Reduced Susceptibility to Azithromycin and High Percentages of Penicillin and Tetracycline Resistance in Neisseria gonorrhoeae Isolates from Manaus, Brazil, 1998

Ja, Dillon; Jp, Rubabaza; As, Benzaken; Jc, Sardinha; H, Li; Mg, Bandeira; E, dos Santos Fernando Filho

doi:10.1097/00007435-200109000-00008

Cited by 56 publications

(32 citation statements)

References 30 publications

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“…Emerging resistance to extended-spectrum cephalosporins (19,29,30), as well as resistance to fluoroquinolone (15,41) and macrolide (8,10,13,23) antibiotics, among gonococcal isolates is an ongoing challenge for the treatment and control of gonorrhea infections. In this study, we have provided insight into the antimicrobial profiles of N. gonorrhoeae isolates collected over a large geographic area using past and present antimicrobial agents recommended for gonococcal treatment (5,6).…”

Section: Discussionmentioning

confidence: 99%

Longitudinal Analysis of the Evolution and Dissemination of Neisseria gonorrhoeae Strains (Saskatchewan, Canada, 2005 to 2008) Reveals Three Major Circulating Strains and Convergent Evolution of Ciprofloxacin and Azithromycin Resistance

Vidović¹,

Thakur²,

Horsman

et al. 2012

J Clin Microbiol

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A longitudinal study combining multilocus sequence typing with molecular evolutionary analysis determined the distribution, population structure, and evolution of antibiotic resistance in Neisseria gonorrhoeae isolates in Saskatchewan that were collected between 2005 and 2008. Of 195 gonococcal isolates examined, 29 sequence types (STs) were identified with 3 major circulating strains (ST-1 through ST-3) comprising 52% of all gonococcal isolates studied. The prevalences, persistence, distribution patterns, and clonalities of these isolates strongly suggest that gonorrhea endemicity within this broad geographic region was driven by these 3 circulating strains. ST-1 exhibited a significantly (P ‫؍‬ 0.001) higher prevalence throughout the study than did the others, accounting for ϳ25% of the tested isolates each year. The spatial distributions of the gonococcal strains indicated that ST-1 in 2007 entered a linear component of the sexual network, reaching the remote north and resulting in the further spread and maintenance of infection. Ciprofloxacin and azithromycin resistances were observed in distantly related gonococcal lineages, clearly indicating the convergent acquisition of these antibiotic-resistant phenotypes. In addition, all ciprofloxacinand azithromycin-resistant lineages were found at the edges of the minimum spanning tree, far from the major lineages, suggesting that these antibiotic phenotypes were most likely introduced into the province. In contrast, resistance to penicillin was found mostly in the endemic gonococcal lineages, suggesting that penicillin resistance was probably acquired in Saskatchewan as a result of spontaneous mutations in already-established lineages. Tetracycline resistance was present in all STs except one, indicating its ubiquitous nature in the gonococcal population studied. N eisseria gonorrhoeae, a fastidious Gram-negative diplococcus, is an obligate human pathogen that causes the disease gonorrhea. Complications from the spread of the organism along the mucosal surfaces may result in endometritis, salpingitis, and peritonitis in females (3), which can lead to infertility or ectopic pregnancy (27). In Canada, between 1999 and 2008, the overall rate of gonococcal infection increased by 116.5%, from 17.6 to 38 cases per 100,000 (20). Saskatchewan has had the highest infection rate of all the Canadian provinces, with an increase from 45.2 cases per 100,000 in 2000 to 131.3 cases per 100,000 in 2008, resulting in a 290.4% increase (173.4% above the national average) (20). Antimicrobial resistance in N. gonorrhoeae is a major public health problem, as treatment options are becoming increasingly limited. Recently, N. gonorrhoeae isolates with decreased susceptibilities (MIC Ն 0.25) to third-generation cephalosporins (cefixime and ceftriaxone) have been identified in Japan, Europe, the United States, and Canada (4,15,16,19,29,30). These antibiotics are the last remaining options for treating gonorrhea in a single-dose fashion, a preferred mode of treatment for gonococcal infection...

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Section: Discussionmentioning

confidence: 99%

Longitudinal Analysis of the Evolution and Dissemination of Neisseria gonorrhoeae Strains (Saskatchewan, Canada, 2005 to 2008) Reveals Three Major Circulating Strains and Convergent Evolution of Ciprofloxacin and Azithromycin Resistance

Vidović¹,

Thakur²,

Horsman

et al. 2012

J Clin Microbiol

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“…Despite strong regulatory rulings, most antibiotics have historically been available to anyone who requested them from unlicensed salespersons in private pharmacies; 37 such practices undoubtedly contributed to high levels of antimicrobial resistance in patients with communityacquired urinary infections 38 and gonorrhoea. 39 At the end of 2010, new legislation was passed to prohibit sales of antibiotics without a medical prescription, but whether it will be enforced eff ectively throughout the country remains to be seen.…”

Section: Regulation and Drugsmentioning

confidence: 99%

Health conditions and health-policy innovations in Brazil: the way forward

et al. 2011

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Brazil is a large complex country that is undergoing rapid economic, social, and environmental change. In this Series of six articles, we have reported important improvements in health status and life expectancy, which can be ascribed largely to progress in social determinants of health and to implementation of a comprehensive national health system with strong social participation. Many challenges remain, however. Socioeconomic and regional disparities are still unacceptably large, refl ecting the fact that much progress is still needed to improve basic living conditions for a large proportion of the population. New health problems arise as a result of urbanisation and social and environmental change, and some old health issues remain unabated. Administration of a complex, decentralised public-health system, in which a large share of services is contracted out to the private sector, together with many private insurance providers, inevitably causes confl ict and contradiction. The challenge is ultimately political, and we conclude with a call for action that requires continuous engagement by Brazilian society as a whole in securing the right to health for all Brazilian people.

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“…These compounds are used extensively to treat community-acquired pneumonia and chlamydial infection (4,12). Although erythromycin and azithromycin, in the 1-g dose, are not recommended for treatment of gonococcal infection, azithromycin has been used in some parts of the world to treat gonorrhea (7,30). Increased gonococcal resistance to erythromycin has been noted since the 1960s (19), and resistance to azithromycin has been recently identified (7,13).…”

mentioning

confidence: 99%

Acquired Macrolide Resistance Genes in Pathogenic Neisseria spp. Isolated between 1940 and1987

Cousin¹,

Whittington

Roberts³

2003

Antimicrob Agents Chemother

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Seventy-six Neisseria gonorrhoeae isolates, isolated between 1940 and 1987, and seven Neisseria meningitidis isolates, isolated between 1963 and 1987, were screened for the presence of acquired mef(A), erm(B), erm(C), and erm(F) genes by using DNA-DNA hybridization, PCR analysis, and sequencing. The mef(A), erm(B), and erm(F) genes were all identified in a 1955 N. gonorrhoeae isolate, while the erm(C) gene was identified in a 1963 N. gonorrhoeae isolate. Similarly, both the mef(A) and erm(F) genes were identified in a 1963 N. meningitidis isolate. All four acquired genes were found in later isolates of both species. The mef(A) gene from a 1975 N. gonorrhoeae isolate was sequenced and had 100% DNA and amino acid identity with the mef(A) gene from a 1990s Streptococcus pneumoniae isolate. Selected early isolates were able to transfer their acquired genes to an Enterococcus faecalis recipient, suggesting that these genes are associated with conjugative transposons. These isolates are the oldest of any species to carry the mef(A) gene and among the oldest to carry these erm genes.

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Reduced Susceptibility to Azithromycin and High Percentages of Penicillin and Tetracycline Resistance in Neisseria gonorrhoeae Isolates from Manaus, Brazil, 1998

Cited by 56 publications

References 30 publications

Longitudinal Analysis of the Evolution and Dissemination of Neisseria gonorrhoeae Strains (Saskatchewan, Canada, 2005 to 2008) Reveals Three Major Circulating Strains and Convergent Evolution of Ciprofloxacin and Azithromycin Resistance

Longitudinal Analysis of the Evolution and Dissemination of Neisseria gonorrhoeae Strains (Saskatchewan, Canada, 2005 to 2008) Reveals Three Major Circulating Strains and Convergent Evolution of Ciprofloxacin and Azithromycin Resistance

Health conditions and health-policy innovations in Brazil: the way forward

Acquired Macrolide Resistance Genes in Pathogenic Neisseria spp. Isolated between 1940 and1987

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