitted infections continue to evolve. The natural history of syphilis in HIV-infected patients is leading to more aggressive policies in terms of both investigation and treatment. In particular, treatment protocols for late syphilis, especially neurosyphilis, are under scrutiny. Epidemiological change typified by the spread of penicillinase-producing Neisseria gonorrhoeae (PPNG) has led to a search for new agents to treat gonorrhoea, with a more extensive use of cephalosporin and quinolone antibiotics emerging. The problem of compliance with the antibiotic courses presently required for chlamydial infection may be close to being solved with the development of newer macrolide agents. Single dose azithromycin, although expensive, seems to be as effective as longer courses with other agents. Furthermore, its efficacy in gonococcal infection is also encouraging. Increased understanding of the pathogenesis and natural history of pelvic inflammatory disease (PID) and bacterial vaginosis (BV) has led to rationalization of treatment policies for these conditions.

Penicillinase producing Neisseria gonorrhoeae associated with severe vulvovaganitis in a post menopausal woman.

Penicillinase producing Neisseria gonorrhoeae associated with severe vulvovaganitis in a post menopausal woman.

PPNG at St Thomas' Hospital--a changing provenance.

Between 1986 and 1992, 15% of all cases of penicillinase-producing Neisseria gonorrhoeae (PPNG) notified in the UK were seen at our central London clinic. During this time the geographical provenance of PPNG has changed. Africa and SE Asia have been supplanted by the Caribbean as the predominant source, with 21.4% of all cases being directly imported from there in 1992. If all gonococcal infections acquired outside the UK had been assumed to be PPNG, together with those occurring in patients with family origins in Africa or SE Asia, some 60% of cases of PPNG could have been predicted before laboratory confirmation of resistance. There is little evidence that PPNG has become endemic in the United Kingdom.

Penicillinase producing Neisseria gonorrhoeae from St Thomas' Hospital 1976-1990--the first fifteen years.

To examine the penicillinase producing N. gonorrhoeae (PPNG) collected at St Thomas' Hospital from 1976-1990 and, by determination of antibiotic susceptibility pattern and application of three typing methods, examine the prevalence of different gonococcal types. Also to determine whether there is any relationship between antibiotic sensitivity, plasmid profile, auxotype and serovar. A total of 665 isolates of PPNG from patients attending the Department of Genitourinary Medicine at St Thomas' Hospital were characterised by antibiotic MIC, plasmid profile, auxotyping and serotyping. Penicillin MICs for 85% of all isolates were between 0.25 and 32 mg/l. The MIC of tetracycline for 60-80% of the isolates was < 1 mg/l. A small number of isolates had tetracycline MICs of 32 mg/l but MICs > 32 mg/l were not seen. Over 90% of the isolates were sensitive to the remaining three antibiotics tested, erythromycin, cefuroxime and spectinomycin. The 3.2 or 4.4 MDa plasmid with or without the 24.5 MDa conjugal plasmid was seen in all isolates until 1989/90 when a 2.9 MDa beta-lactamase encoding plasmid and the 25.2 MDa plasmid mediating tetracycline resistance were also recognised. Ninety-nine percent of all isolates belonged to one of four auxotypes, prototrophic, arginine, proline or proline/arginine requiring. An initial predominance of isolates with the 1A outer membrane protein was reversed in 1982 and 1B has remained predominant. Thirty two different serovars were identified among the 665 isolates, 14 belonged to serogroup 1A and 18 to 1B, and the eight most common accounted for 83.9% (554) of all isolates. Analysis of the results of combined typing methods showed there was an association between antibiotic resistance, plasmid profile and serogroup. The number of auxotypes and serovars detected in the collection, indicates the possibility that PPNG have been introduced from abroad or outside our local population. Temporal trends in the distribution of auxotype/serovar classes show that the total population of PPNG isolates is formed by a heterogenous mixture in which certain auxotype/serovar classes appear, disappear and may re-emerge. Others were present throughout in small numbers.

Gang-Related Outbreak of Penicillinase-Producing Neisseria gonorrhoeae and Other Sexually Transmitted Diseases—Colorado Springs, Colorado

In April 1990, the El Paso County (Colorado) Health Department (EPCHD) recognized an outbreak of penicillinase-producing Neisseria gonorrhoeae (PPNG) and other sexually transmitted diseases (STDs) occurring in Colorado Springs (1990 census population: 397,014), Colorado. An investigation by the EPCHD and the Colorado Department of Health eventually identified 56 cases of PPNG from December 1989 through March 1991 (Figure 1). The outbreak revealed a previously unidentified core group of persons with STDs in Colorado Springs. This report summarizes traditional and innovative measures used to investigate and manage the outbreak, and describes this core group and its role in STD transmission in Colorado Springs.

From the Centers for Disease Control and Prevention. Gang-related outbreak of penicillinase-producing Neisseria gonorrhoeae and other sexually transmitted diseases--Colorado Springs, Colorado

From the Centers for Disease Control and Prevention. Gang-related outbreak of penicillinase-producing Neisseria gonorrhoeae and other sexually transmitted diseases--Colorado Springs, Colorado

Resistance of recent Neisseria gonorrhoeae isolates in Nigeria and outcome of single-dose treatment with ciprofloxacin.

One hundred four patients (71 males, 33 females) with acute gonococcal urethritis or cervicitis were treated with a single oral 250 mg dose of ciprofloxacin at Jos University Teaching Hospital, Jos, Nigeria. All gonococcal strains were isolated from appropriate pre-treatment swabs. Penicillinase-producing Neisseria gonorrhoeae (PPNG) accounted for 72.8% of all isolates. In vitro sensitivity of gonococcal isolates to ciprofloxacin was 100%, while that to penicillin, ampicillin and co-trimoxazole was below 15%. Of the 104 patients treated with ciprofloxacin, 73 (70%) attended a follow-up visit. Seventy-three (100%) patients showed clinical cure and elimination of N. gonorrhoeae from the respective site of infection. Post-gonococcal urethritis or cervicitis believed to be due to concomitant chlamydial infection was found in 22 (30.1%) patients--18 males and four females. No adverse reactions were reported by any patient. Our findings show that a single oral dose of ciprofloxacin (250 mg) is well tolerated and effective in the treatment of uncomplicated gonorrhoea and is particularly useful in regions with a high prevalence of PPNG.

Urinary Tract Pathogens with a Special Reference to Mucoid Pseudomonas Aeruginosa at Aflaj General Hospital

Letters to the EditorUrinary Tract Pathogens with a Special Reference to Mucoid Pseudomonas Aeruginosa at Aflaj General Hospital Tolu Odugbemi, MD, PhD, MRCPath, FWACP N. Anandan, and MS, FRCS Olivia F. LinaBSMT Tolu Odugbemi Aflaj General Hospital, Aflaj, Riyadh 11912, Saudi Arabia Search for more papers by this author , N. Anandan Aflaj General Hospital, Aflaj, Riyadh 11912, Saudi Arabia Search for more papers by this author , and Olivia F. Lina Aflaj General Hospital, Aflaj, Riyadh 11912, Saudi Arabia Search for more papers by this author Published Online:1 Nov 1992https://doi.org/10.5144/0256-4947.1992.581SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionTo the Editor: In recent articles [1,2], various microorganisms responsible for urinary tract infections from hospitals in Saudi Arabia were reported. The most frequently isolated etiological agents of urinary tract infections with Escherichia coli, Klebsiella-Enterobacter group and Pseudomonas sp.[2]; and because many of the gram-negative organisms were found to be resistant to ampicillin, but susceptible to augmentin, it was suggested that ampicillin resistance was probably due to beta-lactamase production by the pathogens.We report our observation on urinary tract pathogens isolated between April 1991 and October 1991 from urine specimens submitted to the Pathology Laboratory, Aflaj General Hospital. This is a modern 110-bed general hospital situated in the Central Province of Saudi Arabia. It provides general medical, pediatric, and various surgical specialty services to the population of Aflaj and surrounding area.All clinical urine samples were collected into sterile universal containers and were received for bacteriological processing within 30 minutes of collection. Urinalysis including macroscopic and microscopic examinations were carried out. Specimens were aseptically inoculated onto CLED (Cystine lactose electrolye-deficient agar, oxoid). All inoculated agar plates were incubated at 37°C for 18 to 48 hours. Culture plates showing evidence of significant bacteriuria (greater 105 colony forming units (CFU/ml) were identified using standard method [3]. Further identification of bacterial isolates included the use of API 20E and API 20NE (Analytic Profile Index System, La Balme Les Grottes, France). Beta-lactamase production was determined using white-bond starch-paper technique [4].A total of 144 urine specimens (12.2%) out of 1183 clinical urine samples had significant bacteriuria.Table 1 shows the type of organisms isolated with Escherichia coli accounting for 51.0% of all the 144 clinical isolates. Other frequently isolated organisms in our study were Klebsiella-Enterobacter group and Pseudomonas sp. It is worth noting that the majority of urinary tract pathogens were beta-lactamase producers (Table 1). These findings confirm the report [2] that beta-lactamase could have accounted for prevalent ampicillin-resistance mentioned earlier.Table 1. Types of microorganisms isolated from urine and their beta-lactamase activity at Aflaj General Hospital.Table 1. Types of microorganisms isolated from urine and their beta-lactamase activity at Aflaj General Hospital.It is also interesting to note that a highly mucoid strain of Pseudomonas aeruginosa and a mucoid Escherichia coli were isolated from urine samples in our study. The two bacterial isolates had similar appearance to culture of Klebsiella which are usually mucoid. Sonnenwirth [5] highlighted the fact that mucoid Pseudomonas aeruginosa often isolated from sputum of patients with cystic fibrosis could be misidentified as Klebsiella. Careful interpretation of bacteriological tests including Oxidase test, Indole, Methyl-red, Voges-Proskauer, and Oxidation-fermentation of glucose could be useful in differentation of the mucoid microorganisms [5].This preliminary report is to share our experience on the need for further studies on the prevalence of beta-lactamase producing organisms and mucoid strains of Pseudomonas in clinical bacterial isolates in Saudi Arabia.ARTICLE REFERENCES:1. El-Tahawy AT, Khalaf RMF. "Urinary tract infection at university hospital in Saudi Arabia: incidence, microbiology and antimicrobial susceptibility" . Ann Saudi Med. 1988; 8(4):261–6. Google Scholar2. El-Bashier AM. "Bacteriuria, incidence, causative micro-ogranism, and susceptibility pattern at Qatif Central Hospital" . Ann Saudi Med. 1991; 11(4):429–34. Google Scholar3. Cowan ST. In: Cowan and Steel's manual for identification of medical bacteria, ed 2. Cambridge: Cambridge University Press, 1974. Google Scholar4. Odugbemi TO, Hafiz S, McEntegart MG. "Penicillinase-producing Neisseria gonorrhoeae: detection by starch-paper technique" . Br Med J. 1977; 2:500. Google Scholar5. Sonnenwirth AC. Gram-negative bacilli, vibrios and spirilla. In: Sonnenwirth AC, Jarrett L. eds. Gradwohl's clinical laboratory methods and diagnosis, ed 8. St. Louis, Toronto, London: CV Mosby Company; 1980:1731–852. Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 12, Issue 6November 1992 Metrics History Published online1 November 1992 InformationCopyright © 1992, Annals of Saudi MedicinePDF download

The emergence of penicillinase-producing Neisseria gonorrhoeae strains carrying the 4.9 kb (Toronto) plasmid in Denmark and of a novel large plasmid in two nonpenicillinase-producing Neisseria gonorrhoeae strains.

This study comprised plasmid analysis and antimicrobial susceptibility testing of 712 out of a total of 730 penicillinase-producing Neisseria gonorrhoeae (PPNG) and 744 random non-PPNG strains isolated in Denmark between 1985 and 1990. The rate of patients with PPNG infections rose from 1% to 2% during 1985-1987 to 6.9% in 1989, and then decreased to 4.8% in 1990. A decrease in cases of gonorrhea from 9,798 to 1,990 was seen during the same period. Strains harboring the 4.9 kb (Toronto) plasmid first appeared in 1987; in 1988-1990, 65% to 78% of strains from patients with PPNG infections acquired in Denmark contained this plasmid. The majority of these strains seemed to belong to a single clone. Tetracycline-resistant PPNG strains (MIC greater than 32 mg/L) first appeared in Denmark in 1989, and tetracycline-resistant non-PPNG strains carrying a 40 kb plasmid (tetM?) first appeared in 1990. A novel 41-42 kb plasmid appeared in one strain in 1987 and another in 1988. The minimum inhibitory concentration (MIC) of tetracycline for these two strains was 4 mg/l. The significance of this plasmid is yet unknown.

Strain characteristics and antibiotic susceptibility of isolates of Neisseria gonorrhoeae causing disseminated gonococcal infection in Australia. Members of the Australian Gonococcal Surveillance Programme.

The auxotype (A) and serovar (S) distribution and antibiotic and serum sensitivity of 22 strains of Neisseria gonorrhoeae isolated from blood and joints were determined. With one exception, these strains from disseminated gonococcal infections (DGI) belonged to one of 4 serovars of the IA serogroup and were resistant to killing by normal human serum. The auxotype distribution of these Australian strains differed significantly from that reported elsewhere in that 17 of the 22 isolates were proline requires, but none were of the AHU auxotype. This lack of the AHU auxotype in the DGI strains in Australia was explained by the virtual absence of AHU requirers in a sample of 1560 mucosal strains isolated in Sydney and Darwin from 1987 to 1990. The A/S distribution of these mucosal isolates also helped to account for the low (0.12) percentage of DGI strains in isolates examined by the Australian Gonococcal Surveillance Programme (AGSP) from 1981 to 1991, and the differences in the rates of DGI in Sydney (0.08%) and Darwin (0.87%). There was a relative lack of the IA serogroup strains which are mostly responsible for DGI in the mucosal isolates from Sydney (15% of all strains) but a higher proportion of these serovars (40%) in the Darwin sample. There were 46 cases of DGI in data from the AGSP, 29 of these being women. Seven of the cases diagnosed in Australia were infected with penicillinase-producing gonococci suggesting that antibiotics other than the penicillins should now be used for this condition in this region.