Emergence of High Level Azithromycin-Resistant Neisseria gonorrhoeae Strain Isolated in Argentina

Galarza, Patricia; Alcalá, Belén; Salcedo, Celia; Canigia, Liliana Fernández; Buscemi, Luis; Pagano, Irene; Oviedo, Claudia; Vázquez, Julio

doi:10.1097/olq.0b013e3181b61bb1

Cited by 69 publications

(53 citation statements)

References 12 publications

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“…These findings are consistent with those of other regions of Argentina and other countries (Galarza, 2009;Palmer, 2008;Starnino, 2009, Chisholm, 2010 and point to the emergence of high-level resistance to azithromycin, it has impact public health and would limit the drug as a treatment option for gonorrhea.…”

Section: Wwwintechopencomsupporting

confidence: 80%

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Gonorrhea in Men Sex Men and Heterosexual Men

Famiglietti¹,

García²

2012

Sexually Transmitted Infections

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Section: Wwwintechopencomsupporting

confidence: 80%

“…Recently, in several countries are emerging of high-level resistance to azithromycin strains (Galarza 2009;Palmer, 2008;Chisholm, 2009;Starnino, 2009). …”

Section: Neisseria Gonorrhoeae: Antimicrobial Resistance and Clinic Imentioning

confidence: 99%

Gonorrhea in Men Sex Men and Heterosexual Men

Famiglietti¹,

García²

2012

Sexually Transmitted Infections

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“…Sporadic infections with highly azithromycin-resistant N. gonorrhoeae isolates have been reported since 2001 in Argentina [7], in Scotland (2004) [8], in Wales (2007) [9], in Italy (2007) [10], in the United States (2011) [11] and in Sweden in 2013 [12]. Here we described the first isolate identified and presumably acquired in France.…”

Section: Discussionmentioning

confidence: 92%

“…Here we described the first isolate identified and presumably acquired in France. In previous publications [7,9,11,12], high-level azithromycin resistance was shown to result from the accumulation of mutations in the four rrl alleles at positions 2143 (G instead of A) or 2599 (T instead of C) in the domain V of the 23S rRNA involved in the binding site of azithromycin (NG numbering). In this report, our isolate harboured the C2599T mutation in the four rrl alleles.…”

Section: Discussionmentioning

confidence: 99%

High-level azithromycin-resistant Neisseria gonorrhoeae clinical isolate in France, March 2014

et al. 2014

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We report the first case in France of a high-level azithromycin-resistant Neisseria gonorrhoeae (minimum inhibitory concentration (MIC) = 96 mg/L) assigned to MLST7363 (NG-MAST ST6360), also resistant to ciprofloxacin and tetracycline but susceptible to ceftriaxone. The patient was a 51 year-old heterosexual man who returned following 1g azithromycin monotherapy. Mechanisms of azithromycin resistance were a C2599T mutation in the four copies of the rrl gene and a novel mutation in the promoter of the mtrR gene.The surveillance of Neisseria gonorrhoeae (NG) susceptibility to antibiotics in France is based on a voluntary sentinel network of laboratories [1]. In March 2014, the first NG strain showing a high level of azithromycin resistance was isolated from the urine of a 51 year-old man living in the south of France. He had a history of a Chlamydia trachomatis infection 20 years ago. The patient was heterosexual and declared having sex with only two regular female partners (last sexual contact four and ten days before symptoms). Case descriptionAt the first visit, the patient presented with mild symptoms of urethritis. He was in good general state of health and his HIV test was negative. No microbiological analyses were performed and the patient was treated empirically with a single dose of azithromycin (1 g orally) for suspected C. trachomatis infection. The patient presented again with persisting symptoms 48 hours later. At that time, he was treated empirically with a single dose of spectinomycin (2 g intramuscularly) and bacteriological examination was performed with direct microscopic examination and culture. Culture results indicated the presence of an azithromycin-resistant NG isolate. The absence of C. trachomatis infection was determined retrospectively by negative nucleic acid amplification test. At a third visit, one week later the patient was successfully cured and free of clinical symptoms.In France, the first-line treatment of uncomplicated urogenital gonorrhoea is ceftriaxone (500 mg intramuscularly), whereas spectinomycin is used in cases of contraindication to beta-lactams. For our patient, the clinician chose spectinomycin because of his own prescribing practices. Infection with the azithromycinresistant-strain was presumably acquired in France since neither the patient nor his sexual contacts had travelled in the past six months or had other known sexual contacts. In addition, they had not received any antibiotic treatment in the preceding six months.

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“…Emerging resistance to extended-spectrum cephalosporins (19,29,30), as well as resistance to fluoroquinolone (15,41) and macrolide (8,10,13,23) antibiotics, among gonococcal isolates is an ongoing challenge for the treatment and control of gonorrhea infections. In this study, we have provided insight into the antimicrobial profiles of N. gonorrhoeae isolates collected over a large geographic area using past and present antimicrobial agents recommended for gonococcal treatment (5,6).…”

Section: Discussionmentioning

confidence: 99%

Longitudinal Analysis of the Evolution and Dissemination of Neisseria gonorrhoeae Strains (Saskatchewan, Canada, 2005 to 2008) Reveals Three Major Circulating Strains and Convergent Evolution of Ciprofloxacin and Azithromycin Resistance

Vidović¹,

Thakur²,

Horsman

et al. 2012

J Clin Microbiol

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A longitudinal study combining multilocus sequence typing with molecular evolutionary analysis determined the distribution, population structure, and evolution of antibiotic resistance in Neisseria gonorrhoeae isolates in Saskatchewan that were collected between 2005 and 2008. Of 195 gonococcal isolates examined, 29 sequence types (STs) were identified with 3 major circulating strains (ST-1 through ST-3) comprising 52% of all gonococcal isolates studied. The prevalences, persistence, distribution patterns, and clonalities of these isolates strongly suggest that gonorrhea endemicity within this broad geographic region was driven by these 3 circulating strains. ST-1 exhibited a significantly (P ‫؍‬ 0.001) higher prevalence throughout the study than did the others, accounting for ϳ25% of the tested isolates each year. The spatial distributions of the gonococcal strains indicated that ST-1 in 2007 entered a linear component of the sexual network, reaching the remote north and resulting in the further spread and maintenance of infection. Ciprofloxacin and azithromycin resistances were observed in distantly related gonococcal lineages, clearly indicating the convergent acquisition of these antibiotic-resistant phenotypes. In addition, all ciprofloxacinand azithromycin-resistant lineages were found at the edges of the minimum spanning tree, far from the major lineages, suggesting that these antibiotic phenotypes were most likely introduced into the province. In contrast, resistance to penicillin was found mostly in the endemic gonococcal lineages, suggesting that penicillin resistance was probably acquired in Saskatchewan as a result of spontaneous mutations in already-established lineages. Tetracycline resistance was present in all STs except one, indicating its ubiquitous nature in the gonococcal population studied. N eisseria gonorrhoeae, a fastidious Gram-negative diplococcus, is an obligate human pathogen that causes the disease gonorrhea. Complications from the spread of the organism along the mucosal surfaces may result in endometritis, salpingitis, and peritonitis in females (3), which can lead to infertility or ectopic pregnancy (27). In Canada, between 1999 and 2008, the overall rate of gonococcal infection increased by 116.5%, from 17.6 to 38 cases per 100,000 (20). Saskatchewan has had the highest infection rate of all the Canadian provinces, with an increase from 45.2 cases per 100,000 in 2000 to 131.3 cases per 100,000 in 2008, resulting in a 290.4% increase (173.4% above the national average) (20). Antimicrobial resistance in N. gonorrhoeae is a major public health problem, as treatment options are becoming increasingly limited. Recently, N. gonorrhoeae isolates with decreased susceptibilities (MIC Ն 0.25) to third-generation cephalosporins (cefixime and ceftriaxone) have been identified in Japan, Europe, the United States, and Canada (4,15,16,19,29,30). These antibiotics are the last remaining options for treating gonorrhea in a single-dose fashion, a preferred mode of treatment for gonococcal infection...

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Emergence of High Level Azithromycin-Resistant Neisseria gonorrhoeae Strain Isolated in Argentina

Cited by 69 publications

References 12 publications

Gonorrhea in Men Sex Men and Heterosexual Men

Gonorrhea in Men Sex Men and Heterosexual Men

High-level azithromycin-resistant Neisseria gonorrhoeae clinical isolate in France, March 2014

Longitudinal Analysis of the Evolution and Dissemination of Neisseria gonorrhoeae Strains (Saskatchewan, Canada, 2005 to 2008) Reveals Three Major Circulating Strains and Convergent Evolution of Ciprofloxacin and Azithromycin Resistance

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