Cooperative Recognition of Internationally Disseminated Ceftriaxone-Resistant Neisseriagonorrhoeae Strain

Abstract

Ceftriaxone remains a first-line treatment for patients infected by Neisseria gonorrhoeae in most settings. We investigated the possible spread of a ceftriaxone-resistant FC428 N. gonorrhoeae clone in Japan after recent isolation of similar strains in Denmark (GK124) and Canada (47707). We report 2 instances of the FC428 clone in Australia in heterosexual men traveling from Asia. Our bioinformatic analyses included core single-nucleotide variation phylogeny and in silico molecular typing; phylogenetic analysis showed close genetic relatedness among all 5 isolates. Results showed multilocus sequence type 1903; N. gonorrhoeae sequence typing for antimicrobial resistance (NG-STAR) 233; and harboring of mosaic penA allele encoding alterations A311V and T483S (penA-60.001), associated with ceftriaxone resistance. Our results provide further evidence of international transmission of ceftriaxone-resistant N. gonorrhoeae. We recommend increasing awareness of international spread of this drug-resistant strain, strengthening surveillance to include identifying treatment failures and contacts, and strengthening international sharing of data.

Multidrug-resistant Neisseria gonorrhoeae failing treatment with ceftriaxone and doxycycline in France, November 2017

“…F90 differs from the French F89 isolate detected in 2010 [16], however, it is similar to a ceftriaxone-resistant clone initially described in Japan in 2016 (FC428 strain; similar antibiogram and an identical mosaic penA-60.001 allele, MLST 1903 , and NG-STAR 233 ) [14]. The FC428 strain appears to have spread internationally and has been subsequently detected in Australia, Canada and Denmark [20]. In early-2018 the first global strain with ceftriaxone resistance combined with highlevel azithromycin resistance was identified in the UK [21], followed by two similar cases in Australia [22].…”

Structures of glyceraldehyde 3‐phosphate dehydrogenase in Neisseria gonorrhoeae and Chlamydia trachomatis

“…Resistance to nearly all previously and currently recommended antibiotics heightens the need for novel drugs that are effective against these so‐called “superbugs.” Azithromycin, cephalosporin, and fluoroquinolone resistance in Ng have been reported worldwide . Ceftriaxone, the last remaining first‐line antimicrobial treatment against Ng infections, is now under threat with the reported isolation of ceftriaxone‐resistant Ng strains . The repertoire of available drugs to treat resistant Ng is limited.…”

“…11,12 Ceftriaxone, the last remaining first-line antimicrobial treatment against Ng infections, is now under threat with the reported isolation of ceftriaxone-resistant Ng strains. [13][14][15] The repertoire of available drugs to treat resistant Ng is limited. Consequently, the development of new antimicrobials to address and treat these pathogens is an emerging international public health priority.…”

Acute kidney injury caused by systemic Neisseria gonorrhoeae infection after successful kidney transplantation

“…12 In the United States, the development of CTRX resistant N. gonorrhoeae has been reported recently. 13 Currently, in our country, approximately 90%-95% of N. gonorrhoeae strains still possess sensitivity to 0.25-mg/dL MIC of CTRX, according to the literature. 14 We used high-dose long-term CTRX to rescue the patient with a favorable outcome; however, care must be taken to preserve drug sensitivity for N. gonorrhoeae.…”

“…Because some strains have become resistant to several antibiotics, then the Centers for Disease Control and Prevention (CDC) guidelines does not recommend the usage of spectinomycin and quinolones . In the United States, the development of CTRX resistant N. gonorrhoeae has been reported recently . Currently, in our country, approximately 90%‐95% of N. gonorrhoeae strains still possess sensitivity to 0.25‐mg/dL MIC of CTRX, according to the literature .…”