Decreased Cephalosporin Susceptibility of Oropharyngeal Neisseria Species in Antibiotic-using Men Who Have Sex With Men in Hanoi, Vietnam

Dong, Huan; Pham, Loc Quang; Nguyen, Hoa Thi; Nguyen, Minh; Nguyen, Trung Vu; May, Folasade P.; Le, Giang Minh; Klausner, Jeffrey D.

doi:10.1093/cid/ciz365

Cited by 50 publications

(60 citation statements)

References 32 publications

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“…The oropharynx represents a pivotal site for N. gonorrhoeae residency [5]: it is a suitable ecological niche for NG to replicate and persist over time [6]. Moreover, commensal Neisseria species found in this site act as a significant reservoir for genetic material, conferring cephalosporin resistance in N. gonorrhoeae, and, thus, potentially, leading to the emergence of multidrug resistant gonorrhoea [7,8].…”

Section: Introductionmentioning

confidence: 99%

Pharyngeal microbiome alterations during Neisseria gonorrhoeae infection

et al. 2020

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Pharyngeal gonorrhoea is a common sexually transmitted infection among 'men having sex with other men' (MSM). Neisseria gonorrhoeae (NG) pharyngeal infections are usually characterized by the absence of symptoms, acting as an important reservoir for their further spread. To the best of our knowledge, no information about the composition of the pharyngeal microbiome during an ongoing NG infection is currently available. Therefore, in this study, we characterized the pharyngeal bacterial community profiles associated with NG infection in a well-selected cohort of HIV-negative MSM reporting unsafe oral intercourse. A total of 70 pharyngeal swabs were considered, comparing non-infected subjects (n = 45) versus patients with pharyngeal gonorrhoea (n = 25) whose microbiota composition was analyzed from pharyngeal swabs through sequencing of hypervariable V3-V4 regions of the 16S rRNA gene. The pharyngeal microbiome of all subjects was dominated by Prevotellaceae, Veillonellaceae and Streptococcaceae families. Patients with pharyngeal gonorrhoea harboured a pharyngeal microbiome quite similar to negative subjects. Nevertheless, when looking to less-represented bacterial species (relative abundance approximately 1% or less), an imbalance between aerobe and anaerobe microorganisms was observed in NGinfected patients. In particular, the pharyngeal microbiome of NG-positive individuals was richer in several anaerobes (e.g. Treponema, Parvimonas, Peptococcus, Catonella, Filifactor) and poorer in various aerobe genera (i.e. Pseudomonas, Escherichia), compared to non-infected controls. No significant differences were noticed in the distribution of commensal Neisseria species of the oropharynx between NG-positive and negative subjects. Metabolic variations induced by changes in the microbiome abundance were assessed by a functional prediction of the bacterial metabolic pathways: a more abundant involvement of D-glutamine and D-glutamate metabolism, carbohydrate metabolism, as well as a greater activation of the energy metabolism was observed in patients with pharyngeal gonorrhoea compared to non-infected individuals. Information about the bacterial composition of the pharyngeal microbiome in case of gonorrhoea could shed light on the pathogenesis of the infection and open new perspectives for the prevention and control of this condition.

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Section: Introductionmentioning

confidence: 99%

Pharyngeal microbiome alterations during Neisseria gonorrhoeae infection

et al. 2020

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“…Ten different Neisseria species were identified. Twenty-eight percent of samples had reduced susceptibility to ceftriaxone (minimum inhibitory concentration ≥0.125 mg/L) [4]. The reason for the high prevalence of commensal Neisseria with reduced antimicrobial susceptibility in these groups of patients presumably parallels the one proposed for gonorrhea: repeated cycles of reinfection/recolonization and antimicrobial exposure in individuals within a highly connected transmission-network [31].…”

Section: Discussionmentioning

confidence: 90%

“…Although it was already known that household members and intimate partners share oral commensal microbiota [24][25][26], the current analysis demonstrates that intimate partners also share similar commensal Neisseria. This is a logical, yet important finding, as commensal Neisseria are known to harbor several AMR determinants [27] that are a frequent source of AMR for pathogenic Neisseria [4,28,29].…”

Section: Discussionmentioning

confidence: 94%

“…The genus Neisseria is one of the three most abundant phyla in the human oral microbiome [2], with almost all individuals being colonized with at least one Neisseria species [3]. This high prevalence, in combination with extensive antimicrobial exposure, is thought to explain the extensive AMR in commensal Neisseria that has been found in certain populations, like cohorts of men who have sex with men (MSM) [4] and that has played an important role in the genesis of AMR in N. gonorrhoeae [5].…”

Section: Introductionmentioning

confidence: 99%

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Commensal Neisseria Are Shared between Sexual Partners: Implications for Gonococcal and Meningococcal Antimicrobial Resistance

et al. 2020

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Antimicrobial resistance in pathogenic Neisseria parallels reduced antimicrobial susceptibility in commensal Neisseria in certain populations, like men who have sex with men (MSM). Although this reduced susceptibility can be a consequence of frequent antimicrobial exposure at the individual level, we hypothesized that commensal Neisseria are transmitted between sexual partners. We used data from a 2014 microbiome study in which saliva and tongue swabs were taken from 21 couples (42 individuals). Samples were analyzed using 16S rRNA gene sequencing. We compared intimate partners with unrelated individuals and found that the oral Neisseria communities of intimate partners were more similar than those of unrelated individuals (average Morisita-Horn dissimilarity index for saliva samples: 0.54 versus 0.71, respectively (p = 0.005); and for tongue swabs: 0.42 versus 0.63, respectively (p = 0.006)). This similarity presumably results from transmission of oral Neisseria through intimate kissing. This finding suggests that intensive gonorrhea screening in MSM may, via increased antimicrobial exposure, promote, rather than prevent, the emergence and spread of antimicrobial resistance in Neisseria. Non-antibiotic strategies such as vaccines and oral antiseptics could prove more sustainable options to reduce gonococcal prevalence.

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“…This may have important consequences for not only gonococcal AMR but also that of commensal bacteria. There is increasing evidence that high antimicrobial exposure increases the risk of AMR in N. gonorrohoeae as well as various other Neisseriae and other commensal species [6][7][8][9]. If excess antimicrobial consumption results in a type A, stage 2 or 3 trajectory in not only N. gonorrhoeae but also in these commensal species then this may be a warning of more wide-ranging adverse effects of antimicrobials on our microbiomes and resistomes [10].…”

Section: Introductionmentioning

confidence: 99%

Where have all the susceptible gonococci gone? A historical review of changes in MIC distribution over the past 75 years

Kenyon

Laumen

Bossche

et al. 2019

Preprint

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Background Does the emergence of antimicrobial resistance in Neisseria gonorrhoeae include the erasure of highly susceptible strains or does it merely involve a stretching of the MIC distribution? If it was the former this would be important to know as it would increase the probability that the loss of susceptibility is irreversible.Methods We conducted a historical analysis based on a literature review of changes of N. gonorrhoeae MIC distribution over the past 75 years for 3 antimicrobials (benzylpenicillin, ceftriaxone and azithromycin) in five countries (Denmark, Japan, South Africa, the United Kingdom and the United States).Results Changes in MIC distribution were most marked for benzylpenicillin and showed evidence of a right shifting of MIC distribution that was associated with a reduction/elimination of susceptible strains in all countries. In the case of ceftriaxone and azithromycin, where only more recent data was available, right shifting was also found in all countries but the extent of right shifting varied and the evidence for the elimination of susceptible strains was more mixed.Conclusions The finding of right shifting of MIC distribution combined with reduction/elimination of susceptible strains is concerning since it suggests that this shifting may not be reversible. Since excess antimicrobial consumption is likely to be responsible for this right shifting, this insight provides additional impetus to promote antimicrobial stewardship.

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Decreased Cephalosporin Susceptibility of Oropharyngeal Neisseria Species in Antibiotic-using Men Who Have Sex With Men in Hanoi, Vietnam

Cited by 50 publications

References 32 publications

Pharyngeal microbiome alterations during Neisseria gonorrhoeae infection

Pharyngeal microbiome alterations during Neisseria gonorrhoeae infection

Commensal Neisseria Are Shared between Sexual Partners: Implications for Gonococcal and Meningococcal Antimicrobial Resistance

Where have all the susceptible gonococci gone? A historical review of changes in MIC distribution over the past 75 years

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