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Sharma D, Muralidhar S, Lachyan AS, Khunger N. Risk factors associated with increasing prevalence of gonorrhea and the antimicrobial susceptibility profiles of Neisseria gonorrhoeae among adolescents: A decade-long, hospital-based study from India. Indian J Sex Transm Dis AIDS 2024; 45:15-18. [PMID: 38989070 PMCID: PMC11233057 DOI: 10.4103/ijstd.ijstd_74_23] [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: 08/10/2023] [Revised: 09/09/2023] [Accepted: 09/29/2023] [Indexed: 07/12/2024] Open
Abstract
Background Gonorrhea is a significant cause of morbidity among sexually active population. Young adults and adolescents have a high risk of contracting sexually transmitted infections (STIs) due to behavioral, biological, and cultural factors fuelling the epidemic among them. The Centers for Disease Control recommends annual STI screening for sexually active individuals under twenty-five and those at higher risk. The present study aims at determining the risk factors linked to the rising prevalence of gonorrhea among Indian adolescents and antimicrobial susceptibility profiles of Neisseria gonorrhoeae. Materials and Methods Clinical samples from adolescents attending the STI clinics were collected over 10 years. The isolates were confirmed as N. gonorrhoeae and antimicrobial susceptibility tests were performed to various drugs using the minimum inhibitory concentration strip method. Results A total of 7308 genital discharge specimens were collected from STI clinic attendees, of which 417 samples were positive for gonorrhea (25 among male adolescents). Seventy six percent of positive adolescents had multiple sex partners, with only 4% using condoms. Nearly 20% practiced exchange of drugs for sex. Antimicrobial susceptibility rates were 96% sensitive for azithromycin, cefixime, and ceftriaxone. Gentamicin and spectinomycin reported 100% sensitivity rates. High resistance rates were reported to penicillin, ciprofloxacin, and tetracycline at 80%, 88%, and 68%, respectively. Conclusion Regular screening for STIs helps understand the trends and transmission of gonorrhea, which helps initiate appropriate control measures. The resistance to recommended treatment regimens such as azithromycin and cefixime seems to be escalating gradually, probably due to irrational use of antibiotics for non-STI cases and empirical treatment, which needs close monitoring.
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Affiliation(s)
- Devanshi Sharma
- Apex Regional STD Centre and State Reference Laboratory for HIV, New Delhi, India
| | - Sumathi Muralidhar
- Apex Regional STD Centre and State Reference Laboratory for HIV, New Delhi, India
| | | | - Niti Khunger
- Department of Dermatology and STD, Apex Regional STD Centre, Safdarjung Hospital, New Delhi, India
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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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Saeed DK, Farooqi J, Shakoor S, Hasan R. Antimicrobial resistance among GLASS priority pathogens from Pakistan: 2006-2018. BMC Infect Dis 2021; 21:1231. [PMID: 34876041 PMCID: PMC8650393 DOI: 10.1186/s12879-021-06795-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/08/2021] [Indexed: 11/20/2022] Open
Abstract
Background In 2018 Pakistan initiated its national antimicrobial resistance (AMR) surveillance aligned with Global Antimicrobial Surveillance System (GLASS). To complement this surveillance, we conducted a situational analysis of AMR rates among GLASS organisms in the country. Data from published studies and from antibiograms was compared and role of antibiograms as potential contributors to national AMR surveillance explored. Methods AMR rates for GLASS specified pathogen/antimicrobials combination from Pakistan were reviewed. Data sources included published studies (2006–2018) providing AMR rates from Pakistan (n = 54) as well as antibiograms (2011–2018) available on the Pakistan Antimicrobial Resistance Network (PARN) website. Resistance rates were categorized as follows: Very low: 0–10%, Low: 11–30%, Moderate: 30–50% and High: > 50%. Results Published data from hospital and community/laboratory-based studies report resistance rates of > 50% and 30–50% respectively to 3rd generation cephalosporins, fluoroquinolones and cotrimoxazole amongst Klebsiella pneumoniae and Escherichia coli. Carbapenem resistance rates amongst these organisms remained below 30%. High (> 50%) resistance was reported in Acinetobacter species to aminoglycosides and carbapenems among hospitalized patients. The evolution of ceftriaxone resistant Salmonella Typhi and Shigella species is reported. The data showed > 50% to fluoroquinolones amongst Neisseria gonorrhoeae and the spread of methicillin resistant Staphylococcus aureus (< 30%; 2008) to (> 50%; 2010) in hospital settings. Resistance reported in published studies aligned well with antibiogram data. The latter also captured a clear picture of evolution of resistance over the study period. Conclusion Both published studies as well antibiograms suggest high rates of AMR in Pakistan. Antibiogram data demonstrating steady increase in AMR highlight its potential role towards supplementing national AMR surveillance efforts particularly in settings where reach of national surveillance may be limited. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06795-0.
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Affiliation(s)
- Dania Khalid Saeed
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, 74800, Pakistan
| | - Joveria Farooqi
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, 74800, Pakistan
| | - Sadia Shakoor
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, 74800, Pakistan
| | - Rumina Hasan
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, 74800, Pakistan. .,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
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Molecular Antimicrobial Resistance of Neisseria gonorrhoeae in a Moroccan Area. Infect Dis Obstet Gynecol 2018; 2018:7263849. [PMID: 30584266 PMCID: PMC6280242 DOI: 10.1155/2018/7263849] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 10/24/2018] [Accepted: 11/11/2018] [Indexed: 12/02/2022] Open
Abstract
Objectives To identify the prevalence and the types of Neisseria gonorrhoeae (NG) resistance plasmids-mediated penicillin (PPNG) and tetracycline (TRNG), the ciprofloxacin resistance (CRNG), and related risk factors of each types of resistance. Methods The beta-lactamase-producing plasmid types (Africa, Asia, and Toronto), tetM tetracycline resistance plasmid types (America and Dutch), and the determination of the Ser-91 mutation of GyrA were detected by specifics PCRs on 149 diagnosed NG positives samples followed by Hinf1 digestion for tetM and gyrA mutation. Results 135 (90.1%) samples showed a profile of molecular resistance to at least one antibiotic with predominance of ciprofloxacin resistance. In fact, 36 (24.2%) and 69 (46.3%) cases harbored PPNG and TRNG, respectively, and 116 (77.9%) cases showed the mutation Ser-91 of GyrA (CRNG). From a total of 36 PPNG isolates, the Toronto, Asian, and Toronto/Asian types were detected in 13 (36.1%), 10 (27.8%), and 13 (36.1%) cases, respectively, whereas the African type was not detected. In addition, the American type of TRNG was detected in 92.8% (64/69) of cases, while the Dutch type was detected in 7.2% (5/69) of cases. The association of demographics and clinical variables with NG resistance to ciprofloxacin, penicillin, and tetracycline was studied and the risk factors have been determined. Conclusion Resistance to penicillin, tetracycline, and ciprofloxacin among NG samples positives remained at high levels in Morocco as determined by molecular profile. So, the use of molecular tools for NG antimicrobial resistance detection can help in the management and spread limitation of this infection.
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Escobedo-Guerra MR, Katoku-Herrera M, Lopez-Hurtado M, Gutierrez-Trujillo R, Guerra-Infante FM. Use of the mtrR Gene for Rapid Molecular Diagnosis of Neisseria gonorrhoeae and Identification of the Reduction of Susceptibility to Antibiotics in Endocervical Swabs. Mol Diagn Ther 2018; 22:361-368. [PMID: 29589256 DOI: 10.1007/s40291-018-0328-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Neisseria gonorrhoeae is one of the main etiological agents of sexually transmitted diseases. The asymptomatic course of the infection and its resistance to antibiotics can lead to pelvic inflammatory disease and infertility. OBJECTIVES We developed a polymerase chain reaction (PCR) test using the methyltetrahydrofolate homocysteine methyltransferase reductase (mtrR) gene to identify N. gonorrhoeae and detect reduced susceptibility to antibiotics. MATERIAL AND METHODS We analysed 250 samples of endocervical exudate from infertile women with a negative diagnosis of N. gonorrhoeae. We designed NGmtr primers to detect N. gonorrhoeae and identify the antibiotic-resistant strain. RESULTS Of the 250 samples, 60 (24%) tested positive for N. gonorrhoeae using real-time PCR. Our study was validated using the HO primers and the Seeplex STD6 ACE System, with a 100% correlation. Furthermore, the NGmtr primers are specific for N. gonorrhoeae and not for other species. Additionally, the curves generated by real-time PCR differed between wild and variant strains (10.93%). The dissociation temperatures for the wild and variant strains were 86.5 and 89 °C, respectively. CONCLUSIONS The NGmtr primers enabled us to identify N. gonorrhoeae strains with or without reduction of susceptibility to antibiotics. Therefore, this work constitutes a tool that will facilitate the diagnosis of this infection for a low cost and improve patient quality of life.
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Affiliation(s)
- Marcos R Escobedo-Guerra
- Departamento de Infectología, Instituto Nacional de Perinatología, Montes Urales No. 800, Colonia Lomas de Virreyes, Miguel Hidalgo, CP 11000, Mexico City, Mexico
| | - Mitzuko Katoku-Herrera
- Departamento de Infectología, Instituto Nacional de Perinatología, Montes Urales No. 800, Colonia Lomas de Virreyes, Miguel Hidalgo, CP 11000, Mexico City, Mexico
| | - Marcela Lopez-Hurtado
- Departamento de Infectología, Instituto Nacional de Perinatología, Montes Urales No. 800, Colonia Lomas de Virreyes, Miguel Hidalgo, CP 11000, Mexico City, Mexico
| | - Rodrigo Gutierrez-Trujillo
- Departamento de Infectología, Instituto Nacional de Perinatología, Montes Urales No. 800, Colonia Lomas de Virreyes, Miguel Hidalgo, CP 11000, Mexico City, Mexico
| | - Fernando M Guerra-Infante
- Departamento de Infectología, Instituto Nacional de Perinatología, Montes Urales No. 800, Colonia Lomas de Virreyes, Miguel Hidalgo, CP 11000, Mexico City, Mexico.
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Sood S, Agarwal M, Bala M, Mahajan N, Singh R, Kapil A, Sreenivas V, Ram RJ, Kar HK, Sharma VK. Exploring quinolone resistance-determining region in Neisseria gonorrhoeae isolates from across India. Indian J Med Res 2018; 146:S64-S69. [PMID: 29205198 PMCID: PMC5735573 DOI: 10.4103/ijmr.ijmr_730_15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background & objectives: Antimicrobial resistance in Neisseria gonorrhoeae, the causative agent of gonorrhoea, is a subject of worldwide attention. The present study was undertaken to examine the rates of ciprofloxacin resistance, to correlate mutations in gyrA and parC genes with the level of resistance and to look for a variation in mutation pattern, if any, in isolates from across the country. Methods: A total of 113 isolates of N. gonorrhoeae collected from sexually transmitted infection patients in six centres during November 2010 to October 2013 were investigated. Minimum inhibitory concentration (MIC) determination was done by E-test and results interpreted as per Calibrated Dichotomous Sensitivity criteria. DNA sequence analysis of gyrA and parC genes was done. Results: Of the 113 isolates, only three (2.6%) were susceptible whereas eight (7.07%) were less susceptible, 32 [28.3%, 95% confidence interval (CI): 20.4-37.6%] resistant (MIC 1-3 µg/ml) and 70 (61.9%, 95% CI: 52.2-70.7%) exhibited high-level resistance (HLR) (MIC ≥4 µg/ml) to ciprofloxacin. A S91F substitution in gyrA gene was demonstrated in all ciprofloxacin non-susceptible isolates. All resistant and HLR isolates had a double mutation in gyrA gene. However, only 5.7 per cent of HLR isolates showed double mutations in parC gene. One isolate (MIC 32 µg/ml) had a previously undescribed G85D substitution in the parC gene. Interpretation & conclusions: A S91F substitution in gyrA gene was seen in all non-susceptible isolates of N. gonorrhoeae. It may be used as a marker for ciprofloxacin resistance for molecular surveillance approaches to complement the culture-based methods.
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Affiliation(s)
- Seema Sood
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Madhav Agarwal
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Manju Bala
- Apex Regional STD, Teaching, Training & Research Centre, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Neeraj Mahajan
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajendra Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Arti Kapil
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - R J Ram
- Department of Dermatology, Lal Bahadur Shastri Hospital, Delhi, India
| | - Hemanta Kumar Kar
- Department of Dermatology, STDs & Leprosy, Postgraduate Institute of Medical Education and Research & Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Vinod Kumar Sharma
- Department of Dermatology & Venereology, All India Institute of Medical Sciences, New Delhi, India
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Saksena R, Gaind R, Sinha A, Kothari C, Chellani H, Deb M. High prevalence of fluoroquinolone resistance amongst commensal flora of antibiotic naïve neonates: a study from India. J Med Microbiol 2018; 67:481-488. [PMID: 29458558 DOI: 10.1099/jmm.0.000686] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The emergence of resistance amongst commensal flora is a serious threat to the community. However, there is paucity of data regarding antibiotic resistance in commensals in the absence of antibiotic pressure. METHODS Altogether, 100 vaginally delivered antibiotic naïve exclusively breastfed neonates were selected. Stool samples collected on day (D)1, D21 and D60 of birth were cultured. Enterobacteriaceae isolates were screened for nalidixic acid (NA) and ciprofloxacin susceptibility as per CLSI guidelines. In 28 randomly selected neonates, isolates (n=92) resistant to NA and ciprofloxacin were characterized for the presence of plasmid-mediated quinolone resistance (PMQR) genes (qnrA, qnrB and qnrS, qepAand aac(6')-Ib-cr) and mutations in the quinolone resistance determining region (QRDR) of gyrA and parC genes by specific primers and confirmed by sequencing. RESULTS A total of 343 Enterobacteriaceae were isolated from 100 neonates. On D1, 58 % of neonates were colonized with at least one Enterobacteriaceae predominantly E. coli. Overall resistance to NA was 60 % but ciprofloxacin resistance increased significantly from 15 % (14/96) on D1 to 38 % (50/132) on D60 (P-value <0.001). The predominant mechanism of fluoroquinolone resistance was mutation in gyrA (n=49) with or without PMQR. PMQR carrying isolates increased more than fivefold from D1 to D60. CONCLUSION A high level of fluoroquinolone resistance in gut flora of antibiotic naïve and exclusively breastfed neonates suggests a rampant rise of resistance in the community. The source of resistance genes on D1 is probably maternal flora acquired at birth. High load of PMQR genes in commensal flora are a potential source of spread to pathogenic organisms.
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Affiliation(s)
- Rushika Saksena
- Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Rajni Gaind
- Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Anju Sinha
- Department of Reproductive and Child Health, Indian council of Medical Research, New Delhi, India
| | - Charu Kothari
- Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Harish Chellani
- Department of Paediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Manorama Deb
- Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Antimicrobial Resistance and Neisseria gonorrhoeae Multiantigen Sequence Typing Profile of Neisseria gonorrhoeae in New Delhi, India. Sex Transm Dis 2017; 43:506-16. [PMID: 27414684 DOI: 10.1097/olq.0000000000000471] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Molecular epidemiology of 100 consecutive gonococcal isolates collected between April 2010 and October 2013 from New Delhi was investigated using Neisseria gonorrhoeae multiantigen sequence typing (NG-MAST) along with its association with antimicrobial resistance profiles. Neisseria gonorrhoeae isolates were assigned into 60 different sequence types and 43 (71.6%) were novel. Sole representation was seen in 76.6% sequence types. There was significant association between ST6058 and resistance to penicillin (P = 0.00) and tetracycline (P = 0.002).
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Jabeen K, Bhawan Mal P, Khan E, Chandio S, Jacobsson S, Unemo M. Antimicrobial resistance and Neisseria gonorrhoeae multiantigen sequence typing (NG-MAST) genotypes in N. gonorrhoeae during 2012-2014 in Karachi, Pakistan. BMC Infect Dis 2016; 16:353. [PMID: 27449234 PMCID: PMC4957325 DOI: 10.1186/s12879-016-1673-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 06/27/2016] [Indexed: 11/10/2022] Open
Abstract
Background Globally, increasing antimicrobial resistance (AMR) in Neisseria gonorrhoea has led to decreased treatment options for gonorrhoea. Continuous monitoring of resistance is crucial to determine evolving resistance trends in Neisseria gonorrhoea and to suggest treatment recommendations. Quality assured gonococcal AMR data from Pakistan are mainly lacking. This study was performed to determine prevalence and trends of gonococcal AMR and molecular epidemiology of local strains during 2012–2014 in Karachi, Pakistan. Methods Gonococcal isolates (n = 100) were obtained from urogenital specimens submitted to the Aga Khan University Laboratory, Karachi, Pakistan. Antimicrobial susceptibility was determined using Etest and molecular epidemiology was assessed by N. gonorrhoeae multiantigen sequence typing (NG-MAST). Quality control was performed using N. gonorrhoeae WHO reference strains C, F, G, K, L, M, N, O, and P, and ATCC 49226. Results Susceptibility to spectinomycin, ceftriaxone and cefixime was 100 % and to azithromycin was 99 %. All isolates had low ceftriaxone MICs, i.e., ≤0.032 mg/L. Resistance to ciprofloxacin, tetracycline and penicillin G were 86 %, 51 % and 43 %, respectively. NG-MAST analysis identified 74 different sequence types (STs). Conclusions A highly diversified gonococcal population, 74 NG-MAST STs (62 novel STs) with an increased resistance to penicillin G, ciprofloxacin and tetracycline circulated in Karachi, Pakistan. Fortunately, no resistance to ceftriaxone was detected. Accordingly, ceftriaxone can continuously be recommended as the treatment of choice. However it is recommended to increase the dose of ceftriaxone from 125 mg intramuscularly to 250 mg intramuscularly due to ceftriaxone MIC creep and emerging resistance reported in the region. Furthermore, due to the high level of resistance to ciprofloxacin (86 %) it is essential to exclude ciprofloxacin from the recommended first-line therapy. It is imperative to significantly broaden the gonococcal AMR monitoring with participation from other laboratories and cities in Pakistan. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1673-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kauser Jabeen
- Department of Pathology and Laboratory Medicine, Aga Khan University, Stadium Road, Karachi, Pakistan.
| | - Pushpa Bhawan Mal
- Department of Pathology and Laboratory Medicine, Aga Khan University, Stadium Road, Karachi, Pakistan
| | - Erum Khan
- Department of Pathology and Laboratory Medicine, Aga Khan University, Stadium Road, Karachi, Pakistan
| | - Saeeda Chandio
- Department of Pathology and Laboratory Medicine, Aga Khan University, Stadium Road, Karachi, Pakistan
| | - Susanne Jacobsson
- WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Bharara T, Bhalla P, Rawat D, Garg VK, Sardana K, Chakravarti A. Rising trend of antimicrobial resistance among Neisseria gonorrhoeae isolates and the emergence of N. gonorrhoeae isolate with decreased susceptibility to ceftriaxone. Indian J Med Microbiol 2016; 33:39-42. [PMID: 25560000 DOI: 10.4103/0255-0857.148374] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
CONTEXT Gonorrhoea is one of the most common sexually transmitted infections (STI) in developing countries and is a global health problem. AIMS To analyze the trend of antimicrobial susceptibility of Neisseria gonorrhoeae isolates over the years, in a tertiary care hospital of North India. SETTINGS AND DESIGN The study population comprised males with urethritis and females with endocervicitis attending STI clinic of our hospital. MATERIALS AND METHODS In our STI laboratory, all gonococcal isolates are subjected to antimicrobial susceptibility testing by disc diffusion method as per CLSI guidelines. β-Lactamase production is determined by chromogenic cephalosporin test. Minimum Inhibitory Concentration (MIC) for ceftriaxone is determined by E-test. STATISTICAL ANALYSIS USED Data were expressed as percentages. The differences in percentages were tested for statistical significance by using χ2 test and P values were determined. RESULTS The percentage of penicillinase producing N. gonorrhoeae (PPNG) increased from 8% in 1995-96 to 20% in 2004-05 and 88% in 2011-2013. Quinolone-resistant N. gonorrhoeae (QRNG) showed a significant increase from 12% in 1995-96 to 98.3% in 2004-05, while 84% isolates were found to be QRNG by 2011-2013. In January 2013 we detected our first gonococcal isolate with decreased susceptibility to third-generation cephalosporins; Ceftriaxone, Cefixime and Cefpodoxime (MIC for ceftriaxone = 0.19 μg/ml). CONCLUSIONS The results of our study highlighted an alarming increase in the percentage of PPNG and QRNG strains over the years. Emergence of N. gonorrhoeae isolates with decreased susceptibility to third-generation cephalosporins is a cause of concern and thus emphasises the importance of antimicrobial susceptibility testing.
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Affiliation(s)
| | - P Bhalla
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
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Chen Y, Gong Y, Yang T, Song X, Li J, Gan Y, Yin X, Lu Z. Antimicrobial resistance in Neisseria gonorrhoeae in China: a meta-analysis. BMC Infect Dis 2016; 16:108. [PMID: 26941028 PMCID: PMC4778342 DOI: 10.1186/s12879-016-1435-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 02/16/2016] [Indexed: 11/23/2022] Open
Abstract
Background Neisseria gonorrhoeae (N. gonorrhoeae) resistance to antimicrobial has been a major concern in China, and epidemiological data on N. gonorrhoeae resistance are not well understood. This meta-analysis was aimed at summarizing the evidence on N. gonorrhoeae resistance to penicillin, tetracycline, ciprofloxacin, ceftriaxone and spectinomycin in China. Methods Two researchers independently searched five databases to identify studies on N. gonorrhoeae resistance to antimicrobials from the databases’ inception to November 7, 2014. A random-effects model was used to estimate the antimicrobial resistance rates and their corresponding 95 % confidence intervals (CIs). Publication bias was assessed with the Begg rank correlation test and the Egger test. Results We included 127 studies in our synthesis reporting antimicrobial resistance. Our analyses demonstrated that N. gonorrhoeae resistance to penicillin and tetracycline respectively increased from 74.41 % (95 % CI: 64.1–84.7 %) and 68.3 % (95 % CI: 58.7–78.0 %) in 2000 to 84.2 % (95 % CI: 79.7–88.8 %) and 82.4 % (95 % CI: 79.9–84.7 %) in 2012. N. gonorrhoeae resistance to ciprofloxacin experienced a steady increase from 12.7 % (95 % CI, 8.6–16.7 %) in 1995 and reached 93.8 % (95 % CI: 91.9–95.7 %) in 2003. N. gonorrhoeae resistance to ceftriaxone was 1.7 % (95 % CI: 0.5–5.7 %) before 1995 and 0.5 % (95 % CI: 0.2–1.4 %) in 2012, and N. gonorrhoeae resistance to spectinomycin was less than 2 % from 1995 to 2012. Conclusions N. gonorrhoeae resistance rates to penicillin, tetracycline and ciprofloxacin were high in China. Ceftriaxone and spectinomycin remained effective therapy for the treatment of gonorrhea. It is essential to strengthen N. gonorrhoeae resistance surveillance and update treatment guidelines timely. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1435-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yawen Chen
- Department of Social Medicine and Health Management, School of Public Health Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Yanhong Gong
- Department of Social Medicine and Health Management, School of Public Health Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Tingting Yang
- Department of Social Medicine and Health Management, School of Public Health Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Xingyue Song
- Department of Social Medicine and Health Management, School of Public Health Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Jing Li
- Department of Social Medicine and Health Management, School of Public Health Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Yong Gan
- Department of Social Medicine and Health Management, School of Public Health Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Xiaoxv Yin
- Department of Social Medicine and Health Management, School of Public Health Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Zuxun Lu
- Department of Social Medicine and Health Management, School of Public Health Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Laxminarayan R, Matsoso P, Pant S, Brower C, Røttingen JA, Klugman K, Davies S. Access to effective antimicrobials: a worldwide challenge. Lancet 2016; 387:168-75. [PMID: 26603918 DOI: 10.1016/s0140-6736(15)00474-2] [Citation(s) in RCA: 720] [Impact Index Per Article: 90.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Recent years have seen substantial improvements in life expectancy and access to antimicrobials, especially in low-income and lower-middle-income countries, but increasing pathogen resistance to antimicrobials threatens to roll back this progress. Resistant organisms in health-care and community settings pose a threat to survival rates from serious infections, including neonatal sepsis and health-care-associated infections, and limit the potential health benefits from surgeries, transplants, and cancer treatment. The challenge of simultaneously expanding appropriate access to antimicrobials, while restricting inappropriate access, particularly to expensive, newer generation antimicrobials, is unique in global health and requires new approaches to financing and delivering health care and a one-health perspective on the connections between pathogen transmission in animals and humans. Here, we describe the importance of effective antimicrobials. We assess the disease burden caused by limited access to antimicrobials, attributable to resistance to antimicrobials, and the potential effect of vaccines in restricting the need for antibiotics.
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Affiliation(s)
- Ramanan Laxminarayan
- Princeton Environmental Institute, Princeton, NJ, USA; Public Health Foundation of India, New Delhi, India.
| | | | - Suraj Pant
- Center for Disease Dynamics, Economics & Policy, Washington, DC, USA
| | - Charles Brower
- Center for Disease Dynamics, Economics & Policy, Washington, DC, USA
| | - John-Arne Røttingen
- Norwegian Institute of Public Health, and Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
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Chen SC, Yin YP, Dai XQ, Unemo M, Chen XS. First nationwide study regarding ceftriaxone resistance and molecular epidemiology of Neisseria gonorrhoeae in China. J Antimicrob Chemother 2015; 71:92-9. [PMID: 26472770 DOI: 10.1093/jac/dkv321] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 09/05/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a major public health concern worldwide. This is the first nationwide study, performed within the China Gonococcal Antimicrobial Susceptibility Programme (China-GASP), regarding AMR, including ceftriaxone genetic resistance determinants, and molecular epidemiology of gonococci in China. METHODS Gonococcal isolates (n = 1257) from consecutive patients were collected at 11 sentinel sites distributed across China during 2012-13. Susceptibility to ceftriaxone, spectinomycin, ciprofloxacin and tetracycline was determined using the agar dilution method. Ceftriaxone resistance determinants penA and penB were examined using sequencing. N. gonorrhoeae multiantigen sequence typing (NG-MAST) was performed for molecular epidemiology. RESULTS Among isolates, 0.2% were resistant to spectinomycin, 4.4% to ceftriaxone, 42.9% to tetracyclines (high-level resistance) and 99.8% to ciprofloxacin. Among 890 sequenced isolates, 16 (1.8%) possessed a penA mosaic allele; 4 of these isolates belonged to the MDR internationally spread NG-MAST genogroup G1407 (first description in China). Non-mosaic penA alleles with an A501T mutation and an A102D alteration in porB1b were statistically associated with decreased susceptibility/resistance to ceftriaxone. NG-MAST G10339, G1424 and G1053 were associated with decreased susceptibility/resistance to ceftriaxone. CONCLUSIONS In China, ceftriaxone and spectinomycin can continue to be recommended for gonorrhoea treatment, with the possible exception of Hainan and Sichuan provinces where ceftriaxone resistance exceeded 5% and AMR surveillance needs to be strengthened. Molecular approaches including genotyping and AMR determinant analysis can be valuable to supplement and enhance conventional surveillance of gonococcal AMR in China.
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Affiliation(s)
- Shao-Chun Chen
- National Center for STD Control, Chinese Center for Disease Control and Prevention, and Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
| | - Yue-Ping Yin
- National Center for STD Control, Chinese Center for Disease Control and Prevention, and Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
| | - Xiu-Qin Dai
- National Center for STD Control, Chinese Center for Disease Control and Prevention, and Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Xiang-Sheng Chen
- National Center for STD Control, Chinese Center for Disease Control and Prevention, and Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
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Zheng H, Wu X, Huang J, Qin X, Xue Y, Zeng W, Lan Y, Ou J, Tang S, Fang M. The prevalence and epidemiology of plasmid-mediated penicillin and tetracycline resistance among Neisseria gonorrhoeae isolates in Guangzhou, China, 2002-2012. BMC Infect Dis 2015; 15:412. [PMID: 26453557 PMCID: PMC4600260 DOI: 10.1186/s12879-015-1148-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 09/24/2015] [Indexed: 11/23/2022] Open
Abstract
Background Gonococcal antimicrobial resistance is a global problem. Different resistance plasmids have emerged and spread among the isolates of Neisseria gonorrhoeae worldwide and in China. We conducted this study to monitor the plasmid-mediated penicillin and tetracycline resistance among N. gonorrhoeae isolates in Guangzhou from 2002 to 2012. Methods Consecutive isolates of N. gonorrhoeae were collected from outpatients with gonorrhea attending the STD clinic in Guangdong Provincial Centre for Skin Diseases and STIs Control and Prevention. Penicillinase-producing N. gonorrhoeae (PPNG) isolates were analyzed by the paper acidometric method. Plasmid-mediated resistance to tetracycline in N. gonorrhoeae (TRNG) isolates was screened by the agar plate dilution method. Plasmid types were determined for TRNG and PPNG isolates using polymerase chain reaction (PCR). Minimum inhibitory concentrations (MICs) to penicillin and tetracycline were detected by the agar plate dilution. Results Of 1378 consecutive N. gonorrhoeae isolates, 429 PPNG and 639 TRNG isolates were identified. The prevalence of PPNG, TRNG, and PPNG/TRNG increased from 18.3 to 47.1 % (χ2 = 31.57, p < 0.001), from 29.4 to 52.1 % (χ2 = 16.28, p < 0.001) and from 10.0 to 26.2 % (χ2 = 10.46, p < 0.001) between 2002 and 2012, respectively. Genotyping of plasmids among PPNGs showed that the majority (93.7 %) of the isolates were the Asian type plasmids, while the African type plasmid emerged in 2008 and rapidly increased to 14.0 % in 2012 (χ2 = 25.03, p < 0.001). For TRNGs, all 639 isolates carried the Dutch type plasmid. MICs of penicillin G and tetracycline persisted at high levels and the MIC90s were 32-fold higher than the resistant cutoff point over 11 years. The prevalence rates of penicillin- and tetracycline-resistant N. gonorrhoeae varied from 90.9 to 91.1 % and from 88.3 to 89.3 % during 2002 to 2012, respectively. Conclusions Resistance to penicillin and tetracycline among N. gonorrhoeae isolates remained at high levels in Guangzhou. The Asian type PPNG continued to spread and Dutch type TRNG was still the dominant strain. The African type PPNG has emerged and is spreading rapidly.
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Affiliation(s)
- Heping Zheng
- Guangdong Provincial Centre for Skin Diseases and STIs Control and Prevention, Guangzhou, 510091, China.
| | - Xingzhong Wu
- Guangdong Provincial Centre for Skin Diseases and STIs Control and Prevention, Guangzhou, 510091, China.
| | - Jinmei Huang
- Guangdong Provincial Centre for Skin Diseases and STIs Control and Prevention, Guangzhou, 510091, China.
| | - Xiaolin Qin
- Guangdong Provincial Centre for Skin Diseases and STIs Control and Prevention, Guangzhou, 510091, China.
| | - Yaohua Xue
- Guangdong Provincial Centre for Skin Diseases and STIs Control and Prevention, Guangzhou, 510091, China.
| | - Weiying Zeng
- Guangdong Provincial Centre for Skin Diseases and STIs Control and Prevention, Guangzhou, 510091, China.
| | - Yinyuan Lan
- Guangdong Provincial Centre for Skin Diseases and STIs Control and Prevention, Guangzhou, 510091, China.
| | - Jiangli Ou
- Guangdong Provincial Centre for Skin Diseases and STIs Control and Prevention, Guangzhou, 510091, China.
| | - Sanmei Tang
- Guangdong Provincial Centre for Skin Diseases and STIs Control and Prevention, Guangzhou, 510091, China.
| | - Mingheng Fang
- Guangdong Provincial Centre for Skin Diseases and STIs Control and Prevention, Guangzhou, 510091, China.
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Zheng H, Yang B, Wu X, Huang J, Zeng W, Xue Y, Qin X, Lan Y, Tang S, Ou J, Li Y. Antibiotic susceptibility of Neisseria gonorrhoeae isolates from Guangzhou, China, during 2002-2011. Jpn J Infect Dis 2015; 67:288-91. [PMID: 25056075 DOI: 10.7883/yoken.67.288] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Antibiotic susceptibility of Neisseria gonorrhoeae in Guangzhou during 2002-2011 showed that resistance to penicillin and ciprofloxacin was high, while ceftriaxone remained effective although there was a trend towards reduced sensitivity.
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Affiliation(s)
- Heping Zheng
- Guangdong Provincial Center for Skin Diseases and STD Control
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Li S, Su XH, Le WJ, Jiang FX, Wang BX, Rice PA. Antimicrobial susceptibility of Neisseria gonorrhoeae isolates from symptomatic men attending the Nanjing sexually transmitted diseases clinic (2011-2012): genetic characteristics of isolates with reduced sensitivity to ceftriaxone. BMC Infect Dis 2014; 14:622. [PMID: 25427572 PMCID: PMC4263019 DOI: 10.1186/s12879-014-0622-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 11/07/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Evolving gonococcal antimicrobial resistance (AMR) poses a serious threat to public health. The aim of this study was to: update antimicrobial susceptibility data of Neisseria gonorrhoeae recently isolated in Nanjing, China and identify specific deteminants of antimicrobial resistance and gentoypes of isolates with decreased sensitivity to ceftriaxone. METHODS 334 N. gonorrhoeae isolates were collected consecutively from symptomatic men attending the Nanjing STD Clinic between April 2011 and December 2012. The minimum inhibitory concentrations (MICs) for penicillin, tetracycline, ciprofloxacin, spectinomycin and ceftriaxone were determined by agar plate dilution for each isolate. Penicillinase-producing N. gonorrhoeae (PPNG) and tetracycline-resistant N. gonorrhoeae (TRNG) were examined and typed for β-lactamase and tetM encoding plasmids respectively. Isolates that displayed elevated MICs to ceftriaxone (MIC ≥0.125 mg/L) were also tested for mutations in penA, mtrR, porB1b, ponA and pilQ genes and characterized by Neisseria gonorrhoeae multi-antigen sequence typing (NG-MAST). RESULTS 98.8% (330/334) of N. gonorrhoeae isolates were resistant to ciprofloxacin; 97.9% (327/334) to tetracycline and 67.7% (226/334) to penicillin. All isolates were susceptible to ceftriaxone (MIC ≤0.25 mg/L) and spectinomycin (MIC ≤32 mg/L). Plasmid mediated resistance was exhibited by 175/334 (52%) of isolates: 120/334 (36%) of isolates were PPNG and 104/334 (31%) were TRNG. 90.0% (108/120) of PPNG isolates carried the Asia type β-lactamase encoding plasmid and 96% (100/104) of TRNG isolates carried the Dutch type tetM containing plasmid. Elevated MICs for ceftriaxone were present in 15 (4.5%) isolates; multiple mutations were found in penA, mtrR, porB1b and ponA genes. The 15 isolates were distributed into diverse NG-MAST sequence types; four different non-mosaic penA alleles were identified, including one new type. CONCLUSIONS N. gonorrhoeae isolates in Nanjing generally retained similar antimicrobial resistance patterns to isolates obtained five years ago. Fluctuations in resistance plasmid profiles imply that genetic exchange among gonococcal strains is ongoing and is frequent. Ceftriaxone and spectinomycin remain treatments of choice of gonorrhea in Nanjing, however, decreased susceptibility to ceftriaxone and rising MICs for spectinomycin of N. gonorrhoeae isolates underscore the importance of maintaining surveillance for AMR (both phenotypic and genotypic).
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Affiliation(s)
- Sai Li
- STD Clinic, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, 210042, China.
| | - Xiao-Hong Su
- STD Clinic, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, 210042, China.
| | - Wen-Jing Le
- STD Clinic, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, 210042, China.
| | - Fa-Xing Jiang
- Department of Dermatology, Anhui Provincial Hospital, Hefei, 230001, China.
| | - Bao-Xi Wang
- STD Clinic, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, 210042, China.
| | - Peter A Rice
- Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, MA, 01602, USA.
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Aguilera-Arreola MG, González-Cardel AM, Tenorio AM, Curiel-Quesada E, Castro-Escarpulli G. Highly specific and efficient primers for in-house multiplex PCR detection of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma hominis and Ureaplasma urealyticum. BMC Res Notes 2014; 7:433. [PMID: 24997675 PMCID: PMC4099392 DOI: 10.1186/1756-0500-7-433] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 06/30/2014] [Indexed: 11/10/2022] Open
Abstract
Background Although sophisticated methodologies are available, the use of endpoint polymerase chain reaction (PCR) to detect 16S rDNA genes remains a good approach for estimating the incidence and prevalence of specific infections and for monitoring infections. Considering the importance of the early diagnosis of sexually transmitted infections (STIs), the development of a sensitive and affordable method for identifying pathogens in clinical samples is needed. Highly specific and efficient primers for a multiplex polymerase chain reaction (m-PCR) system were designed in silico to detect the 16S rDNA genes of four bacteria that cause genital infections, and the PCR method was developed. Methods The Genosensor Probe Designer (GPD) (version 1.0a) software was initially used to design highly specific and efficient primers for in-house m-PCR. Single-locus PCR reactions were performed and standardised, and then primers for each locus in turn were added individually in subsequent amplifications until m-PCR was achieved. Amplicons of the expected size were obtained from each of the four bacterial gene fragments. Finally, the analytical specificity and limits of detection were tested. Results Because they did not amplify any product from non-STI tested species, the primers were specific. The detection limits for the Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma hominis and Ureaplasma urealyticum primer sets were 5.12 × 105, 3.9 × 103, 61.19 × 106 and 6.37 × 105 copies of a DNA template, respectively. Conclusions The methodology designed and standardised here could be applied satisfactorily for the simultaneous or individual detection of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma hominis and Ureaplasma urealyticum. This method is at least as efficient as other previously described methods; however, this method is more affordable for low-income countries.
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Affiliation(s)
- Ma Guadalupe Aguilera-Arreola
- Medical bacteriology, Department of Microbiology, Escuela Nacional de Ciencias Biológicas of Instituto Politécnico Nacional (ENCB-IPN), Esq, Prol, Carpio y Plan de Ayala s/n Col, Santo Tomás, Del, Miguel Hidalgo CP 11340, Mexico DF.
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The frequency of Neisseria gonorrhoeae endocervical infection among female carrier and changing trends of antimicrobial susceptibility patterns in Kashan, Iran. IRANIAN JOURNAL OF MICROBIOLOGY 2014; 6:194-7. [PMID: 25870754 PMCID: PMC4393497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Neisseria gonorrhoeae is the second most sexually transmitted diseases agents in developing countries. Antimicrobial resistance strains have created serious health concern. The aim of this study was to determine the frequency of endocervical gonococcal infection and antimicrobial susceptibility of N. gonorrhoeae in Kashan, Iran. MATERIALS AND METHODS In this study, 294 endocervical swabs were collected from married women referred to the obstetrics and gynecology clinics in Kashan from December 2012 to May 2013. The samples were cultured in modified Thayer Martin in 37°C with 5-10% CO2 for 72 hours. Gram staining, oxidase, catalase and carbohydrate utilization tests were used to identify the isolated species. All isolates were tested for their susceptibilities to antimicrobials using the Kirby Bauer-disk diffusion techniques. RESULTS N. gonorrhoeae was detected in 2.38% of studied cases (95% confidence interval [CI] 1.5-3.26%). All isolates were resistance to ceftriaxone, penicillin G, ciprofloxacin, cefepime, and two isolate (28.5%) showed intermediate sensitivity to tetracycline. CONCLUSION Continued monitoring of prevalence of N. gonorrhoeae is important for preventing the dissemination of this microorganism. The present study emphasizes the importance of surveillance of antimicrobial resistance of N. gonorrhoeae in order to manage the rate of resistant strains and to revise the treatment policies.
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Chico RM, Hack BB, Newport MJ, Ngulube E, Chandramohan D. On the pathway to better birth outcomes? A systematic review of azithromycin and curable sexually transmitted infections. Expert Rev Anti Infect Ther 2013; 11:1303-32. [PMID: 24191955 PMCID: PMC3906303 DOI: 10.1586/14787210.2013.851601] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
The WHO recommends the administration of sulfadoxine-pyrimethamine (SP) to all pregnant women living in areas of moderate (stable) to high malaria transmission during scheduled antenatal visits, beginning in the second trimester and continuing to delivery. Malaria parasites have lost sensitivity to SP in many endemic areas, prompting the investigation of alternatives that include azithromycin-based combination (ABC) therapies. Use of ABC therapies may also confer protection against curable sexually transmitted infections and reproductive tract infections (STIs/RTIs). The magnitude of protection at the population level would depend on the efficacy of the azithromycin-based regimen used and the underlying prevalence of curable STIs/RTIs among pregnant women who receive preventive treatment. This systematic review summarizes the efficacy data of azithromycin against curable STIs/RTIs.
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Affiliation(s)
- R Matthew Chico
- London School of Hygiene and Tropical Medicine Keppel Street, London, WC1E 7HT,UK
| | - Berkin B Hack
- Brighton and Sussex Medical School,Brighton, East Sussex, BN1 9PX,UK
| | - Melanie J Newport
- Brighton and Sussex Medical School,Brighton, East Sussex, BN1 9PX,UK
| | - Enesia Ngulube
- London School of Hygiene and Tropical Medicine Keppel Street, London, WC1E 7HT,UK
| | - Daniel Chandramohan
- London School of Hygiene and Tropical Medicine Keppel Street, London, WC1E 7HT,UK
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Shiota S, Mahachai V, Vilaichone RK, Ratanachu-Ek T, Tshering L, Uchida T, Matsunari O, Yamaoka Y. Seroprevalence of Helicobacter pylori infection and gastric mucosal atrophy in Bhutan, a country with a high prevalence of gastric cancer. J Med Microbiol 2013; 62:1571-1578. [PMID: 23831768 DOI: 10.1099/jmm.0.060905-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Gastric cancer is the second leading cause of cancer-related mortality in the world. Recently, serum Helicobacter pylori antibodies and pepsinogen (PG) have been used for gastric cancer screening. The incidence of gastric cancer in Bhutan is reported to be quite high compared with that in neighbouring countries. In this study, 381 subjects from three areas of Bhutan were assessed for gastric mucosal atrophy and serological parameters. Anti-H. pylori IgG, PG I, PG II and cytotoxin-associated gene A (CagA) antibodies were measured using ELISA. Subjects were classified into four groups according to H. pylori and PG seropositivity: Group A (H. pylori-negative/PG-negative), Group B (H. pylori-positive/PG-negative), Group C (H. pylori-positive/PG-positive) and Group D (H. pylori-negative/PG-positive). The prevalence of H. pylori in the 381 subjects was 71.1% (271/381), with high infection rates found in rural areas. The PG I/II ratio was significantly inversely correlated with the atrophy score in the antrum and the corpus (P<0.001). Multivariate analysis showed that the PG status was significantly associated with the presence of atrophy in the corpus. The prevalence of the PG-positive status was significantly higher among H. pylori-positive subjects than among H. pylori-negative subjects (P<0.001). Based on the ABC method, Group B was the most dominant, followed by Group A, Group C and Group D. The high incidence of gastric cancer in Bhutan can be attributed to the high prevalence of H. pylori infection and gastric mucosal atrophy.
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Affiliation(s)
- Seiji Shiota
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan
| | | | - Ratha-Korn Vilaichone
- Gastroenterology Unit, Department of Medicine, Thammasat University Hospital, Pathumthani, Thailand
| | | | - Lotay Tshering
- Department of Surgery, Jigme Dorji Wangchuk National Referral Hospital, Thimphu, Bhutan
| | - Tomohisa Uchida
- Department of Molecular Pathology, Oita University Faculty of Medicine, Yufu, Japan
| | - Osamu Matsunari
- Department of Gastroenterology, Oita University Faculty of Medicine, Yufu, Japan
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan
| | - Yoshio Yamaoka
- Department of Medicine, Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, TX, USA
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan
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Olsen B, Pham TL, Golparian D, Johansson E, Tran HK, Unemo M. Antimicrobial susceptibility and genetic characteristics of Neisseria gonorrhoeae isolates from Vietnam, 2011. BMC Infect Dis 2013; 13:40. [PMID: 23351067 PMCID: PMC3574855 DOI: 10.1186/1471-2334-13-40] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 01/17/2013] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a major public health concern worldwide. In Vietnam, knowledge regarding N. gonorrhoeae prevalence and AMR is limited, and data concerning genetic characteristics of N. gonorrhoeae is totally lacking. Herein, we investigated the phenotypic AMR (previous, current and possible future treatment options), genetic resistance determinants for extended-spectrum cephalosporins (ESCs), and genotypic distribution of N. gonorrhoeae isolated in 2011 in Hanoi, Vietnam. METHODS N. gonorrhoeae isolates from Hanoi, Vietnam isolated in 2011 (n = 108) were examined using antibiograms (Etest for 10 antimicrobials), Neisseria gonorrhoeae multi-antigen sequence typing (NG-MAST), and sequencing of ESC resistance determinants (penA, mtrR and penB). RESULTS The levels of in vitro resistance were as follows: ciprofloxacin 98%, tetracycline 82%, penicillin G 48%, azithromycin 11%, ceftriaxone 5%, cefixime 1%, and spectinomycin 0%. The MICs of gentamicin (0.023-6 mg/L), ertapenem (0.002-0.125 mg/L) and solithromycin (<0.016-0.25 mg/L) were relatively low. No penA mosaic alleles were found, however, 78% of the isolates contained an alteration of amino acid A501 (A501V (44%) and A501T (34%)) in the encoded penicillin-binding protein 2. A single nucleotide (A) deletion in the inverted repeat of the promoter region of the mtrR gene and amino acid alterations in MtrR was observed in 91% and 94% of the isolates, respectively. penB resistance determinants were detected in 87% of the isolates. Seventy-five different NG-MAST STs were identified, of which 59 STs have not been previously described. CONCLUSIONS In Vietnam, the highly diversified gonococcal population displayed high in vitro resistance to antimicrobials previously recommended for gonorrhoea treatment (with exception of spectinomycin), but resistance also to the currently recommended ESCs were found. Nevertheless, the MICs of three potential future treatment options were low. It is essential to strengthen the diagnostics, case reporting, and epidemiologic surveillance of gonorrhoea in Vietnam. Furthermore, the surveillance of gonococcal AMR and gonorrhoea treatment failures is imperative to reinforce. Research regarding novel antimicrobial treatment strategies (e.g., combination therapy) and new antimicrobials is crucial for future treatment of gonorrhoea.
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Affiliation(s)
- Birgitta Olsen
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden
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