Neisseria gonorrhoeae and fosfomycin: Past, present and future

Tesh, Lauren D; Shaeer, Kristy M.; Cho, Jonathan C.; Estrada, Sandy; Huang, Vanthida; Bland, Christopher M.; DiMondi, V. Paul; Potter, Alicia N.; Hussein, Gamal; Bookstaver, P. Brandon

doi:10.1016/j.ijantimicag.2015.05.007

Cited by 14 publications

(7 citation statements)

References 31 publications

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“…In this review, isolates with a MIC < 16 mg/L were considered as susceptible, while those with MICs between 32 and 64 mg/L were moderately susceptible. These MICs are similar to those found by our study, but it is necessary to establish susceptibility breakpoints in order to understand how to appropriately dose fosfomycin to treat N. gonorrhoeae infections [29].…”

Section: Discussionsupporting

confidence: 80%

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Antimicrobial susceptibility of Neisseria gonorrhoeae in Barcelona during a five-year period, 2013 to 2017

et al. 2020

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Increasing rates of antimicrobial resistance in Neisseria gonorrhoeae cause problems for treating gonorrhoea. Aim: This observational study aimed to describe isolates from all patients found infected with N. gonorrhoeae, in Barcelona, Spain, between 2013 and 2017, and with available antimicrobial susceptibility data. Methods: Minimum inhibitory concentrations (MICs) of penicillin (PEN), cefixime (CFM), ceftriaxone (CRO), azithromycin (AZM), ciprofloxacin (CIP), spectinomycin (SPT), fosfomycin (FOF) and gentamicin (GEN) were determined by E-test. Susceptibility was assessed using clinical breakpoints from the European Committee on Antimicrobial Susceptibility Testing. Time trends for PEN, CFM, AZM and CIP were investigated using logistic regression. Results: Of 1,979 patients with infection (2,036 isolates), 1,888 (95.4%) were men. Patient median age was 32 years. The proportions of isolates resistant to extended-spectrum cephalosporins were low, with 0.3% (5/1,982) resistant to CRO and 4.9% (98/1,985) to CFM. AZM resistance prevalence was 2.7% (52/1,981), including 16 isolates detected in 2016 and 2017, with high-level resistance. For CIP, 51.3% (1,018/1,986) of isolates were resistant, and for PEN, 20.1% (399/1,985). All isolates were susceptible to SPT. MIC 50 and MIC90 values of GEN were 4 and 6 mg/L and of FOF 12 and 24 mg/L, respectively. Between 2013 and 2017, PEN and CFM resistance rates each decreased from 28.1% (92/327) to 12.2% (70/572) and from 8.3% (27/327) to 4.4% (25/572) (p ≤ 0.0073). In contrast, AZM resistance prevalence appeared to increase from 1.5% in 2014 (5/340) to 3.0% (17/572) in 2017. No trend was identified for CIP. Conclusion: Antimicrobial susceptibility surveillance is important to timely detect new phenotypes and trends.

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Section: Discussionsupporting

confidence: 80%

“…Similar to gentamicin, no clinical breakpoints for fosfomycin exist. The review conducted by Tesh et al suggests that fosfomycin can be an alternative treatment for gonococcal infection [29]. In this review, isolates with a MIC < 16 mg/L were considered as susceptible, while those with MICs between 32 and 64 mg/L were moderately susceptible.…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial susceptibility of Neisseria gonorrhoeae in Barcelona during a five-year period, 2013 to 2017

et al. 2020

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“…FOS is an oral option that is being considered for the treatment of gonorrhoea [ 22 ]. However, no interpretive criteria have been published by the CLSI for N. gonorrhoeae , which complicates its utilization in clinical settings.…”

Section: Discussionmentioning

confidence: 99%

Gradient diffusion susceptibility testing for Neisseria gonorrhoeae: an accurate alternative to agar dilution in high-MIC strains?

Desjardins

Lefebvre

Lavallée

et al. 2020

Access Microbiology

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Introduction The correlation of antimicrobial susceptibility testing (AST) between agar dilution and gradient diffusion for Neisseria gonorrhoeae is not well established, especially in strains with high MICs. Aim The objective of this study was to evaluate the accuracy of gradient diffusion for N. gonorrhoeae . Methods Fifty strains of N. gonorrhoeae , all tested by the agar dilution method according to CLSI methods and confirmed to be genetically distinct using molecular typing (NG-MAST), were selected. Isolates with high MICs were targeted. Gradient diffusion was performed for ceftriaxone (CRO), cefixime (CFX), azithromycin (AZT), tetracycline (TET) and fosfomycin (FOS) using two different commercial antimicrobial strips on different culture media (a non-commercial GC agar base with 1 % defined growth supplement and two commercial media). The performance of agar gradient diffusion was assessed based on accuracy, using essential and category agreements (EA and CA). Results Essential and categorical agreement were over 90 % for CRO, CFX and AZT on the two commercial agar media tested. Category disagreements were seen for CFX and AZT, mostly just very major errors. For TET, EA ranged from 80 to 96 % and CA ranged from 38 to 76 %, most of the misclassifications being minor errors. Finally, EA for FOS ranged between 80 and 98 %. Conclusion Gradient diffusion is an accurate and acceptable alternative for CRO, CFX and AZT. Caution is advised when MICs are reported by gradient diffusion approach breakpoints because of the possibility of very major errors. The use of gradient diffusion is limited for TET because of the high rate of minor errors.

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“…16 Fosfomycin also has been suggested as a possible alternative antibiotic against N. gonorrhoeae both in vitro and in vivo. 17,18 Previously, in vitro studies have demonstrated that fosfomycin can retain activity against ceftriaxone-resistant N. gonorrhoeae. 17 Moreover, a recent randomized controlled clinical trial of the use of fosfomycin trometamol to treat uncomplicated gonococcal urethritis in men exhibited excellent efficacy in China.…”

Section: Introductionmentioning

confidence: 99%

“…17,18 Previously, in vitro studies have demonstrated that fosfomycin can retain activity against ceftriaxone-resistant N. gonorrhoeae. 17 Moreover, a recent randomized controlled clinical trial of the use of fosfomycin trometamol to treat uncomplicated gonococcal urethritis in men exhibited excellent efficacy in China. 18 Additionally, berberine, a plant alkaloid with a long history of medicinal use in both Ayurvedic and Chinese medicine has been reported to be active against grampositive and gram-negative bacteria with an unclear antibacterial mechanism.…”

Section: Introductionmentioning

confidence: 99%

<p>Evaluation of Drugs with Therapeutic Potential for Susceptibility of Neisseria Gonorrhoeae Isolates from 8 Provinces in China from 2018</p>

Zheng

Liu

et al. 2020

IDR

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Purpose The study aimed to evaluate meropenem, fosfomycin, berberine hydrochloride, and doxycycline minimum inhibitory concentrations (MICs) of Neisseria gonorrhoeae collected from eight provinces in China in 2018. Methods The MICs of 540 Neisseria gonorrhoeae isolates (451 isolates selected randomly and 89 isolates selected with preference) were determined to meropenem, fosfomycin, berberine hydrochloride, and doxycycline using the agar dilution method, and the MICs of ceftriaxone and azithromycin were detected for comparison. Results Among 451 randomly selected isolates, the MIC 90 was 0.06 mg/L for meropenem, 64 mg/L for fosfomycin, 64 mg/L for berberine hydrochloride, and 16 mg/L for doxycycline. All isolates showed the MIC ≤ 0.125 mg/L to meropenem, 13 isolates (2.9%) showed MIC > 64 mg/L to fosfomycin, 8 isolates (1.8%) demonstrated MIC > 64 mg/L to berberine hydrochloride, and 271 isolates (60.1%) demonstrated MIC > 1 mg/L to doxycycline. Comparing all 540 tested isolates, a correlation of r = 0.50 ( P < 0.001) between meropenem and ceftriaxone MIC was observed. In 24 ceftriaxone-decreased susceptibility isolates, all isolates showed an MIC ≤ 0.125 mg/L for meropenem, 1 isolate (4.2%) showed an MIC > 64 mg/L for fosfomycin, 1 isolate (4.2%) showed an MIC > 64 mg/L for berberine hydrochloride, and 13 isolates (54.2%) showed an MIC > 1 mg/L for doxycycline. In 87 azithromycin resistant isolates, all isolates showed an MIC ≤ 0.125 mg/L for meropenem, 2 isolates (2.3%) showed an MIC > 64 mg/L for fosfomycin, 4 isolates (4.6%) showed an MIC > 64 mg/L for berberine hydrochloride, and 64 isolates (73.6%) showed an MIC > 1 mg/L for doxycycline. Conclusion The in vitro results suggest that meropenem might be a promising treatment option for resistant gonococcal infections, while the effects of fosfomycin and berberine hydrochloride should be further evaluated as potential therapeutic agents. The effectiveness of these drugs in animal experiments and clinical use may need further study.

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Neisseria gonorrhoeae and fosfomycin: Past, present and future

Cited by 14 publications

References 31 publications

Antimicrobial susceptibility of Neisseria gonorrhoeae in Barcelona during a five-year period, 2013 to 2017

Antimicrobial susceptibility of Neisseria gonorrhoeae in Barcelona during a five-year period, 2013 to 2017

Gradient diffusion susceptibility testing for Neisseria gonorrhoeae: an accurate alternative to agar dilution in high-MIC strains?

<p>Evaluation of Drugs with Therapeutic Potential for Susceptibility of Neisseria Gonorrhoeae Isolates from 8 Provinces in China from 2018</p>

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