Antimicrobial Resistance and Whole Genome Sequencing Analysis of Neisseria gonorrhoeae Isolates in Bulgaria, 2019

Abstract

Neisseria gonorrhoeae is evolving into a superbug with resistance to previously and currently recommended antimicrobials for treatment of gonorrhoea, which creates a significant public health concern globally. Antimicrobial resistance (AMR) poses a great threat; it causes longer duration of illness and treatment, and increases health care costs and the social, psychological and financial burden to families and societies. In response to this worrying situation laboratory research should be strengthened with implementation of newer molecular methods for monitoring and detecting AMR, and evaluation of the correlation of obtained genetic data with corresponding phenotypes.
 This study aimed to implement whole genome sequencing analysis for the first time of N. gonorrhoeae isolates from Bulgaria and to acquire molecular epidemiological and AMR information linked with phenotypic resistance data.
 Although the tested strains were susceptible to current recommended dual therapy, genetic analysis showed the presence of several mutations responsible for reducing susceptibility to third generation cephalosporins, namely the presence of genotype G1407 strains in the Bulgarian population. Regarding previously recommended antimicrobials, penicillin resistance and intermediate sensitivity to tetracyclines was demonstrated in all strains, and fluoroquinolone resistance in two strains.
 The obtained results showed that the use of whole genome sequencing was feasible, could describe current circulating gonococcal strains and predict and infer transmission of antimicrobial resistance. Therefore, gonococcal infections prevention and control programmes will be aided to target interventions where needed and to revise treatment guidelines that will help improve patient care.