Tetracycline-resistant N. Gonorrhoeae Research Articles

Changing antimicrobial susceptibility and molecular characterisation of Neisseria gonorrhoeae isolates in Guangdong, China: in a background of rapidly rising epidemic

The prevalence of Neisseria gonorrhoeae infections has increased rapidly since 2015 in China. Antimicrobial resistance and molecular mobilisation in N. gonorrhoeae are two important factors driving this increasing prevalence. This study explored changes in antimicrobial susceptibility and molecular characteristics of N. gonorrhoeae collected in Guangdong, China (2013-2017). A total of 704 isolates were collected in two cities in Guangdong. MICs of major antimicrobials were determined. Penicillinase-producing N. gonorrhoeae (PPNG) and tetracycline-resistant N. gonorrhoeae (TRNG) were characterised, and N. gonorrhoeae multiantigen sequence typing (NG-MAST) was performed. High resistance to penicillin (68.2%), tetracycline (85.7%) and ciprofloxacin (98.2%) was observed. Spectinomycin, ceftriaxone and azithromycin appeared effective, with susceptibilities of 100%, 96.4% and 90.7%, respectively. Resistance to penicillin decreased significantly from 78.4% to 73.6% and to azithromycin from 11.9% to 3.7%. Total prevalence of PPNG, TRNG and PPNG/TRNG was 25.4%, 33.1% and 13.4%, respectively. Rates of PPNG decreased significantly from 37.3% to 23.9%, TRNG from 50.0% to 31.3%, and PPNG/TRNG from 23.5% to 11.7%. However, the ratio of African-type PPNG increased significantly (18.4% to 64.1%) compared with decreasing Asian-type PPNG (81.6% to 33.3%), and the ratio of American-type TRNG increased significantly (0% to 13.7%) compared with decreasing Dutch-type TRNG (100% to 86.3%). A total of 271 sequence types (STs) were identified by NG-MAST from 380 isolates collected in 2013, 2014 and 2017, with 145 novel STs. African-type PPNG is increasing and replacing Asian-type, and novel STs have emerged. Gonococcal isolates with new genotypes might contribute to the rising gonorrhoea epidemic in this area.

1489. Trends in Antimicrobial Resistance in N. gonorrhoeae Isolated in Korea During 2015–2017

BackgroundThe trends of antimicrobial resistance (AMR) and the molecular epidemiology of gonococcal strains were analyzed in Korean during 2015 to 2017.MethodsThe susceptibility tests of 187 N. gonorrhoeae isolates were investigated. The minimum inhibitory concentration (MIC) of N. gonorrhoeae isolates were determined by the agar dilution method. Penicillinase-producing N. gonorrhoeae (PPNG) and plasmid-mediated tetracycline-resistant N. gonorrhoeae (TRNG) were evaluated. Isolates were tested for mutations in penA and also genotyped using N. gonorrhoeae multi-antigen sequence typing (NG-MAST) to determine the molecular epidemiological characteristics of the isolates.ResultsThe rates of resistance to ceftriaxone (CRO) increased from 6.5% in 2015 to 13.4% in 2017. Azithromycin resistance was documented only in 1.1%, but 53.5% of isolates showed intermediate susceptibility. All isolates were susceptible to spectinomycin. However, none of isolates was susceptible to ciprofloxacin and penicillin (PEN) and 4.3% of isolates were susceptible to tetracycline. The PPNG and TRNG increased from 25.7% and 39.4% in 2015 to 47.8% and 81.5% in 2017, respectively. 74.7% of the extended-spectrum cephalosporins (ESCs)-resistant isolates contained the mosaic PBP2 X allele, which has been previously associated with ESC resistance including treatment failures. penA mosaic alleles X were found in 83.8% of all isolates that harbored decreased susceptibility to cefixime. Among the 16 N. gonorrhoeae isolates with decreased susceptibility to CRO, penA mosaic X allele was identified in the 11 isolates. The 189 N. gonorrhoeae isolates were assigned to 112 different NG-MASTs; seven sequence types (STs) were novel. The most common ST was 10,668 (16.1%), followed by ST15024 (7.1%). Two ST1407 strains have been isolated in 2015. Although ST1407 was known to display decreased susceptibility to ESCs or full resistance, they were susceptible for CRO (MIC = 0.06 μg/mL) and cefixime (MIC = 0.12 μg/mL).ConclusionThe recent emergence of ESC-resistant N. gonorrhoeae strains which was often associated with mutations in the penA gene is a major concern and enhanced AMR surveillance is necessary to prevent transmission of these strains.Disclosures All authors: No reported disclosures.

Surveillance of Antibiotic Susceptibility Patterns of Neisseria gonorrhoeae from 2013 to 2015 in Guangxi Province, China.

Neisseria gonorrhoeae is a sexually transmitted pathogen highly prevalent worldwide with an increasing trend of resistance to antimicrobial treatment. We conducted this study to trace the susceptibility of N. gonorrhoeae to penicillin (PC), spectinomycin (SPCM), ciprofloxacin (CPFX), azithromycin (AZM), cefixime (CFIX), and ceftriaxone (CTRX) in Guangxi province. In total, 303 N. gonorrhoeae isolates were obtained from patients infected with N. gonorrhoeae in 6 cities in Guangxi during 2013-2015, and the antibiotic susceptibility patterns were analyzed by an agar dilution assay. The results showed that N. gonorrhoeae was susceptible to treatment with cephalosporins, including CTRX (99.7% of isolates), CFIX (99%), SPCM (100%), and AZM (96.4%), and this is the first report of antibiotic susceptibility for AZM surveillance of N. gonorrhoeae in Guangxi. Penicillinase-producing N. gonorrhoeae (PPNG) isolates increased in prevalence from 37% in 2013 to 64% in 2015 (P = 0.068), and tetracycline-resistant N. gonorrhoeae (TRNG) prevalence increased from 23% in 2013 to 44% in 2015 (P = 0.071). High resistance of N. gonorrhoeae to PC was associated with infection in patients at ages 25 to 30 years (P ＜ 0.05), whereas PPNG positivity (P ＜ 0.01), and TRNG positivity were risk factors for CPFX resistance (P = 0.0407). Our study provides plausible evidence for therapeutic strategies and N. gonorrhoeae infection control and prevention in Guangxi, China.

Antimicrobial susceptibility of Neisseria gonorrhoeae isolates from Hefei (2014\u20132015): genetic characteristics of antimicrobial resistance

BackgroundAntimicrobial resistance (AMR) and genetic determinants of resistance of N. gonorrhoeae isolates from Hefei, China, were characterized adding a breadth of information to the molecular epidemiology of gonococcal resistance in China.Methods126 N. gonorrhoeae isolates from a hospital clinic in Hefei, were collected between January, 2014, and November, 2015. The minimum inhibitory concentration (MIC) of N. gonorrhoeae isolates for seven antimicrobials were determined by the agar dilution method. Isolates were tested for mutations in penA and mtrR genes and 23S rRNA, and also genotyped using N. gonorrhoeae multi-antigen sequence typing (NG-MAST).ResultsAll N. gonorrhoeae isolates were resistant to ciprofloxacin; 81.7% (103/126) to tetracycline and 73.8% (93/126) to penicillin. 39.7% (50/126) of isolates were penicillinase producing N. gonorrhoeae (PPNG), 31.7% (40/126) were tetracycline resistant N. gonorrhoeae (TRNG) and 28.6% (36/126) were resistant to azithromycin. While not fully resistant to extended spectrum cephalosporins (ESCs), a total of 14 isolates (11.1%) displayed decreased susceptibility to ceftriaxone (MIC ≥ 0.125 mg/L, n = 10), cefixime (MIC ≥ 0. 25 mg/L, n = 1) or to both ESCs (n = 3). penA mosaic alleles XXXV were found in all isolates that harbored decreased susceptibility to cefixime, except for one. Four mutations were found in mtrR genes and mutations A2143G and C2599T were identified in 23S rRNA. No isolates were resistant to spectinomycin. Gonococcal isolates were distributed into diverse NG-MAST sequence types (STs); 86 separate STs were identified.ConclusionsN. gonorrhoeae isolates from Hefei during 2014–2015, displayed high levels of resistance to antimicrobials that had been recommended previously for treatment of gonorrhea, e.g., penicillin, tetracycline and ciprofloxacin. The prevalence of resistance to azithromycin was also high (28.6%). No isolates were found to be fully resistant to spectinomycin, ceftriaxone or cefixime; however, 11.1% isolates, overall, had decreased susceptibility to ESCs.

Antimicrobial susceptibility of Neisseria gonorrhoeae isolates from symptomatic men attending the Nanjing sexually transmitted diseases clinic (2011-2012): genetic characteristics of isolates with reduced sensitivity to ceftriaxone.

BackgroundEvolving gonococcal antimicrobial resistance (AMR) poses a serious threat to public health. The aim of this study was to: update antimicrobial susceptibility data of Neisseria gonorrhoeae recently isolated in Nanjing, China and identify specific deteminants of antimicrobial resistance and gentoypes of isolates with decreased sensitivity to ceftriaxone.Methods334 N. gonorrhoeae isolates were collected consecutively from symptomatic men attending the Nanjing STD Clinic between April 2011 and December 2012. The minimum inhibitory concentrations (MICs) for penicillin, tetracycline, ciprofloxacin, spectinomycin and ceftriaxone were determined by agar plate dilution for each isolate. Penicillinase-producing N. gonorrhoeae (PPNG) and tetracycline-resistant N. gonorrhoeae (TRNG) were examined and typed for β-lactamase and tetM encoding plasmids respectively. Isolates that displayed elevated MICs to ceftriaxone (MIC ≥0.125 mg/L) were also tested for mutations in penA, mtrR, porB1b, ponA and pilQ genes and characterized by Neisseria gonorrhoeae multi-antigen sequence typing (NG-MAST).Results98.8% (330/334) of N. gonorrhoeae isolates were resistant to ciprofloxacin; 97.9% (327/334) to tetracycline and 67.7% (226/334) to penicillin. All isolates were susceptible to ceftriaxone (MIC ≤0.25 mg/L) and spectinomycin (MIC ≤32 mg/L). Plasmid mediated resistance was exhibited by 175/334 (52%) of isolates: 120/334 (36%) of isolates were PPNG and 104/334 (31%) were TRNG. 90.0% (108/120) of PPNG isolates carried the Asia type β-lactamase encoding plasmid and 96% (100/104) of TRNG isolates carried the Dutch type tetM containing plasmid. Elevated MICs for ceftriaxone were present in 15 (4.5%) isolates; multiple mutations were found in penA, mtrR, porB1b and ponA genes. The 15 isolates were distributed into diverse NG-MAST sequence types; four different non-mosaic penA alleles were identified, including one new type.ConclusionsN. gonorrhoeae isolates in Nanjing generally retained similar antimicrobial resistance patterns to isolates obtained five years ago. Fluctuations in resistance plasmid profiles imply that genetic exchange among gonococcal strains is ongoing and is frequent. Ceftriaxone and spectinomycin remain treatments of choice of gonorrhea in Nanjing, however, decreased susceptibility to ceftriaxone and rising MICs for spectinomycin of N. gonorrhoeae isolates underscore the importance of maintaining surveillance for AMR (both phenotypic and genotypic).Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0622-0) contains supplementary material, which is available to authorized users.

P5.103 Increase of African-Type Penicillinase-Producing N. Gonorrhoeae Strains Isolated in Guangzhou, China, 2001–2011

Background The continuing spread of drug-resistant gonococci has posed a challenge for successful treatment worldwide. Guangdong Province in South China has one of the highest resistance rates of gonococci in China and a large number of international migrants. We investigated the in vitro antimicrobial susceptibility and genotypes of N. gonorrhoeae isolated in Guangzhou, the capital city, in 2001–11. Methods MICs to penicillin, ceftriaxone, tetracycline, ciprofloxacin, and spectinomycin were determined by agar plate dilution and susceptibilities were interpreted according to WHO standards. Penicillinase-producing N. gonorrhoeae (PPNG) was determined by paper acidometric testing and high-level tetracycline resistant N. gonorrhoeae (TRNG) by MIC. The isolates with resistant plasmids were genotyped by PCR. Results Of 1250 consecutive gonococci isolated during 2001–11, no ceftriaxone and spectinomycin resistant strains were found, but the prevalence of less susceptible strains to ceftriaxone rose from 17% to 46.5%. The MIC 90 for ceftriaxone showed intermediate sensitivity (0.06–0.125µg/mL) and spectinomycin near the resistant level (16–32µg/mL). The resistance to penicillin, tetracycline and ciprofloxacin were from 85%, 85% and 78% in 2001 to 81.9%, 100% and 98.4% in 2011, respectively. Of 349 (27.9%) PPNG and 539 (43.1%) TRNG detected. 232 (18.6%) strains were both PPNG and TRNG. PPNG increased from 17.0% to 32.3% and TRNG from 26.0% to 41.7% during 2001–10. Genotyping TEM-1 gene showed 94.8% PPNGs carrying the Asia-type β-lactamase plasmids. The Africa-type PPNG (1, 1.3%) emerged in 2008 and has increased to 8(6.2%) in 2011. Genotyping of tetM gene showed all TRNGs were Dutch variants. Conclusion Gonorrhea resistance continues to be a major public health problem in Guangzhou. The emergence and increase of African-type PPNG may be related to the large African diasporas in Guangzhou, migration of Chinese to Africa, or other migration patterns. More research is needed to determine what practises, systems and behaviours contribute to escalating resistance patterns.

P5.101 Rising Trend of Antimicrobial Resistance Among Neisseria Gonorrhoeae Isolates in a Central Delhi Tertiary Care Hospital

BackgroundGonorrhoea continues to be a common sexually transmitted disease (STD) in developing countries. Over the last decade, N.gonorrhoeae has developed resistance against antimicrobial agents such as penicillin, tetracycline and quinolones...

Antimicrobial Resistance ofNeisseria gonorrhoeaeIsolated in Korea

Neisseria gonorrhoeae is the causative agent of gonorrhea, one of the most important sexually transmitted diseases. The incidence of gonorrhea is still prevalent and about 50,000 new cases have been reported annually during the late 2000s in Korea. The antimicrobial resistance of N. gonorrhoeae is very prevalent and most isolates are multi-drug resistant to penicillin G, tetracycline, and fluoroquinolones. The incidence of penicillinase-producing N. gonorrhoeae (PPNG) decreased significantly, but high-level tetracycline-resistant N. gonorrhoeae (TRNG) increased recently. The minimum inhibitory concentrations (MICs) of ceftriaxone were within the susceptible range for all isolates, but MIC creep has been apparent and one cefixime-nonsusceptible isolate (0.5 ㎍/㎖) was found. Spectinomycin-resistant isolates remain rare, but caution should be required when dealing with gonococcal pharyngitis.

Antimicrobial resistance in clinical isolates of Neisseria gonorrhoeae in China,2008:an epidemiological study

Objective To study the current status of antimicrobial resistance of clinical Neisseria gonorrhoeae isolates in China by analyzing the surveillance results in 2008.Methods N. gonorrhoeae strains were collected from 951 eligible patients at national monitoring sites for resistance of N. gonorrheae,including 156 patients from Jiangsu province,71 from Zhejiang province,102 from Fujian province,207 from Guangdong province,77 from Guangxi province,43 from Hainan province,80 from Sichuan province,44 from Chongqing,45 from Xinjiang Uygur Autonomous Region,72 from Shaanxi province,and 54 from Tianjin.The production of β-lactamase was detected by paper acidometric testing,and minimum inhibitory concentrations(MICs)were determined by agar dilution method for spectinomycin,ciprofloxacin,cefiriaxone,tetracycline,respectively.Results Among the 951 N. gonorrhoeae isolates,2(0.21%)were resistant to spectinomycin,451(47.42%)showed reduced sensitivity to ceflriaxone,928(97.58%)were resistant to ciprofloxacin.Penicillinase-producing N.gonorrhoeae (PPNG) and plasmid mediated tetracycline-resistant N. gonorrhoeae (TRNG) accounted for 34.91%(332/951)and 51.21%(487/951) of these isolates respectively.Kendall rank correlation analysis showed that there was a positive correlation between the positivity rate of TRNG and PPNG(r=0.20,P<0.01),but a negative correlation between the susceptibility to cefiriaxone in N.gonorrhoeae and positivity rate of PPNG(r=-0.09,P<0.01).No correlation was observed between the susceptibility to cefiriaxone and susceptibility to ciprofloxacin or the positivity rate of TRNG,or between the susceptibility to ciprofloxacin and positivity rate of PPNG or TRNG.Chi-square analysis showed a marked increase in the percentage of N.gonorrhoeae isolates with reduced susceptibility to ceftriaxone in Guangxi province,Hainan province,Xinjiang Uygur Autonomous Region and Shaanxi province,the percentage of N.gonorrhoeae isolates with resisitance to spectinomycin in Shaanxi province,prevelance of TRNG in Guangdong province,and prevelance of PPNG in Sichuan and Zhejiang provinces compared with the average level (all P<0.05).Conclusions Thero is a significant diffefence in antimicrobial susceptibility of N.gonorrhoeae from difierent areas of China.A significant elevation is observed in the percentage of N.gonorrhoeae with reduced susceptibihty to cefifiaxone and resistance to spectinomycin in Shaanxi province.to which close attention should be paid. Key words: Neisseria gonorrhoeae; Drug resistance,bacterial; Drug monitoring

P1-S1.41 Emergence of an African antimicrobial resistance genotype in Neisseria gonorrhoeae strains isolated in Guangzhou, China, 2001–2009

BackgroundThe continuing spread of drug-resistant gonococci has posed a challenge for successful treatment worldwide. Recently third-generation cephalosporins-resistant strains were isolated in Japan. Guangdong Province in South China has one of...

Plasmid-Mediated Penicillin and Tetracycline Resistance Among Neisseria gonorrhoeae Isolates in South Africa: Prevalence, Detection and Typing Using a Novel Molecular Assay

To detect and type plasmids responsible for penicillin and tetracycline resistance in Neisseria gonorrhoeae isolates using a novel duplex polymerase chain reaction (PCR) assay. A duplex PCR assay, to detect and type penicillinase-producing N. gonorrhoeae (PPNG), and plasmid-mediated tetracycline resistant N. gonorrhoeae (TRNG), was developed on the basis of published single assays. Gonococcal Isolate Surveillance Project control strains were used in assay development and then 209 consecutive N. gonorrhoeae isolates, collected from men with urethral discharge in 2008, were tested. Controls included Asia, Africa, and Toronto β-lactamase plasmids, as well as American and Dutch TRNG plasmids. PCR amplicons were detected using an Agilent 2100 Bioanalyzer. Minimum inhibitory concentrations (MIC) were determined with E tests. Penicillinase production was detected using Nitrocefin solution. Among 209 gonococcal isolates, 54 (25.8%) PPNG and 154 (73.3%) TRNG were detected. The MIC50 and MIC90 values were determined for penicillin (0.19 and 32 mg/L) and tetracycline (6 and 16 mg/L). The assay detected the Africa-type (35.2%), the Toronto-type (44.4%), and a new type (20.3%) of β-lactamase plasmid. The American-type TRNG plasmid was 3-fold more frequent as compared with the Dutch-type. Although there was no overall association between the detection of PPNG and TRNG plasmids, only American type TRNG contained β-lactamase-encoding plasmids (P < 0.0001). The prevalence of plasmid-mediated resistance to tetracycline, and to a lesser extent penicillin, is high and neither drug is likely to have any future role in the treatment of gonorrhoea in South Africa. A novel β-lactamase plasmid was detected during the study and requires further characterization.

Monitoring Antimicrobial Susceptibility of &lt;i&gt;Neisseria gonorrhoeae&lt;/i&gt; Isolated from Bangladesh during 1997-2006: Emergence and Pattern of Drug-resistant Isolates

Gonorrhoea is one of the most common sexually transmitted infections (STIs) in developing countries, and the emergence of resistance to antimicrobial agents in Neisseria gonorrhoeae is a major obstacle in the control of gonorrhoea. Periodical monitoring of antimicrobial susceptibility of N. gonorrhoeae is essential for the early detection of emergence of drug resistance. In total, 1,767 gonococcal strains isolated from males and females (general population and those with high-risk behaviour) from different parts of Bangladesh were studied during 1997-2006. Minimum inhibitory concentrations of penicillin, tetracycline, ciprofloxacin, ceftriaxone, spectinomycin, and azithromycin for the isolates were determined by the agar dilution method. Isolates resistant to three or more antimicrobial agents are considered multidrug-resistant. The prevalence of plasmid-mediated penicillinase-producing N. gonorrhoeae (PPNG) and plasmid-mediated tetracycline-resistant N. gonorrhoeae (TRNG) was determined. Nine percent of the isolates were resistant to ciprofloxacin in 1997 compared to 87% in 2006. Multidrug-resistant N. gonorrhoeae have emerged in 1997, and 44% of the strains (n = 66) isolated during 2006 were multidrug-resistant. Forty-two percent of the isolates in 2006 were both PPNG- and TRNG-positive compared to none in 1997. The rapidly-changing pattern of gonococcal antimicrobial susceptibility warrants the need for an antimicrobial susceptibility-monitoring programme, and periodical analysis and dissemination of susceptibility data are essential to guide clinicians and for successful STI/HIV intervention programmes.

One-step PCR for the identification of multiple antimicrobial resistance in Neisseria gonorrhoeae

One-step multiplex PCR was developed for the identification of gonococci and antimicrobial-resistant profiles. From forty Neisseria gonorrhoeae isolates, the penicillinase-producing N. gonorrhoeae (PPNG), the high-level tetracycline-resistant N. gonorrhoeae (TRNG), and the ciprofloxacin-resistant N. gonorrhoeae (CRNG) were successfully classified. Our method provides expediency and benefit to epidemiology and antimicrobial-resistance mobility with 100% sensitivity and specificity for gonococcal-detection. The detection limit was 500 CFU/reaction.

EPIDEMILOGICAL ANALYSIS OF NEISSERIA GONORRHOEAE ISOLATES BY ANTIMICROBIAL SUSCEPTIBILITY TESTING, AUXOTYPING AND SEROTYPING

Purpose: This study was carried out to analyze the epidemiology of gonorrhea based on antimicrobial susceptibility testing, auxotyping and serotyping in New Delhi, India. Methods: Sixty gonococcal isolates from males with urethritis, females with endocervicitis and their sexual contacts were studied. The isolates were subjected to antimicrobial susceptibility testing, auxotyping and serotyping for epidemiological characterization. Results: We observed nine antibiotic resistance patterns. Ninety-eight percent of isolates were resistant to ciprofloxacin, while 20% isolates were penicillinase producing N. gonorrhoeae (PPNG) and 18.3% isolates were tetracycline resistant N. gonorrhoeae (TRNG). Eight auxotypes were observed, of which the NR (non-requiring), proline requiring and arginine requiring were most common auxotypes. On the basis of serotyping alone, the gonococcal isolates could be differentiated into three serogroups and 18 serovars. Serogroup WI represented 46.7% and WII/III represented 51.7% of isolates and one strain was WI and WII/WIII serogroup combination. When results of auxotyping and serotyping were combined (A/S) 29 A/S classes could be identified. The most prevalent A/S classes were NR/Aost, NR/Arost, Pro/Aost and Pro/Boprt. Conclusions: Although A/S typing had the highest discriminatory index, isolates recovered from index case and their sexual contacts were found to be identical by all typing methods.

Epidemilogical analysis of &lt;i&gt;&lt;i&gt;Neisseria&lt;/i&gt; gonorrhoeae&lt;/i&gt; isolates by antimicrobial susceptibility testing, auxotyping and serotyping

This study was carried out to analyze the epidemiology of gonorrhea based on antimicrobial susceptibility testing, auxotyping and serotyping in New Delhi, India. Sixty gonococcal isolates from males with urethritis, females with endocervicitis and their sexual contacts were studied. The isolates were subjected to antimicrobial susceptibility testing, auxotyping and serotyping for epidemiological characterization. We observed nine antibiotic resistance patterns. Ninety-eight percent of isolates were resistant to ciprofloxacin, while 20% isolates were penicillinase producing N. gonorrhoeae (PPNG) and 18.3% isolates were tetracycline resistant N. gonorrhoeae (TRNG). Eight auxotypes were observed, of which the NR (non-requiring), proline requiring and arginine requiring were most common auxotypes. On the basis of serotyping alone, the gonococcal isolates could be differentiated into three serogroups and 18 serovars. Serogroup WI represented 46.7% and WII/III represented 51.7% of isolates and one strain was WI and WII/WIII serogroup combination. When results of auxotyping and serotyping were combined (A/S) 29 A/S classes could be identified. The most prevalent A/S classes were NR/Aost, NR/Arost, Pro/Aost and Pro/Boprt. Although A/S typing had the highest discriminatory index, isolates recovered from index case and their sexual contacts were found to be identical by all typing methods.

A Pilot Study on Antimicrobial Susceptibility of Neisseria gonorrhoeae Isolates From Nepal

Despite a sharp decline in the incidence of gonococcal infection in developed countries during the last decade gonorrhea remains one of the most common sexually transmitted infections (STIs) in developing countries and a global health problem. In the absence of effective vaccine control of gonococcal infection mainly depends on identification and treatment of the infected individuals and reductions in sexual risk behavior. Early and successful antibiotic treatment of gonococcal infection is important for cure of the patient prevention of complications and to reduce transmission. Strategies for control of gonorrhea have relied on the use of highly effective and often single-dose therapy administered at the time of diagnosis. Information on antimicrobial susceptibility of Neisseria gonorrhoeae is therefore important to guide selection of an appropriate antimicrobial agent. Antimicrobial resistance in gonococci often spreads rapidly between countries and infected travelers often appear for treatment in countries distant from the place of contact. Hence local and regional antimicrobial resistance data are important for management of gonorrhea. Specific data on the incidence of gonorrhea and antimicrobial resistance of N. gonorrhoeae in Nepal is lacking. A pilot study was conducted to assess the effectiveness of current recommendations for treatment for gonorrhea which is a single oral dose of 500 mg ciprofloxacin. (excerpt)

Antimicrobial resistance of Neisseria gonorrhoeae in Liberia

The prevalence and molecular characteristics of penicillinase-producing Neisseria gonorrhoeae (PPNG) and tetracycline-resistant N. gonorrhoeae (TRNG) were determined in 10 clinics in Monrovia, Liberia, to assess the likely effectiveness of the current standard treatment with penicillin or tetracycline. One hundred gonococcal strains were isolated from 146 urethral swabs and 261 cervical swabs and screened for susceptibility to ceftriaxone, penicillin, spectinomycin and tetracycline by the disk diffusion method; 83% were resistant to penicillin and 63% to tetracycline. Twenty-one strains from 18 men and 3 women with uncomplicated gonorrhoea were subjected to more detailed characterization. These 21 strains belonged to 5 auxotype/serovar classes; 86% were PPNG/TRNG. Three PPNG harboured the 4·4 MDa penicillinase plasmid and 16 the 3·2 MDa plasmid. All TRNG harboured the 25·2 MDa plasmid and their MICs for tetracycline were >32 mg/L. They gave a PCR product which, according to its restriction pattern, corresponded to the American type tetM gene. By the agar dilution method, all strains exhibited intermediate resistance to sulphamethoxazole-trimethoprim (19:1) (co-trimoxazole) with MICs of 8–32 mg/L. All strains were susceptible to spectinomycin and ciprofloxacin. The MICs for gentamicin were 4–8 mg/L. The use of effective and affordable antimicrobial chemotherapy with either 500 mg ciprofloxacin or a single dose of gentamicin is discussed, with consideration of molecular biological, pharmacological and public health aspects.

Surveillance of antibiotic resistance in Neisseria gonorrhoeae in The Netherlands, 1977-95.

OBJECTIVE: To evaluate the prevalence and epidemiology of penicillinase producing Neisseria gonorrhoeae (PPNG) and tetracycline resistant N gonorrhoeae (TRNG) in the period 1977-95 in the Netherlands. To compare auxotypes, serovars,...

Molecular epidemiology, in 1994, of Neisseria gonorrhoeae in Manila and Cebu City, Republic of the Philippines.

Failure of gonococcal infections to respond to 500 mg of ciprofloxacin or 400 mg of ofloxacin has been reported from Australia, the United Kingdom, and the United States. Recently, high rates of decreased susceptibility to the fluoroquinolones have been detected in penicillinase-producing Neisseria gonorrhoeae in the Republic of the Philippines. To assess the diversity of antimicrobial-resistant gonococcal strains isolated from female sex workers in Manila and Cebu City in the Republic of the Philippines in 1994. Isolates of N. gonorrhoeae isolated from 92 female sex workers in Manila (n = 28) and Cebu City (n = 64), respectively, were characterized by plasmid profile, auxotype/serovar class, and antimicrobial susceptibility profile. Plasmid-mediated resistance to penicillin or tetracycline was identified in 79.3% (73/92) of the isolates: penicillinase-producing N. gonorrhoeae (65/92; 70.7%), tetracycline-resistant N. gonorrhoeae (6/92; 6.5%), and penicillinase-producing/tetracycline-resistant N. gonorrhoeae (1/92; 1.1%). A beta-lactamase plasmid of 3.9 megadaltons was discovered. Of 54.3% (50/92) of strains resistant to nalidixic acid, 84% (42/50) of strains had minimum inhibitory concentrations of > or = 0.125 microgram/ml ciprofloxacin; penicillinase-producing N. gonorrhoeae (possessing the 3.05-, 3.2-, 3.9-, and 4.4-megadalton beta-lactamase plasmids, respectively) accounted for 68% (34/50) of these strains. In the Republic of the Philippines, gonococcal isolates resistant to penicillin or tetracycline accounted for 85.9% (79/92) of the isolates examined and included strains exhibiting resistance to fluoroquinolones. All gonococcal infections should be treated with antimicrobial therapies known to be active against all gonococcal strains to reduce the spread of strains exhibiting decreased susceptibilities to fluoroquinolones.

Temporal trends in gonococcal antibiotic resistance in Baltimore.

Each month from August 1986 through July 1990, clinical and laboratory data were evaluated for the first 25 urethral isolates of Neisseria gonorrhoeae from men attending a Baltimore sexually transmitted disease (STD) clinic as part of an effort to understand factors that contribute to changes in gonococcal antimicrobial susceptibility. During the 48-month study period, 1193 gonococcal isolates were evaluated; the proportion of penicillinase-producing N. gonorrhoeae (PPNG) isolates steadily increased, the prevalence of tetracycline-resistant N. gonorrhoeae (TRNG) remained relatively stable, and chromosomally mediated penicillin resistance increased steadily during the first 5 6-month intervals, then decreased, only to increase again during the final 2 6-month intervals. Changes in antibiotic treatment regimens for gonorrhea were associated with changes in the prevalence of chromosomally mediated penicillin resistance. In a supplementary study to characterize patterns of antibiotic use among men and women attending the STD clinics, 9% of patients reported antibiotic use in the 2 weeks prior to clinic visit. Antibiotics were taken prior to clinic attendance by 65% of patients reporting antibiotic use, because of concerns regarding possible STD or STD exposure. These patients were significantly less likely to be culture positive for N. gonorrhoeae when compared with patients who did not report antibiotic use. Temporal trends in N. gonorrhoeae antibiotic resistance appear to be influenced by many factors, including treatment regimens and self medication.