Antimicrobial Susceptibilities and Plasmid Contents of Neisseria gonorrhoeae Isolates from Commercial Sex Workers in Dhaka, Bangladesh: Emergence of High-Level Resistance to Ciprofloxacin

Abstract

Commercial sex workers (CSWs) serve as the most important reservoir of sexually transmitted diseases (STD), including gonorrhea. Periodic monitoring of the antimicrobial susceptibility profile ofNeisseria gonorrhoeae in a high-risk population provides essential clues regarding the rapidly changing pattern of antimicrobial susceptibilities. A study concerning the prevalence of gonococcal infection among CSWs was conducted in Bangladesh. The isolates were examined with regards to their antimicrobial susceptibility to, and the MICs of, penicillin, tetracycline, ciprofloxacin, cefuroxime, ceftriaxone, and spectinomycin by disk diffusion and agar dilution methods. The total plasmid profile of the isolates was also analyzed. Of the 224 CSWs, 94 (42%) were culture positive for N. gonorrhoeae. There was a good correlation between the results of the disk diffusion and agar dilution methods. Some 66% of the isolates were resistant to penicillin, and 34% were moderately susceptible to penicillin. Among the resistant isolates, 23.4% were penicillinase-producing N. gonorrhoeae (PPNG). 60.6% of the isolates were resistant and 38.3% were moderately susceptible to tetracycline, 17.5% were tetracycline-resistant N. gonorrhoeae, 11.7% were resistant and 26.6% had reduced susceptibility to ciprofloxacin, 2.1% were resistant and 11.7% had reduced susceptibility to cefuroxime, and 1% were resistant to ceftriaxone. All PPNG isolates contained a 3.2-MDa African type of plasmid, and a 24.2-MDa conjugative plasmid was present in 34.1% of the isolates. Since quinolones such as ciprofloxacin are recommended as the first line of therapy for gonorrhea, the emergence of significant resistance to ciprofloxacin will limit the usefulness of this drug for treatment of gonorrhea in Bangladesh.

Verification of clinical samples, positive in AMPLICOR Neisseria gonorrhoeae polymerase chain reaction, by 16S rRNA and gyrA compared with culture

“…The strain collection from Dhaka, used in studies I, II, IV and V consisted of 25 1 JRQRUUKRHDH strains, highly resistant to ciprofloxacin, with a range of MIC from 4 mg/L to >32 mg/L, and two susceptible strains, isolated from female sex workers in Dhaka in 1997. The strains originated from two studies made by the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B)[49,159].…”

Prevalence of Gonococcal Infection Among the Patients Visiting at Dermatology/Venerology and Gynaecology Department of Tribhuvan University Teaching Hospital

“…It increased over the next 50 years as a large number of antibiotic with different mechanisms of action were introduced, which can be linked to overuse and misuse of antibiotics. 10 The antimicrobial sensitivity test for all isolate showed Ceftriaxone to be 100% effective which is well correlated to the study of Adegbola et al 11 13 Tetracycline resistant N. gonorrhoea (TRNG) isolates are likely to spread more quickly than PPNG. The resistant to penicillin through ß-lactamase production or chromosomal mechanism was wide spread with high level of tetracycline resistant.…”

Multiple sclerosis may be sexually acquired

“…11 Decreased susceptibility to ciprofloxacin and ofloxacin has also been reported from Bangladesh (11.7% were resistant and 26.6% had reduced susceptibility). 9 This widespread emergence of ciprofloxacin resistance in South East Asia is rather alarming.…”

“…3 4 However, the decreased susceptibilities of N gonorrhoeae to fluoroquinolones has recently been reported from a large number of countries. [5][6][7][8][9][10][11][12] Ciprofloxacin, a fluoroquinolone, inhibits DNA replication by targeting DNA gyrase and topoisomerase IV. 13 14 In laboratory mutants of N gonorrhoeae, mutations in the gyrA and gyrB genes of DNA gyrase and in the parC gene of topoisomerase IV, associated with decreased susceptibilities to quinolones, have been identified.…”