Multidrug-resistant Neisseria gonorrhoeae

Tapsall, John W.

doi:10.1503/cmaj.081721

Cited by 27 publications

(23 citation statements)

References 12 publications

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“…Our data from surveillance of QRNG isolates in California has elucidated how new antimicrobial-resistant strains can enter a country and become endemic, similar to what has been reported in Australia and Canada (21,25). In a further examination of these data, we found evidence of resistance to multiple antimicrobial agents within the main endemic strains and found that individuals infected with these strains also had the potential to fail at least lower-dose azithromycin treatment regimens.…”

Section: Discussionsupporting

confidence: 81%

Strain Typing and Antimicrobial Resistance of Fluoroquinolone-Resistant Neisseria gonorrhoeae Causing a California Infection Outbreak

Morris

Moore²,

Hannah³

et al. 2009

J Clin Microbiol

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Antimicrobial-resistant Neisseria gonorrhoeae is an emerging public health problem as a result of the alarming limitation in treatment options. We examined an outbreak in California of fluoroquinolone-resistant Neisseria gonorrhoeae (QRNG) by evaluation of a combination of routine isolates from the Gonococcal Isolate Surveillance Project and isolates collected by expanded surveillance performed between April 2000 and June 2002. QRNG isolates were characterized by two methods: (i) determination of a combination of antibiogram, auxotype, serovar, Lip type, and patterns of amino acid alteration in the quinolone resistance-determining region of GyrA and ParC (ASLGP) and (ii) pulsed-field gel electrophoresis (PFGE). Strain typing was used to describe the QRNG outbreak strains and the associated antimicrobial resistance profiles. Among 79 isolates that were completely characterized, we identified 20 different ASLGP strain types, and 2 of the types were considered to belong to outbreak strains that comprised 65% (51/79) of the isolates. By PFGE typing, there were 24 different strain types, and 4 of these were considered outbreak types and comprised 66% (52/79) of the isolates. The overall agreement between the typing methods in distinguishing outbreak strains and nonoutbreak strains was 84% (66/79). The most common QRNG ASLGP strain type had chromosomally mediated resistance to penicillin and tetracycline and an azithromycin MIC of 0.5 g/ml. The occurrence of an outbreak caused by QRNG strains that could fail to be eradicated by most antibiotic classes reinforces the serious problem with antimicrobial resistance in Neisseria gonorrhoeae that the public health system faces. Adherence to a regimen with the recommended antibiotics at the appropriate dose is critical, and monitoring for antimicrobial susceptibility needs to be actively maintained to adapt treatment guidelines appropriately.

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Section: Discussionsupporting

confidence: 81%

Strain Typing and Antimicrobial Resistance of Fluoroquinolone-Resistant Neisseria gonorrhoeae Causing a California Infection Outbreak

Morris

Moore²,

Hannah³

et al. 2009

J Clin Microbiol

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“…Ciprofloxacin has been one of the recommended first-line therapies for these infections worldwide, including in Brazil. However, a number of studies have revealed an increasing frequency of ciprofloxacin-resistant N. gonorrhoeae isolates in different geographic regions (13,26,31). In Brazil, information about epidemiologic and antimicrobial susceptibility aspects of this pathogen is still scarce (2, 3, 10, 11).…”

Section: Discussionmentioning

confidence: 99%

“…In 2003, the incidence of gonococcal infections in Brazil was estimated in 1,54 million of cases, being 657,139 cases in the Southeast region and more than 130,000 cases in Rio de Janeiro state (5). Recently, two studies conducted among men attending STD clinics (1) and among pregnant women (15) in six Brazilian cities revealed prevalences of infection by Neisseria gonorrhoeae of 18.4 and 1.5%, respectively.Since the emergence and increasing occurrence of plasmidmediated high-level or chromosomally mediated low-level resistance to penicillin and/or tetracycline, fluoroquinolones (ciprofloxacin or ofloxacin) or cephalosporins (ceftriaxone and cefixime) constitute the therapeutic regimen recommended by the World Health Organization for treatment of gonococcal infections worldwide (25).However, the emergence of quinolone-resistant N. gonorrhoeae (QRNG) isolates has generated significant concern in several countries (13,26,31). Mechanisms of quinolone resistance in N. gonorrhoeae isolates include point mutations at the "quinolone resistance-determining regions" (QRDRs) of the gyrA and parC genes which code for the enzymes DNA gyrase and topoisomerase IV, respectively, that were the target of this drug, conferring high-level quinolone resistance (13).…”

mentioning

confidence: 99%

“…However, the emergence of quinolone-resistant N. gonorrhoeae (QRNG) isolates has generated significant concern in several countries (13,26,31). Mechanisms of quinolone resistance in N. gonorrhoeae isolates include point mutations at the "quinolone resistance-determining regions" (QRDRs) of the gyrA and parC genes which code for the enzymes DNA gyrase and topoisomerase IV, respectively, that were the target of this drug, conferring high-level quinolone resistance (13).…”

mentioning

confidence: 99%

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Molecular Characterization of Quinolone-Resistant Neisseria gonorrhoeae Isolates from Brazil

Uehara

Amorin²,

Ferreira³

et al. 2011

J Clin Microbiol

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Despite the rapid spread of antibiotic resistance among gonococci worldwide, limited reports are available from Brazilian locations. In the present study, 25 quinolone-resistant Neisseria gonorrhoeae (QRNG) strains isolated in Rio de Janeiro, Brazil, were characterized by phenotypic and molecular methods, including analysis of mutations in the gyrA and parC genes. They represented 16.5% of the N. gonorrhoeae isolates obtained during a survey performed from 2006 to 2010. A trend for increasing resistance to ciprofloxacin was observed in the period investigated. The most prevalent pattern of mutation observed among QRNG isolates, Ser-91 to Phe and Asp-95 to Gly in gyrA and Ser-87 to Arg in parC, was detected in 40% of the isolates exhibiting MICs ranging from 4 to >32 g/ml. Gonorrhea is among the most prevalent sexually transmitted diseases (STDs) throughout the world. The causative agent, Neisseria gonorrhoeae, predominantly infects human urogenital tract, causing cervicitis, urethritis, and rectal infections. In 2003, the incidence of gonococcal infections in Brazil was estimated in 1,54 million of cases, being 657,139 cases in the Southeast region and more than 130,000 cases in Rio de Janeiro state (5). Recently, two studies conducted among men attending STD clinics (1) and among pregnant women (15) in six Brazilian cities revealed prevalences of infection by Neisseria gonorrhoeae of 18.4 and 1.5%, respectively.Since the emergence and increasing occurrence of plasmidmediated high-level or chromosomally mediated low-level resistance to penicillin and/or tetracycline, fluoroquinolones (ciprofloxacin or ofloxacin) or cephalosporins (ceftriaxone and cefixime) constitute the therapeutic regimen recommended by the World Health Organization for treatment of gonococcal infections worldwide (25).However, the emergence of quinolone-resistant N. gonorrhoeae (QRNG) isolates has generated significant concern in several countries (13,26,31). Mechanisms of quinolone resistance in N. gonorrhoeae isolates include point mutations at the "quinolone resistance-determining regions" (QRDRs) of the gyrA and parC genes which code for the enzymes DNA gyrase and topoisomerase IV, respectively, that were the target of this drug, conferring high-level quinolone resistance (13).In Brazil, reports on the antimicrobial susceptibility of N. gonorrhoeae have been sporadically available, and only a few isolates with decreased susceptibility to ciprofloxacin were described (2, 11, 12). In 2007, we detected the occurrence of resistance to ciprofloxacin in 7.7% (4/52) of the N. gonorrhoeae isolates recovered from male urethral specimens or vaginal specimens in Rio de Janeiro, Brazil (A. A. Uehara and S. E. L. Fracalanzza, unpublished data). Simultaneously, a resistance rate of 3.1% was found in strains isolated from patients attending the STD Service of the University of São Paulo teaching hospital, in São Paulo, Brazil (3).The aim of the present study was to characterize ciprofloxacin-resistant N. gonorrhoeae isolates recovered in Rio de Janeiro,...

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“…With N. gonorrhoeae, East Asian strains are thought to have entered western North America and spread eastward due to travelers bringing MDR strains (11,116). The countries that are highly connected to the Pacific Rim show similar epidemiological patterns (116).…”

Section: Explanations For the Proliferation Of Mdr Strainsmentioning

confidence: 99%

Origin and Proliferation of Multiple-Drug Resistance in Bacterial Pathogens

Chang

Cohen

Grad

et al. 2015

Microbiol Mol Biol Rev

207

143

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SUMMARY Many studies report the high prevalence of multiply drug-resistant (MDR) strains. Because MDR infections are often significantly harder and more expensive to treat, they represent a growing public health threat. However, for different pathogens, different underlying mechanisms are traditionally used to explain these observations, and it is unclear whether each bacterial taxon has its own mechanism(s) for multidrug resistance or whether there are common mechanisms between distantly related pathogens. In this review, we provide a systematic overview of the causes of the excess of MDR infections and define testable predictions made by each hypothetical mechanism, including experimental, epidemiological, population genomic, and other tests of these hypotheses. Better understanding the cause(s) of the excess of MDR is the first step to rational design of more effective interventions to prevent the origin and/or proliferation of MDR.

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Multidrug-resistant Neisseria gonorrhoeae

Cited by 27 publications

References 12 publications

Strain Typing and Antimicrobial Resistance of Fluoroquinolone-Resistant Neisseria gonorrhoeae Causing a California Infection Outbreak

Strain Typing and Antimicrobial Resistance of Fluoroquinolone-Resistant Neisseria gonorrhoeae Causing a California Infection Outbreak

Molecular Characterization of Quinolone-Resistant Neisseria gonorrhoeae Isolates from Brazil

Origin and Proliferation of Multiple-Drug Resistance in Bacterial Pathogens

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