Antimicrobial susceptibility/resistance and genetic characteristics of Neisseria gonorrhoeaeisolates from Poland, 2010-2012

Abstract

BackgroundIn Poland, gonorrhoea has been a mandatorily reported infection since 1948, however, the reported incidences are likely underestimated. No antimicrobial resistance (AMR) data for Neisseria gonorrhoeae has been internationally reported in nearly four decades, and data concerning genetic characteristics of N. gonorrhoeae are totally lacking. The aims of this study were to investigate the AMR to previously and currently recommended gonorrhoea treatment options, the main genetic resistance determinant (penA) for extended-spectrum cephalosporins (ESCs), and genotypic distribution of N. gonorrhoeae isolates in Poland in 2010-2012.MethodsN. gonorrhoeae isolates cultured in 2010 (n = 28), 2011 (n = 92) and 2012 (n = 108) in Warsaw and Bialystok, Poland, were examined using antimicrobial susceptibility testing (Etest), pyrosequencing of penA and N. gonorrhoeae multi-antigen sequence typing (NG-MAST).ResultsThe proportions of N. gonorrhoeae isolates showing resistance were as follows: ciprofloxacin 61%, tetracycline 43%, penicillin G 22%, and azithromycin 8.8%. No isolates resistant to ceftriaxone, cefixime or spectinomycin were found. However, the proportion of isolates with an ESC MIC = 0.125 mg/L, i.e. at the resistance breakpoint, increased significantly from none in 2010 to 9.3% and 19% in 2012 for ceftriaxone and cefixime, respectively. Furthermore, 3.1% of the isolates showed multidrug resistance, i.e., resistance to ciprofloxacin, penicillin G, azithromycin, and decreased susceptibility to cefixime (MIC = 0.125 mg/L). Seventy-six isolates (33%) possessed a penA mosaic allele and 14 isolates (6.1%) contained an A501V/T alteration in penicillin-binding protein 2. NG-MAST ST1407 (n = 58, 25% of isolates) was the most prevalent ST, which significantly increased from 2010 (n = 0) to 2012 (n = 46; 43%).ConclusionsIn Poland, the diversified gonococcal population displayed a high resistance to most antimicrobials internationally previously recommended for gonorrhoea treatment and decreasing susceptibility to the currently recommended ESCs. The decreasing susceptibility to ESCs was mostly due to the introduction of the internationally spread multidrug-resistant NG-MAST ST1407 in 2011. It is essential to promptly revise the gonorrhoea treatment guidelines, improve the gonorrhoea laboratory diagnostics, and implement quality assured surveillance of gonococcal AMR (ideally also treatment failures) in Poland.

High Prevalence of Azithromycin-Resistant Neisseria gonorrhoeae Isolates With a Multidrug Resistance Phenotype in Fukuoka, Japan

“…Recently, the elevated proportion of azithromycin-resistant gonococci was also reported from other countries including Canada, 19 Italy, 20 Poland, 21 Switzerland, 22 and Hungary. 23 Because the combination of ceftriaxone plus azithromycin is routinely recommended as a first-line treatment of gonorrhea in these countries, continued surveillance of gonococcal susceptibility to azithromycin is necessary.…”

Characterization of the Novel DNA Gyrase Inhibitor AZD0914: Low Resistance Potential and Lack of Cross-Resistance in Neisseria gonorrhoeae

“…However, organisms with decreased susceptibilities to these cephalosporins are now emerging, with several reports of high-level resistance to these drugs (5,(17)(18)(19), essentially removing the last option for empirical therapy. Furthermore, even though drugs like ciprofloxacin are no longer widely used to treat gonorrhea, resistance to this drug persists in these multidrug-resistant pathogens and has resulted in patients having fewer effective treatment options (3)(4)(5)(6)(7)(8)(9)(10). Taken together, this has created an urgent need for the discovery and development of novel first-in-class oral agents that can successfully treat infections caused by N. gonorrhoeae carrying preexisting resistance caused by long-term fluoroquinolone and cephalosporin usage.…”

“…However, N. gonorrhoeae isolates that were resistant to ciprofloxacin arose quickly, and treatment guidelines needed to be amended, as the effective treatment of infections was being compromised. Indeed, the global burden of ciprofloxacinresistant N. gonorrhoeae isolates is now significant and is between 35% and Ͼ95% in many countries (3)(4)(5)(6)(7)(8)(9)(10), although the level in the United States is slightly lower, at 15% (11). Ciprofloxacin resistance in N. gonorrhoeae, like that in other species, is typically manifested by point mutations in the quinolone resistance-determining region (QRDR) of the A subunits of the type II topoisomerases (GyrA and ParC) (5,(12)(13)(14).…”

Plasmid-mediated resistance to tetracyclines among Neisseria gonorrhoeae strains isolated in Poland between 2012 and 2013

“…They had been obtained from urethral (54 strains), cervical (9 strains) or pharyngeal (2 strains) swabs of patients who visited the outpatient facility at the Dermatology and Venereology Clinic, Medical University in Warsaw at the end of 2012 and throughout 2013. Out of the strains isolated in 2012, we selected those previously unreported [18]. The strains were identified to the species level based on their colony and cell morphology as well as oxidase test and carbohydrate fermentation test results (API NH, bioMérieux).…”