Two cases of extensively drug-resistant (XDR) Neisseria gonorrhoeae infection combining ceftriaxone-resistance and high-level azithromycin resistance, France, November 2022 and May 2023

Abstract

We report two extensively drug-resistant (XDR) Neisseria gonorrhoeae (NG) isolates combining high-level resistance to azithromycin and resistance to ceftriaxone, obtained in France from two heterosexual patients, one of whom returned from Cambodia. Whole genome sequencing identified MLST ST16406, the mosaic penA-60.001 which caused ceftriaxone resistance in the internationally spreading FC428 clone, and the A2059G mutation in the 23S rRNA gene. The NG isolates F93 and F94 were related to XDR isolates detected in Austria and the United Kingdom in 2022.

World Health Organization Enhanced Gonococcal Antimicrobial Surveillance Programme, Cambodia, 2023

“…Furthermore, 3 penA- 60 . 001–containing isolates (3/76; 4%) had an extensively drug resistant (XDR) phenotype ( 3 ), all from a single sequence type (ST), ST-16406, and similar to previously reported XDR N. gonorrhoeae isolates with links to the region ( 3 ).…”

In Vitro Bactericidal Activity of Biogenic Copper Oxide Nanoparticles for Neisseria gonorrhoeae with Enhanced Compatibility for Human Cells

“…Ceftriaxone, an extended-spectrum cephalosporin, is the last option for the treatment of uncomplicated gonorrhea in many countries. However, reduced effectiveness or resistance to ceftriaxone is progressively appearing worldwide. − Reports also indicate occasional treatment failures even with the recommended dual therapy (ceftriaxone plus azithromycin) and specifically with ceftriaxone alone, corroborating these concerns on a global scale. , In this context, we studied if the GT-CuO NPs also had antibacterial effects against some gonococcal isolates belonging to the CDC/FDA panel of gonococcal strains with reported resistance against ceftriaxone and azithromycin (Figure ). In the bactericidal assay, a concentration of 15.625 μg/mL of our GT CuNPs effectively killed 100% of strains AR-165, -166, -173, and -190 within 1 h. The SI for these strains was also determined and ranged from 14 to 74 for these strains and 203 for sensitive reference strain P9–17 (Table ).…”

Multicentre double-blind randomised placebo-controlled trial evaluating the efficacy of the meningococcal B vaccine, 4CMenB (Bexsero), againstNeisseria gonorrhoeaeinfection in men who have sex with men: the GoGoVax study protocol

“…In 2018, extensively drug-resistant (and ceftriaxone-resistant) N. gonorrhoeae were identified in Australia, as resistant to all commonly used antibiotics, and very recently further isolates were reported in the UK, Austria, Cambodia and France. [9][10][11][12][13][14][15][16] As such, N. gonorrhoeae has been prioritised as an urgent public health threat for which new preventive measures are needed, such as a vaccine. [17][18][19] Unfortunately, gonococcal vaccine development has been unsuccessful to date and there are large knowledge gaps regarding what constitutes a protective immune response for N. gonorrhoeae.…”