Reliable data concerning the incidence and phenotypic and genotypic characteristics of the Neisseria gonorrhoeae population in many eastern European countries are lacking. Clinically significant N. gonorrhoeae isolates (n = 76) from 76 consecutive patients in Arkhangelsk, Russia were characterised by antimicrobial susceptibility testing, serovar determination, porB gene sequencing and N. gonorrhoeae multi-antigen sequence typing (NG-MAST). The isolates were assigned to 12 different serovars, displayed 35 divergent porB sequences, and belonged to 40 different sequence types (STs). All the serovars, but only seven of the STs, had been identified previously in other countries. Twelve ST clusters of between two and 14 isolates were identified, which indicated that many multiple transmission networks exist in Arkhangelsk. The high number of unique STs (n = 28) may be a consequence of sub-optimal diagnostic procedures, ineffective partner tracing, local emergence of new STs, import of strains via sexual tourists, or foreign travel. The N. gonorrhoeae population circulating in Arkhangelsk was highly diverse and differed from the N. gonorrhoeae populations disseminated in some western European countries. Thorough knowledge concerning the incidence of gonorrhoea, antibiotic susceptibility and other phenotypic and genotypic characteristics of the N. gonorrhoeae strains circulating in eastern Europe is crucial.

A total of 91 consecutive clinical isolates of Staphylococcus aureus were collected at the Regional Hospital of Arkhangelsk, Russia, from May to December 2004, and examined for antimicrobial susceptibility, methicillin resistance and presence of Panton-Valentine leucocidin (PVL) genes. Epidemiological typing was performed by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Methicillin-resistant S. aureus (MRSA) isolates were examined by staphylococcal cassette chromosome mec (SCCmec) typing. High-to-moderate rates of resistance to penicillin (beta-lactamase production; 93%), tetracycline (40%), erythromycin and clindamycin (32%) were observed. Forty out of ninety-one (44%) isolates were positive for PVL genes. Thirty-six (40%) PVL-positive methicillin-susceptible S. aureus (MSSA) strains were shown by PFGE and MLST typing (ST121, ST681, ST837) to be part of a nosocomial outbreak caused by clonal complex (CC) 121. PFGE, MLST and SCCmec typing revealed three MRSA clones. Sequence type (ST) 239-III (n=11), ST1097-III (n=1) and ST8-IV (n=3) belong to CC8 of epidemic multiresistant MRSA, whereas ST426-MRSA-IV/CC395 (n=1) has not been reported previously. All MRSA strains were PVL negative. The overall results underline the necessity of microbiological sampling, antimicrobial susceptibility testing, and epidemiological typing as a rational basis for antimicrobial treatment of S. aureus infections, and infection control measures to limit the spread of multiresistant MRSA and epidemic MSSA clones.

Objectives: To characterise comprehensively the antibiotic susceptibility of Neisseria gonorrhoeae in Arkhangelsk, Russia, and to investigate whether the recommended treatment guidelines are updated and effective. Methods: The susceptibility of N gonorrhoeae isolates, cultured during June-November 2004 mainly from consecutive patients with gonorrhoea (n = 76) in Arkhangelsk, to penicillin G, ampicillin, cefixime, ceftriaxone, ciprofloxacin, erythromycin, azithromycin, kanamycin, spectinomycin and tetracycline was analysed using Etest. Nitrocefin discs were used for b-lactamase detection. Results: The levels of intermediate susceptibility and resistance to the different antibiotics were as follows: penicillin G 76%, ampicillin 71%, cefixime 0%, ceftriaxone 3%, ciprofloxacin 17%, erythromycin 54%, azithromycin 14%, kanamycin 49%, spectinomycin 0% and tetracycline 92%. Of the isolates 55 (72%) were determined as multiresistant-that is, they showed intermediate susceptibility or resistance to three or more classes of antibiotics. However, none of the isolates were b-lactamase producing. Conclusions: In Arkhangelsk, and presumably in many other areas of Russia, penicillins, ciprofloxacin, erythromycin, azithromycin, kanamycin and tetracycline should not be used in the treatment of gonorrhoea if the results of antibiotic susceptibility testing are not available. In Russia, optimised, standardised and qualityassured antibiotic susceptibility testing needs to be established in many laboratories. Subsequently, continuous local, regional and national surveillance of antibiotic susceptibility is crucial to detect the emergence of new resistance, monitor changing patterns of susceptibility and be able to update treatment recommendations on a regular basis.A s a result of the break-up of the Soviet Union, during the past decade, Russia and the other newly independent states have gone through major changes, which have considerably influenced the healthcare system too. Regarding the incidence of gonorrhoea, reliable figures are still lacking mainly because of suboptimal diagnostics, incomplete epidemiological surveillance and reporting of new cases, as well as self-medication.1 Furthermore, the prevalence of antibiotic resistance of Neisseria gonorrhoeae is unknown in most Russian areas, and this knowledge is crucial for empirical treatment. Owing to the worldwide rapid increase of antibiotic resistance, empirical treatment strategies need constant re-evaluation, 2 and antibiotic susceptibility testing is the main tool for updating them.3 Consequently, it is also essential to monitor the level of antibiotic resistance of N gonorrhoeae in Russia.1 4 As in most of the east European countries, it is crucial to establish local, regional and national antibiotic resistance networks and, in addition, monitor antibiotic consumption in Russia.5 During the 1990s, controlled, centralised provision of antibiotics and/or antibiotic resistant surveillance ended and the consumption of antibiotics increased markedly in Russia. 6The Arkhangels...