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Maldonado-Barrueco A, Sanz-González C, Falces-Romero I, García-Clemente P, Cacho-Calvo J, Quiles-Melero I. Comparison of gradient diffusion and molecular methods using Allplex™ NG&DR assay (Seegene®) for macrolide and fluoroquinolone screening resistance in Neisseria gonorrhoeae. Eur J Clin Microbiol Infect Dis 2024; 43:1009-1012. [PMID: 38407691 DOI: 10.1007/s10096-024-04786-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/12/2024] [Indexed: 02/27/2024]
Abstract
Antimicrobial resistance in Neisseria gonorrhoeae (NG) is increasing worldwide. Second-line treatments with macrolides or fluoroquinolones are an option for NG infections in some cases following the STI guideline recommendations. In our study, we compared the gradient diffusion test using EUCAST 2024 breakpoints with a new molecular method using the Allplex™ NG&DR assay (Seegene®) including A2059G/C2611 mutations (23S rRNA) associated with high/moderate-level macrolide resistance and S91F mutation (gyrA) relationship with fluoroquinolone resistance in NG isolates (n = 100). We calculated the sensitivity, specificity, and correlation of the molecular test for fluoroquinolone using the gradient diffusion as the reference method. In twenty-three strains was not detected any mutation associated with macrolides or fluoroquinolone resistance. No A2059G/C2611T mutations were detected, and the S91F mutations were detected in 77 out of the 100 isolates screened. Twenty-three NG isolates were reported to be resistant to azithromycin (ECOFF: >1 mg/L), and 78 NG isolates were resistant to ciprofloxacin (MIC: >0.06 mg/L). The molecular method showed a sensitivity of 96.1% and, a specificity of 90.9% for fluoroquinolone susceptibility, but the statistical analysis between the molecular test and gradient diffusion test was not statistically significant for fluoroquinolone resistance (p = 1). Statistical analysis was not performed for macrolides because of the absence of positive RT-PCR results. According to our data, Allplex™ assay cannot replace the gradient diffusion test for macrolide resistance. However, the assay could be used to test fluoroquinolone resistance in NG isolates as a replacement for phenotypic methods.
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Affiliation(s)
| | - Claudia Sanz-González
- Clinical Microbiology Department, Hospital Universitario La Paz, 261, Madrid, 28046, Spain
| | - Iker Falces-Romero
- Clinical Microbiology Department, Hospital Universitario La Paz, 261, Madrid, 28046, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Paloma García-Clemente
- Clinical Microbiology Department, Hospital Universitario La Paz, 261, Madrid, 28046, Spain
| | - Juana Cacho-Calvo
- Clinical Microbiology Department, Hospital Universitario La Paz, 261, Madrid, 28046, Spain
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2
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Salmerón P, Buckley C, Arando M, Alcoceba E, Romero B, Clavo P, Whiley D, Serra-Pladevall J. Genome-based epidemiology and antimicrobial resistance of Neisseria gonorrhoeae in Spain: A prospective multicentre study. J Eur Acad Dermatol Venereol 2023; 37:2575-2582. [PMID: 37620291 DOI: 10.1111/jdv.19458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 08/02/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Whole-genome sequencing (WGS) of Neisseria gonorrhoeae isolates combined with epidemiological and phenotypic data provides better understanding of population dynamics. AIM The objective of this study was to investigate the molecular epidemiology of N. gonorrhoeae isolates from three centres in Spain and determine associations of antimicrobial resistance. METHODS Genetic characterization was performed in 170 N. gonorrhoeae isolates. WGS was carried out with the HiSeq platform (Illumina). Genome assemblies were submitted to the PubMLST Neisseria database website to determine NG-MAST, MLST and NG-STAR. Antimicrobial resistance genes and point mutations were identified with PubMLST. Phylogenomic comparison was based on whole-genome single nucleotide polymorphism analysis. RESULTS Twenty-six MLST, 49 NG-MAST and 41 NG-STAR sequence types were detected, the most prevalent being MLST-ST9363 (27.1%), NG-MAST ST569 (12.4%) and NG-STAR ST193 (14.7%). Phylogenetic analysis identified 13 clusters comprising 69% of the isolates, with two of note: one involved cefixime-resistant isolates from Barcelona presenting a mosaic penA X and belonging to MLST-ST7363 and the other involved azithromycin-resistant isolates from Mallorca that possessed the C2611T mutation in the four 23S rRNA alleles belonging to MLST-ST1901. CONCLUSION The population of N. gonorrhoeae is quite heterogeneous in Spain. Our results agree with previous data published in Europe, albeit with some differences in distribution between regions. This study describes the circulation of two gonococcal populations with a specific resistance profile and sequence type in a specific geographic area. WGS is an effective tool for epidemiological surveillance of gonococcal infection and detection of resistance genes.
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Affiliation(s)
- P Salmerón
- Microbiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Sexually Transmitted Infections Study Group (GEITS), Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC), Madrid, Spain
- Department of Genetics and Microbiology, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - C Buckley
- University of Queensland, UQ Centre for Clinical Research (UQCCR), Herston, Queensland, Australia
| | - M Arando
- Sexually Transmitted Infections Study Group (GEITS), Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC), Madrid, Spain
- Drassanes-Vall d'Hebron Sexually Transmitted Infections Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - E Alcoceba
- Microbiology Department, Son Espases Hospital Universitari, Mallorca, Spain
| | - B Romero
- Microbiology Department, Ramón y Cajal Hospital Universitario, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - P Clavo
- Sandoval Health Centre, San Carlos Hospital Clínico, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - D Whiley
- University of Queensland, UQ Centre for Clinical Research (UQCCR), Herston, Queensland, Australia
| | - J Serra-Pladevall
- Sexually Transmitted Infections Study Group (GEITS), Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC), Madrid, Spain
- Clinical Laboratory, Hospital Universitari de Vic, Catalonia, Spain
- Faculty of Health Sciences, Universitat de Vic - Universitat Central de Catalunya (UVIC -UCC), Vic, Spain
- Multidisciplinary Inflammation Research Group (MIRG), Fundació Institut de Recerca i Innovació en Ciències de la Vida i de la Salut de la Catalunya Central, Vic, Spain
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3
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Carannante A, Vacca P, Fontana S, Dal Conte I, Ghisetti V, Cusini M, Prignano G, Vocale C, Barbui AM, Stroppiana E, Busetti M, Mencacci A, Rotondi M, De Francesco MA, Bonanno CL, Innocenti P, Latino MA, Riccobono E, Poletti F, Casonato IC, Soldato G, Ambrosio L, Boros S, Ciammaruconi A, Lista F, Stefanelli P. Seven Years of Culture Collection of Neisseria gonorrhoeae: Antimicrobial Resistance and Molecular Epidemiology. Microb Drug Resist 2023; 29:85-95. [PMID: 36757312 PMCID: PMC10024589 DOI: 10.1089/mdr.2021.0483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
The emergence of Neisseria gonorrhoeae isolates displaying resistance to antimicrobials, in particular to ceftriaxone monotherapy or ceftriaxone plus azithromycin, represents a global public health concern. This study aimed to analyze the trend of antimicrobial resistance in a 7-year isolate collection retrospective analysis in Italy. Molecular typing on a subsample of gonococci was also included. A total of 1,810 culture-positive gonorrhea cases, collected from 2013 to 2019, were investigated by antimicrobial susceptibility, using gradient diffusion method, and by the N. gonorrhoeae multiantigen sequence typing (NG-MAST). The majority of infections occurred among men with urogenital infections and 57.9% of male patients were men who have sex with men. Overall, the cefixime resistance remained stable during the time. An increase of azithromycin resistance was observed until 2018 (26.5%) with a slight decrease in the last year. In 2019, gonococci showing azithromycin minimum inhibitory concentration above the EUCAST epidemiological cutoff value (ECOFF) accounted for 9.9%. Ciprofloxacin resistance and penicillinase-producing N. gonorrhoeae (PPNG) percentages increased reaching 79.1% and 18.7% in 2019, respectively. The most common sequence types identified were 5,441, 1,407, 6,360, and 5,624. The predominant genogroup (G) was the 1,407; moreover, a new genogroup G13070 was also detected. A variation in the antimicrobial resistance rates and high genetic variability were observed in this study. The main phenotypic and genotypic characteristics of N. gonorrhoeae isolates were described to monitor the spread of drug-resistant gonorrhea.
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Affiliation(s)
- Anna Carannante
- Department Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Paola Vacca
- Department Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Stefano Fontana
- Department Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Ivano Dal Conte
- Department of Prevention, Sexual Health Center, ASL Città di Torino, Turin, Italy
| | - Valeria Ghisetti
- Laboratory of Microbiology and Virology, ASL Città di Torino, Turin, Italy
| | - Marco Cusini
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Grazia Prignano
- Molecular Virology, Pathology and Microbiology, IRCCS San Gallicano Dermatological Institute, Rome, Italy
| | - Caterina Vocale
- Regional Reference Center for Microbiological Emergencies (CRREM), Unit of Microbiology, St Orsola Malpighi University Hospital, Bologna, Italy
| | - Anna Maria Barbui
- Microbiology and Virology Laboratory, Molinette Hospital, Turin, Italy
| | - Elena Stroppiana
- Department of Medical Science, Dermatology Clinic, “Città della Salute e della Scienza of Turin,” Turin, Italy
| | - Marina Busetti
- Microbiology Unit, University Hospital of Trieste, Trieste, Italy
| | - Antonella Mencacci
- Medical Microbiology, Department of Medicine, University of Perugia, Perugia, Italy
- Microbiology, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Marina Rotondi
- Clinical and Microbiological Analysis Laboratory, Marilab s.r.l., Rome, Italy
| | - Maria Antonia De Francesco
- Department of Molecular and Translational Medicine, Institute of Microbiology, University of Brescia-Spedali Civili, Brescia, Italy
| | | | - Patrizia Innocenti
- Microbiology and Virology Laboratory, “Comprensorio Sanitario,” Bolzano, Italy
| | - Maria Agnese Latino
- Unit of Bacteriology, Department of “Medicina di Laboratorio," P. O. Sant'Anna, Città della Salute e della Scienza di Torino,” Turin, Italy
| | - Eleonora Riccobono
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Federica Poletti
- Department Infectious Diseases, Castelli Hospital Verbania, Verbania, Italy
| | | | | | - Luigina Ambrosio
- Department Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Stefano Boros
- Department Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | | | | | - Paola Stefanelli
- Department Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
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Lu Z, Tadi DA, Fu J, Azizian K, Kouhsari E. Global status of Azithromycin and Erythromycin Resistance Rates in Neisseria gonorrhoeae: A Systematic Review and Meta-analysis. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2022; 95:465-478. [PMID: 36568835 PMCID: PMC9765340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: The widespread development of antibiotic resistance or decreased susceptibility in Neisseria gonorrhoeae (NG) infection is a global and significant human public health issue. Objectives: Therefore, this meta-analysis aimed to estimate worldwide resistance rates of NG to the azithromycin and erythromycin according to years, regions, and antimicrobial susceptibility testing (AST). Methods: We systematically searched the published studies in PubMed, Scopus, and Embase from 1988 to 2021. All analyses were conducted using Stata software. Results: The 134 reports included in the meta-analysis were performed in 51 countries and examined 165,172 NG isolates. Most of the included studies were from Asia (50 studies) and Europe (46 studies). In the metadata, the global prevalence over the past 30 years were 6% for azithromycin and 48% for erythromycin. There was substantial change in the prevalence of macrolides NG resistance over time (P <0.01). In this metadata, among 58 countries reporting resistance data for azithromycin, 17 (29.3%) countries reported that >5% of specimens had azithromycin resistance. Conclusions: The implications of this study emphasize the rigorous or improved antimicrobial stewardship, early diagnosis, contact tracing, and enhanced intensive global surveillance system are crucial for control of further spreading of gonococcal emergence of antimicrobial resistance (AMR).
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Affiliation(s)
- Zhiwei Lu
- Graduate School, Zhejiang Chinese Medical University,
Hangzhou, Zhejiang, China,Hangzhou Heyunjia Hospital, Hangzhou, Zhejiang,
China
| | - Danyal Abbasi Tadi
- Department of Veterinary, Azad University of Shahr-e
Kord, Shahr-e Kord, Iran
| | - Jinchao Fu
- Department of General Practice, Shulan (Hangzhou)
Hospital Affiliated to Zhejiang Shuren University Shulan International Medical
College, Hangzhou, Zhejiang, China,To whom all correspondence should be addressed:
Jinchao Fu, ; Ebrahim Kouhsari,
; ORCID:
https://www.orcid.org/0000-0001-5893-6483
| | - Khalil Azizian
- Department of Microbiology, Faculty of Medicine,
Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ebrahim Kouhsari
- Laboratory Sciences Research Center, Golestan
University of Medical Sciences, Gorgan, Iran,Department of Laboratory Sciences, Faculty of
Paramedicine, Golestan University of Medical Sciences, Gorgan, Iran,To whom all correspondence should be addressed:
Jinchao Fu, ; Ebrahim Kouhsari,
; ORCID:
https://www.orcid.org/0000-0001-5893-6483
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Molecular Epidemiology, Antimicrobial Surveillance, and PK/PD Analysis to Guide the Treatment of Neisseria gonorrhoeae Infections. Pharmaceutics 2021; 13:pharmaceutics13101699. [PMID: 34683991 PMCID: PMC8541456 DOI: 10.3390/pharmaceutics13101699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/08/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to apply molecular epidemiology, antimicrobial surveillance, and PK/PD analysis to guide the antimicrobial treatment of gonococci infections in a region of the north of Spain. Antibiotic susceptibility testing was performed on all isolates (2017 to 2019, n = 202). A subset of 35 isolates intermediate or resistant to at least two antimicrobials were selected to search for resistance genes and genotyping through WGS. By Monte Carlo simulation, we estimated the probability of target attainment (PTA) and the cumulative fraction of response (CFR) of the antimicrobials used to treat gonorrhea, both indicative of the probability of treatment success. In total, 2.0%, 6.4%, 5.4%, and 48.2% of the isolates were resistant to ceftriaxone, cefixime, azithromycin, and ciprofloxacin, respectively. Twenty sequence types were identified. Detected mutations were related to antibiotic resistance. PK/PD analysis showed high probability of treatment success of the cephalosporins. In conclusion, multiple populations of N. gonorrhoeae were identified. We can confirm that ceftriaxone (even at the lowest dose: 250 mg) and oral cefixime are good candidates to treat gonorrhea. For patients allergic to cephalosporins, ciprofloxacin should be only used if the MIC is known and ≤0.125 mg/L; this antimicrobial is not recommended for empirical treatment.
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6
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Salmerón P, Viñado B, Arando M, Alcoceba E, Romero B, Menéndez B, Bernal S, Idigoras P, Colomina J, Martin-Saco G, Leal-Negredo Á, Torreblanca A, Martínez O, Serra-Pladevall J. Neisseria gonorrhoeae antimicrobial resistance in Spain: a prospective multicentre study. J Antimicrob Chemother 2021; 76:1523-1531. [PMID: 33569588 DOI: 10.1093/jac/dkab037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/19/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Gonococcal infection is one of the most reported sexually transmitted infections and antimicrobial resistance in Neisseria gonorrhoeae (NG) is challenging for the treatment of this infection. This observational study aimed to describe antimicrobial resistance of NG and epidemiological data from patients with gonococcal infection in eight regions of Spain, for updating the local therapeutic guidelines. METHODS MICs of penicillin, cefixime, ceftriaxone, azithromycin, ciprofloxacin, fosfomycin and gentamicin were determined by Etest for all NG isolates recovered from 1 April 2018 to 30 September 2019 from 10 hospitals in Spain. Resistance determinants were identified using logistic regression analysis. Differences with a P value <0.05 were considered statistically significant. RESULTS Antimicrobial susceptibility testing was performed for 2571 gonococci isolated from 2429 patients. 44.5% (945/2124) of patients were MSM. The resistance rate to extended-spectrum cephalosporins was low, with 0.2% (6/2561) of isolates resistant to ceftriaxone and 1.7% (44/2517) of isolates resistant to cefixime. The overall azithromycin resistance rate was 12.1% (310/2560), but differed greatly depending on the area. 56.2% (1366/2429) of the strains studied were ciprofloxacin resistant. MIC50 and MIC90 values of gentamicin and fosfomycin were 4 and 8 mg/L and 24 and 48 mg/L, respectively. CONCLUSIONS Our study shows that NG susceptibility to extended-spectrum cephalosporins remains high in Spain. The azithromycin resistance rate questions the suitability of dual therapy. This study provides data of interest for updating the national treatment guidelines and highlights the need to develop and implement a national sentinel gonococcal antimicrobial susceptibility programme.
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Affiliation(s)
- Paula Salmerón
- Microbiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Sexually Transmitted Infections Study Group (GEITS), Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain.,Department of Genetics and Microbiology, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Belén Viñado
- Microbiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Maider Arando
- Sexually Transmitted Infections Study Group (GEITS), Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain.,Drassanes-Vall d'Hebron Sexually Transmitted Infections Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Eva Alcoceba
- Microbiology Department, Son Espases Hospital Universitari, Mallorca, Spain
| | - Beatriz Romero
- Microbiology Department, Ramón y Cajal Hospital Universitario, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Blanca Menéndez
- Sexually Transmitted Infections Study Group (GEITS), Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain.,Sandoval Health Centre, San Carlos Hospital Clínico, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - Samuel Bernal
- Sexually Transmitted Infections Study Group (GEITS), Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain.,Microbiology Department, Virgen de Valme Hospital Universitario, Sevilla, Spain
| | - Pedro Idigoras
- Microbiology Department, Donostia Hospital Universitario, San Sebastián, Spain
| | - Javier Colomina
- Microbiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Gloria Martin-Saco
- Sexually Transmitted Infections Study Group (GEITS), Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain.,Microbiology Department, Miguel Servet Hospital Universitario, Zaragoza, Spain
| | - Álvaro Leal-Negredo
- Sexually Transmitted Infections Study Group (GEITS), Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain.,Microbiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Aurora Torreblanca
- Sexually Transmitted Infections Study Group (GEITS), Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain.,Microbiology Department, Cabueñes Hospital Universitario, Gijón, Spain
| | - Olalla Martínez
- Microbiology Department, La Ribera Hospital Universitario, Valencia, Spain
| | - Judit Serra-Pladevall
- Microbiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Sexually Transmitted Infections Study Group (GEITS), Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain.,Department of Genetics and Microbiology, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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7
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Salmerón P, Moreno-Mingorance A, Trejo J, Amado R, Viñado B, Cornejo-Sanchez T, Alberny M, Barbera MJ, Arando M, Pumarola T, Hoyos-Mallecot Y, Serra-Pladevall J, González-López JJ. Emergence and dissemination of three mild outbreaks of Neisseria gonorrhoeae with high-level resistance to azithromycin in Barcelona, 2016-18. J Antimicrob Chemother 2021; 76:930-935. [PMID: 33367806 DOI: 10.1093/jac/dkaa536] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/02/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Neisseria gonorrhoeae (NG) isolates with high-level azithromycin resistance (HL-AziR) have emerged worldwide in recent decades, threatening the sustainability of current dual-antimicrobial therapy. OBJECTIVES This study aimed to characterize the first 16 NG isolates with HL-AziR in Barcelona between 2016 and 2018. METHODS WGS was used to identify the mechanisms of antimicrobial resistance, to establish the MLST ST, NG multiantigen sequence typing (NG-MAST) ST and NG sequence typing for antimicrobial resistance (NG-STAR) ST and to identify the clonal relatedness of the isolates with other closely related NG previously described in other countries based on a whole-genome SNP analysis approach. The sociodemographic characteristics of the patients included in the study were collected by comprehensive review of their medical records. RESULTS Twelve out of 16 HL-AziR isolates belonged to the MLST ST7823/NG-MAST ST5309 genotype and 4 to MLST ST9363/NG-MAST ST3935. All presented the A2059G mutation in all four alleles of the 23S rRNA gene. MLST ST7823/NG-MAST ST5309 isolates were only identified in men who have sex with women and MLST ST9363/NG-MAST ST3935 were found in MSM. Phylogenomic analysis revealed the presence of three transmission clusters of three different NG strains independently associated with sexual behaviour. CONCLUSIONS Our findings support the first appearance of three mild outbreaks of NG with HL-AziR in Spain. These results highlight the continuous capacity of NG to develop antimicrobial resistance and spread among sexual networks. The enhanced resolution of WGS provides valuable information for outbreak investigation, complementing the implementation of public health measures focused on the prevention and dissemination of MDR NG.
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Affiliation(s)
- P Salmerón
- Department of Microbiology, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.,Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain
| | - A Moreno-Mingorance
- Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain.,Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - J Trejo
- Department of Microbiology, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - R Amado
- Department of Microbiology, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - B Viñado
- Department of Microbiology, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.,Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain
| | - T Cornejo-Sanchez
- Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - M Alberny
- Institut Català de Salut (ICS), Barcelona, Spain
| | - M J Barbera
- Drassanes-Vall d'Hebron Sexually Transmitted Infections Unit, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain
| | - M Arando
- Drassanes-Vall d'Hebron Sexually Transmitted Infections Unit, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - T Pumarola
- Department of Microbiology, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.,Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain.,Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Y Hoyos-Mallecot
- Department of Microbiology, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - J Serra-Pladevall
- Department of Microbiology, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.,Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain.,Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - J J González-López
- Department of Microbiology, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.,Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain.,Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
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