First description of a cefixime- and ciprofloxacin-resistant Neisseria gonorrhoeae isolate with mutations in key antimicrobial susceptibility–determining genes from the country of Georgia

Abstract

Antimicrobial resistance in Neisseria gonorrhoeae is a global health problem. Enhanced international collaborative surveillance and disease control are needed to reduce the global burden of this important pathogen. Currently the antimicrobial resistance properties and molecular mechanisms of multidrug-resistant N. gonorrhoeae in the Republic of Georgia represent a significant knowledge gap. Here we report the isolation of a strain of N. gonorrhoeae exhibiting resistance to cefixime and ciprofloxacin with reduced susceptibility to penicillin and tetracycline from a patient being treated at a Georgian medical centre. Notably, this isolate was found to contain a mosaic penA allele and to harbour mutations in genes conferring susceptibility to the β-lactam, cephalosporin, fluoroquinolone, macrolide and penicillin classes of antibiotic. To our knowledge, this is the first report to describe the key mutations conferring the antimicrobial resistance properties of an isolate of N. gonorrhoeae from Georgia.

Surveillance and epidemiology of syphilis, gonorrhoea and chlamydia in the non-European Union countries of the World Health Organization European Region, 2015 to 2020

“…We identified a single published case report from Georgia in 2018 which presented resistance to cefixime and ciprofloxacin identified in a urethral specimen of a 23-year-old heterosexual man [ 20 ]. Data from Ukraine, reported to GASP, were also included in two publications by Boiko et al [ 21 , 22 ].…”

“…The number of countries included in this assessment which participate in the WHO GASP is small as was the availability of published data on AMR in gonorrhoea. It is encouraging that four of these countries reported that there was no resistance to ceftriaxone in 2015 and 2016, although it is noteworthy that a high level of cefixime resistance was found in Belarus and of cefixime-resistant isolates were detected in Kyrgyzstan [ 35 ] and Georgia [ 20 ]. Resistance to ceftriaxone of less than 1% is reported in published literature from Russia [ 25 , 26 ].…”

“…Analysis of AMR data for more than 100 gonococcal isolates in a year in GASP was available only from the Russian Federation in 2015 and 2016. Through literature review using systematic methodology, we identified seven relevant records corresponding to five studies of gonococcal isolates in Georgia [20], Ukraine [21,22] and the Russian Federation [23][24][25][26] (a flow chart of searches and details about these studies are listed in Supplement 2 Figure S1 and Table S2). We assessed an additional five full text articles and excluded them, with reasons provided in Supplement 2 Table S3 [ [27][28][29][30][31].…”