Antimicrobial-resistant Neisseria gonorrhoeae in Europe in 2020 compared with in 2013 and 2018: a retrospective genomic surveillance study

Golparian, Daniel; Cole, Michelle J; Sánchez-Busó, Leonor; Day, Michaela; Jacobsson, Susanne; Uthayakumaran, Thinushaa; Abad, Raquel; Bercot, Beatrice; Caugant, Dominique A; Heuer, Dagmar; Jansen, Klaus; Pleininger, Sonja; Stefanelli, Paola; Aanensen, David M; Bluemel, Benjamin; Unemo, Magnus; Pleininger, Sonja; Stadlbauer, Silke; Indra, Alexander; De Baetselier, Irith; Vanden Berghe, Wim; Lecompte, Amaryl; Hunjak, Blaženka; Blažić, Tatjana Nemeth; Maikanti-Charalambous, Panayiota; Pieridou, Despo; Zákoucká, Hana; Žemličková, Helena; Hoffmann, Steen; Cowan, Susan; Schwartz, Lasse Jessen; Peetso, Rita; Epstein, Jevgenia; Viktorova, Jelena; Bercot, Beatrice; Bébéar, Cécile; Lot, Florence; Torvikoski, Jukka; Korhonen, Suvi; Buder, Susanne; Jansen, Klaus; Miriagou, Vivi; Siatravani, Eirini; Magaziotou, Ioanna; Paparizou, Eleni; Balla, Eszter; Dudás, Mária; Ásmundsdóttir, Lena Rós; Hauksdóttir, Guðrún Svanborg; Gudnason, Thorolfur; Thordardottir, Marianna; Colgan, Aoife; Crowley, Brendan; Saab, Sinéad; Keane, Maeve; Stefanelli, Paola; Carannante, Anna; Parodi, Patrizia; Pakarna, Gatis; Nikiforova, Raina; Bormane, Antra; Dimina, Elina; Barbara, Christopher; Mifsud, Francesca; Cassar, Robert; Haider, Julie; Van Dam, Alje; Van Benthem, Birgit; Visser, Maartje; Linde, Ineke; Kløvstad, Hilde; Caugant, Dominique; Bergheim, Thea; Młynarczyk-Bonikowska, Beata; Azevedo, Jacinta; Borrego, Maria-José; Nascimento, Marina Lurdes Ramos; Pavlik, Peter; Klavs, Irena; Murnik, Andreja; Kustec, Tanja; Vodičar, Polona Maver; Vázquez Moreno, Julio; Diaz, Asuncion; Abad Torreblanca, Raquel; Velicko, Inga; Unemo, Magnus

doi:10.1016/s2666-5247(23)00370-1

Cited by 6 publications

(10 citation statements)

References 25 publications

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“…The novel strains are WHO H (Austria, 2011; ceftriaxone resistant due to a new penA mutation), 36 WHO Q (UK, 2018; ceftriaxone resistant combined with high-level azithromycin resistance), 24 WHO R (Japan, 2015; FC428, internationally spreading ceftriaxone resistant) 5 , 10 , 19–22 and WHO S2 (Sweden, 2020; internationally spreading azithromycin-resistant strain due to a mosaic MtrRCDE efflux pump). 38 Furthermore, all the superseded WHO reference strains ( n = 14) were characterized. All strains were cultivated as described.…”

Section: Methodsmentioning

confidence: 99%

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The novel 2024 WHO Neisseria gonorrhoeae reference strains for global quality assurance of laboratory investigations and superseded WHO N. gonorrhoeae reference strains—phenotypic, genetic and reference genome characterization

Unemo,

Sánchez-Busó,

Golparian

et al. 2024

Journal of Antimicrobial Chemotherapy

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Objectives MDR and XDR Neisseria gonorrhoeae strains remain major public health concerns internationally, and quality-assured global gonococcal antimicrobial resistance (AMR) surveillance is imperative. The WHO global Gonococcal Antimicrobial Surveillance Programme (GASP) and WHO Enhanced GASP (EGASP), including metadata and WGS, are expanding internationally. We present the phenotypic, genetic and reference genome characteristics of the 2024 WHO gonococcal reference strains (n = 15) for quality assurance worldwide. All superseded WHO gonococcal reference strains (n = 14) were identically characterized. Material and Methods The 2024 WHO reference strains include 11 of the 2016 WHO reference strains, which were further characterized, and four novel strains. The superseded WHO reference strains include 11 WHO reference strains previously unpublished. All strains were characterized phenotypically and genomically (single-molecule PacBio or Oxford Nanopore and Illumina sequencing). Results The 2024 WHO reference strains represent all available susceptible and resistant phenotypes and genotypes for antimicrobials currently and previously used (n = 22), or considered for future use (n = 3) in gonorrhoea treatment. The novel WHO strains include internationally spreading ceftriaxone resistance, ceftriaxone resistance due to new penA mutations, ceftriaxone plus high-level azithromycin resistance and azithromycin resistance due to mosaic MtrRCDE efflux pump. AMR, serogroup, prolyliminopeptidase, genetic AMR determinants, plasmid types, molecular epidemiological types and reference genome characteristics are presented for all strains. Conclusions The 2024 WHO gonococcal reference strains are recommended for internal and external quality assurance in laboratory examinations, especially in the WHO GASP, EGASP and other GASPs, but also in phenotypic and molecular diagnostics, AMR prediction, pharmacodynamics, epidemiology, research and as complete reference genomes in WGS analysis.

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Section: Methodsmentioning

confidence: 99%

“…with Neisseria lactamica -like mosaic 2 mtrR promoter and mtrD sequence. 10 , 37 , 38 The 2024 WHO gonococcal reference strains were characterized in detail phenotypically {e.g. antibiograms [25 antimicrobials] and genetically [e.g.…”

Section: Introductionmentioning

confidence: 99%

The novel 2024 WHO Neisseria gonorrhoeae reference strains for global quality assurance of laboratory investigations and superseded WHO N. gonorrhoeae reference strains—phenotypic, genetic and reference genome characterization

Unemo,

Sánchez-Busó,

Golparian

et al. 2024

Journal of Antimicrobial Chemotherapy

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“…As of 2023, the PubMLST database (accessed on 15 December 2023) contains 1442 molecular sequence types for N. gonorrhoeae . The MLST typing scheme is employed for the analysis of gonococcal populations with a view to epidemiological surveillance [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Mini-Multilocus Sequence Typing Scheme for the Global Population of Neisseria gonorrhoeae

Kandinov,

Shaskolskiy,

Kravtsov

et al. 2024

IJMS

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The increasing problem of antimicrobial resistance in N. gonorrhoeae necessitates the development of molecular typing schemes that are suitable for rapid and mass screening. The objective of this study was to design and validate a mini-MLST scheme for N. gonorrhoeae based on global pathogen population data. Using sequences of seven housekeeping genes of 21,402 isolates with known MLSTs from the PubMLST database, we identified eighteen informative polymorphisms and obtained mini-MLST nucleotide profiles to predict MLSTs of isolates. We proposed a new MLST grouping system for N. gonorrhoeae based on mini-MLST profiles. Phylogenetic analysis revealed that MLST genogroups are a stable characteristic of the N. gonorrhoeae global population. The proposed grouping system has been shown to bring together isolates with similar antimicrobial susceptibility, as demonstrated by the characteristics of major genogroups. Established MLST prediction algorithms based on nucleotide profiles are now publicly available. The mini-MLST scheme was evaluated using a MLST detection/prediction method based on the original hydrogel DNA microarray. The results confirmed a high predictive ability up to the MLST genogroup. The proposed holistic approach to gonococcal population analysis can be used for the continuous surveillance of known and emerging resistant N. gonorrhoeae isolates.

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“…The rate of N. gonorrhoeae infections is the highest recorded since European surveillance of sexually transmitted infections began in 2009 [ 2 ]. Resistance to azithromycin and ciprofloxacin was observed in 35% (7/20) and 50% (10/20) of NG isolates in Poland, respectively [ 3 ]. Furthermore, all of these NG isolates (20/20) were susceptible to ceftriaxone and cefixime [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…Resistance to azithromycin and ciprofloxacin was observed in 35% (7/20) and 50% (10/20) of NG isolates in Poland, respectively [ 3 ]. Furthermore, all of these NG isolates (20/20) were susceptible to ceftriaxone and cefixime [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

HIV-Negative MSM Infected with Two Different Isolates of Drug-Resistant Neisseria gonorrhoeae—Case Report

Biała,

Pencakowski,

Mączyńska

et al. 2024

Pathogens

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The antimicrobial resistance of Neisseria gonorrhoeae (NG) is an increasing public health concern, highlighted by the fact that gonococcus is considered as a ‘high’-priority pathogen by the WHO for research and development of new therapeutic options. According to the data of the European Centre for Disease Prevention and Control (ECDC) in 2022, the rate of NG infections is the highest recorded since European surveillance of sexually transmitted infections began in 2009. We report a brief description of a patient infected with two different isolates of drug-resistant N. gonorrhoeae. N. gonorrhoeae cultures were positive from oropharyngeal and urethral swabs and isolates had different antimicrobial susceptibility. We investigated the antimicrobial susceptibility of these isolates to six antimicrobials (ceftriaxone, cefixime, azithromycin, ciprofloxacin, tetracycline, and benzylpenicillin), and minimum inhibitory concentrations (MICs; mg/L) were determined using Etest on gonococcal isolates. Oropharyngeal isolate was resistant to azithromycin while urethral was resistant to penicillin, ciprofloxacin, and tetracycline. Two different and phylogenetically distinct sequence types of NG isolates were identified. Understanding the dynamics and drivers of resistance spread can provide an improved rationale for antibiotic management, and the level of NG resistance should be monitored closely.

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Antimicrobial-resistant Neisseria gonorrhoeae in Europe in 2020 compared with in 2013 and 2018: a retrospective genomic surveillance study

Cited by 6 publications

References 25 publications

The novel 2024 WHO Neisseria gonorrhoeae reference strains for global quality assurance of laboratory investigations and superseded WHO N. gonorrhoeae reference strains—phenotypic, genetic and reference genome characterization

The novel 2024 WHO Neisseria gonorrhoeae reference strains for global quality assurance of laboratory investigations and superseded WHO N. gonorrhoeae reference strains—phenotypic, genetic and reference genome characterization

Mini-Multilocus Sequence Typing Scheme for the Global Population of Neisseria gonorrhoeae

HIV-Negative MSM Infected with Two Different Isolates of Drug-Resistant Neisseria gonorrhoeae—Case Report

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