Trend of antimicrobial resistance in Neisseria gonorrhoeae at New Delhi, India

Antibacterial Activity of Selected Fruit Juices against Multidrug-Resistant Bacterial Pathogens Involved in Urinary Tract and Sexually Transmitted Infections among Tribal Women in Madhya Pradesh, India

Objectives

The aim of this study was to evaluate the effect of fruit juices on Multi-Drug Resistant (MDR) bacterial pathogens involved in Urinary Tract Infections (UTIs) and Sexually Transmitted Infections (STIs) among tribal women in the district Anuppur, Madhya Pradesh, India.

Methods

Fresh juices of lemon (Citrus limon), amla/Indian gooseberry (Phyllanthus emblica), pineapple (Ananas comosus), mosambi/sweet lime (Citrus limetta), orange (Citrus sinensis), kiwi (Actinidia deliciosa), and pomegranate (Punica granatum) fruits were evaluated for in vitro antibacterial activity against bacterial pathogens involved in UITs and STIs among tribal women. Physico-chemical analysis of fresh fruits was also carried out by measuring the pH, moisture, protein, fat, crude fibre, carbohydrate, and ascorbic acid content.

Results

Lemon and amla juice showed better antibacterial activity against the pathogens as compared to other juices. MIC results fruit juices against UTIs and STIs pathogens vary depending on the specific pathogen and juice chemical constituents. The physico-chemical analysis showed that the moisture content was highest in mosambi (90%), followed by orange (87%). Ascorbic acid content was found highest in amla (540 mg/100 g), followed by kiwi (90.3 mg/100 g). Pomegranate showed highest concentration of carbohydrate (15.28 g/100 g), fat (1.28 g/100 g), and protein (1.65 g/100 g). Lemon juice had lowest pH of 2.20, followed by amla 2.67.

Conclusion

The lemon juice showed highest antibacterial activity against MDR bacterial pathogens involved in UTIs and STIs among tribal women in district Anuppur, Madhya Pradesh, India. The low pH of lemon may be responsible for its high antibacterial activity as compared to other juices.

Trends of resistance to antimicrobials recommended currently and in the past for management of gonorrhea in the Apex STD center in India and comparison of antimicrobial resistance profile between 2002-2006 and 2007-2012

BACKGROUND

Antimicrobial resistance in Neisseria gonorrhoeae jeopardizes public health and continues to spread out to currently recommended and older antimicrobial agents. Antimicrobial resistance (AMR) surveillance provides essential clues toward the modification of treatment guidelines. The aim of the study was to determine gonococcal AMR profile and trends between 2007 and 2012 and to evaluate any change in AMR profile in comparison with published trends in 2002 to 2006.

METHODS

Antimicrobial susceptibility testing of 261 N. gonorrhoeae isolates from consecutive patients between 2007 and 2012 was determined for penicillin, tetracycline, ciprofloxacin, spectinomycin, extended-spectrum cephalosporins (ceftriaxone, cefixime, cefpodoxime) and azithromycin by the disk diffusion technique and the Etest method. P value was determined using χ test for comparisons of trends between the 2 periods.

RESULTS

In comparison of AMR trends between 2002-2006 and 2007-2012, penicillinase-producing N. gonorrhoeae, tetracycline-resistant N. gonorrhoeae, and ciprofloxacin-resistant strains increased significantly from 21.2% to 47.9% (P < 0.0001), 13.6% to 25.3% (P = 0.0002), and 78% to 89.7% (P = 0.0001), respectively. An insignificant increase from 2.4% to 4.2% (P > 0.05) in decreased susceptibility to ceftriaxone and 0.8% to 1.5% (P > 0.05) for azithromycin resistance was observed. All isolates were susceptible to spectinomycin over both the periods, except for one isolate in 2002.

CONCLUSIONS

The study highlights that there is a continuous increase in resistance to previously recommended antibiotics despite their disuse for treatment. The increase in number of strains with decreased susceptibility to extended-spectrum cephalosporins and azithromycin resistance, currently recommended for management of gonorrhea, is of serious concern. These trends should be monitored continuously to change antibiotic policy.

Neisseria gonorrhoeae non-susceptible to cephalosporins and quinolones in Northwest Ethiopia

BACKGROUND

The occurrence of antibiotic resistant Neisseria gonorrhoeae isolates is a serious public health problem in different corners of the globe. The objective of this study was to analyze the antimicrobial susceptibility pattern of N. gonorrhoeae in Northwest Ethiopia.

METHODS

This was a retrospective study of N. gonorrhoeae isolated from genital swabs of patients referred to the Amhara Regional Health Research Laboratory between September 2006 and June 2012 in Bahir Dar, Ethiopia. A structured check list was used to collect socio-demographic and laboratory variables. Data were analyzed using SPSS software version 16.

RESULTS

Out of 352 genital specimens processed, 29 clinical strains of N. gonorrhoeae were identified. The percentage of N. gonorrhoeae isolates non-susceptible to ceftriaxone, ciprofloxacin, tetracycline and penicillin G was 27.8%, 40.9%, 92.6% and 94.4% respectively. Twenty percent of the isolates were found to be non-susceptible to both ceftriaxone and ciprofloxacin. Non-susceptibility to an injectable cephalosporin and any two of quinolones, penicillins or tetracyclines was observed in 27.8% of the isolates. The percentage of N. gonorrhoeae which were non-susceptible to tetracycline or penicillin G was high throughout the study period. However, the percentage of fluoroquinolone or cephalosporine non-susceptible strains showed an increasing trend.

CONCLUSIONS

A high percentage of N. gonorrhoeae isolated from genital specimens in Northwest Ethiopia are non-susceptible to an injectable cephalosporin and any two of quinolones, penicillins or tetracyclines. Treatment of gonorrhea in the study area needs to be guided by antibiotic susceptibility testing of isolates.

Fluoroquinolone resistance and mutation patterns in gyrA and parC genes in Neisseria gonorrhoeae isolates from Shanghai, China

In order to study the resistance of Neisseria (N.) gonorrhoeae to the fluoroquinolone and detect mutation patterns of quinolone resistance-determining regions (QRDRs) of clinical isolates in Shanghai, China, a total of 80 clinical isolates of N. gonorrhoeae were consecutively collected from Shanghai. The MIC of fluoroquinolone for the isolates was examined by using the agar dilution method and the mutation profiles of the QRDRs of gyrA and parC were analyzed by sequencing and restriction fragment length polymorphism (RFLP). Chi-square test was used for comparison of the mutation patterns. The results showed that: (1) High percentages of the 8 isolates were resistant to ciprofloxacin (95.0%), ofloxacin (95.0%) and lomefloxacin (97.5%), only one strain was susceptible to the ciprofloxacin. (2) Sensitive strains had a substitute of Asp95-->Ala in the gyrA, and all isolates that were resistant or intermediated to the ciprofloxacin, had a double mutation in the gyrA (Ser91, Ala 92 and Asp95). Some strains also had a mutation in the parC. (3) The MICs of these isolates were significantly associated with the mutation patterns in the gyrA and parC. A double mutation of gyrA combined with parC87 mutation was a predominant pattern in Shanghai and could mediate high level resistance to ciprofloxacin. It suggests that mutations in the QRDRs of gyrA and parC may be responsible for the fluoroquinolone resistance. And fluoroquinolone could not be used as the first line antibiotics for gonorrhea treatment any more in Shanghai, China.

Antimicrobial resistance pattern of Neisseria gonorrhoeae isolates from peripheral health centres and STD clinic attendees of a tertiary care centre in India

Summary:

The aim of the study was to compare the antimicrobial resistance pattern of Neisseria gonorrhoeae isolates from urban and rural peripheral health centres and from sexually transmitted disease (STD) clinic attendees. Antimicrobial susceptibility testing of 191 N. gonorrhoeae isolates (165 isolates from STD clinic attendees and 26 from peripheral health centres) was carried out in Delhi, India, using the calibrated dichotomous sensitivity technique for penicillin, tetracycline, ceftriaxone, ciprofloxacin, spectinomycin and nalidixic acid, and minimum inhibitory concentrations were determined using E-test. Penicillin-resistant, ciprofloxacin-resistant, penicillinase-producing N. gonorrhoeae and tetracycline-resistant N. gonorrhoeae strains were higher in STD clinic attendees than in peripheral health centres, probably because of less antibiotic pressure in the peripheral areas. High-level resistance to ciprofloxacin and multiresistant strains were also higher in STD clinic attendees. The present study emphasizes the importance of surveillance of antimicrobial resistance of N. gonorrhoeae in different population subgroups in order to monitor the spread of multiresistant strains and to update the national treatment recommendations.

Changing trends of antimicrobial susceptibility patterns of Neisseria gonorrhoeae in India and the emergence of ceftriaxone less susceptible N. gonorrhoeae strains

OBJECTIVES

To monitor the trend of antimicrobial susceptibility of Neisseria gonorrhoeae isolates from 2002 to 2006 in New Delhi, India under the Gonococcal Antimicrobial Susceptibility Programme and to document the emergence of any new antimicrobial resistance.

METHODS

Antimicrobial susceptibility of 382 N. gonorrhoeae isolates from clinical cases in males and females to penicillin, tetracycline, ciprofloxacin, spectinomycin and ceftriaxone was determined by disc diffusion technique, using WHO reference strains as controls and WHO interpretative criteria. MICs were determined using Etests.

RESULTS

A significant increasing trend of penicillin and ciprofloxacin resistance up to 2003 and 2004, respectively, and subsequent decrease in resistant strains with a concomitant increase in less susceptible strains, was observed. Tetracycline-resistant N. gonorrhoeae increased significantly from 6.7% in 2002 to 22.9% in 2005. Only one isolate was resistant to spectinomycin and nine isolates were less susceptible to ceftriaxone, during this 5 year period. A substantial proportion (23.3%) of strains were multiresistant.

CONCLUSIONS

Emergence of ceftriaxone less susceptible N. gonorrhoeae isolates is a cause for concern, although treatment failure was not observed. An active, continuous and comprehensive programme for monitoring and surveillance of antimicrobial resistance needs to be established in many laboratories, and a search for new effective agents needs to be initiated to respond to the emergence of resistant isolates.

Preliminary studies on activity of Ocimum sanctum, Drynaria quercifolia, and Annona squamosa against Neisseria gonorrhoeae

BACKGROUND

Despite the progressive increase of antimicrobial resistance of Neisseria gonorrhoeae worldwide, there are limited reports of alternative remedies from plants.

GOAL

The aim of the current study was to screen 3 plants, Ocimum sanctum, Drynaria quercifolia, and Annona squamosa, for activity against Neisseria gonorrhoeae.

STUDY

By disc diffusion method, extracts of these 3 plants were screened for activity against Neisseria gonorrhoeae; their antimicrobial activity was calculated as percentage inhibition and compared with penicillin and ciprofloxacin.

RESULTS

The extracts of all 3 plants caused inhibition of Neisseria gonorrhoeae clinical isolates and World Health Organization (WHO) strains, more so than the multidrug resistant Neisseria gonorrhoeae.

CONCLUSION

Neisseria gonorrhoeae clinical isolates and WHO strains were sensitive to extracts of Ocimum sanctum, Drynaria quercifolia, and Annona squamosa. This motivates us to isolate the active component/second from the 3 plants.

Antimicrobial Resistance of Neisseria gonorrhoeae in Selected World Health Organization Southeast Asia Region Countries: An Overview

BACKGROUND AND OBJECTIVES

A Gonococcal Antimicrobial Susceptibility Program (GASP) under the World Health Organization South East Asia Region (WHO SEAR) is continuing in India and neighboring countries and is being coordinated by the WHO Regional Reference Laboratory (RRL), Vardhman Mahavir Medical College, and Safdarjung Hospital, New Delhi.

GOAL

The present communication describes the current status and trends of antimicrobial resistance patterns of Neisseria gonorrhoeae, isolated in different focal-point laboratories under GASP, as presented in WHO SEAR intercountry consultative meeting conducted in December 2001.

STUDY

Seven laboratories from India and 1 each from Bangladesh, Sri Lanka, and Nepal presented their data for the year 2000/2001. In addition, RRL Delhi, Bangladesh, and Sri Lanka presented data for the years 1995 to 2001, 1997 to 2001, and 1996 to 2000, respectively. Either National Committee for Clinical Laboratory Standards or calibrated dichotomous sensitivity technique was used in the different laboratories for determining antimicrobial susceptibility.

RESULTS

It was observed that in the Indian laboratories, penicillin resistance varied from 20% to 79%, tetracycline resistance from 0% to 45.6%, and ciprofloxacin from 10.6% to 100%. Chromosomal, as well as plasmid-mediated resistance, was observed. The strains were reported to be less sensitive to ceftriaxone in 5 out of 7 laboratories, while none reported spectinomycin resistance. The reasons for wide variation in the results could be due to geographical strain difference in different parts of this vast country. At Sri Lanka, gonococci showed resistance towards penicillin (96.8%) and ciprofloxacin (8.2%). Bangladesh reported N. gonorrhoeae with ciprofloxacin (76%), penicillin (33%), and tetracycline (50%) resistance and decreased susceptibility to ceftriaxone (1.5%). Both the laboratories did not report any spectinomycin resistance. The resistance trends in these 2 centers and the RRL, New Delhi, showed different patterns.

CONCLUSION

The report indicates the necessity for continuous surveillance of antimicrobial resistance pattern in this region of WHO for establishing antimicrobial policy guidelines for management of this common but important sexually transmitted infection (STI) pathogen, known to facilitate human immunodeficiency virus (HIV) infection. It also highlights the importance of ensuring quality assurance in the techniques in order to generate uniform data.

The use of fluoroquinolones in gonorrhoea: the increasing problem of resistance

The recent re-emergence of gonorrhoea in developed countries has been accompanied by the rise and spread of gonococcal resistance to the fluoroquinolones. In the 1980s fluoroquinolones were considered an important addition to the arsenal of agents used to treat gonorrhoea. They proved to be excellent drugs for this indication, including infections caused by penicillinase-producing and tetracycline-resistant strains of Neisseria gonorrhoeae. However, as gonococci have a well-recognised potential to develop resistance to antibiotics, the first reports of reduced susceptibility to fluoroquinolones appeared a few years after their introduction. Gonococcal resistance to fluoroquinolones is now well-established in the Far East, from where it has spread to Australia, Hawaii, California and Europe. In Africa and Latin America, gonococci continue to be susceptible to fluoroquinolones.

Mutation patterns in gyrA and parC genes of ciprofloxacin resistant isolates of Neisseria gonorrhoeae from India

AIM

To analyse mutations in the gyrA and parC genes leading to possible increase in ciprofloxacin resistance (high MIC values for ciprofloxacin) in clinical isolates of Neisseria gonorrhoeae in Delhi, India.

METHOD

MIC of ciprofloxacin for 63 clinical isolates of N gonorrhoeae were examined by the Etest method. Subsequently, gyrA and parC genes of these isolates were amplified and sequenced for possible mutations.

RESULTS

Out of the 63 clinical isolates tested, only five (8%) isolates were found to be susceptible to ciprofloxacin (MIC <0.06 micro g/ml). DNA sequence analysis of the gyrA and the parC genes of all these isolates (n = 63) revealed that all isolates which were not susceptible to ciprofloxacin (n=58) had mutation(s) in gyrA and parC genes. 12 isolates (19%) exhibited high resistance with an MIC for ciprofloxacin of 32 micro g/ml. Two out of these 12 isolates (UD62 and UD63), harboured triple mutations (Ser-91 to Phe, Asp-95 to Asn and Val-120 to Leu) in the gyrA gene. The third mutation of Val-120 to Leu, lies downstream of the quinolone resistance determining region (QRDR) of the gyrA and has not been described before in gonococcus. In addition, both these isolates had a Phe-100 to Tyr substitution in the parC, a hitherto unknown mutation.

CONCLUSIONS

Emergence of ciprofloxacin resistance with high levels of MIC values (up to 32 micro g/ml) in India is alarming. Double and triple mutations in gyrA alone or together in gyrA and parC could be responsible for such a high resistance.