High Percentages of Resistance to Tetracycline and Penicillin and Reduced Susceptibility to Azithromycin Characterize the Majority of Strain Types of Neisseria gonorrhoeae Isolates in Cuba, 1995???1998

Sosa, Jorge; Ramírez‐Arcos, Sandra; Ruben, Martha; Li, Hui; Llanes, Rafael; Llop, Alina; Dillon, Jo-Anne R.

doi:10.1097/00007435-200305000-00012

Cited by 25 publications

(18 citation statements)

References 31 publications

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“…In Japan, infections caused by strains exhibiting decreased susceptibility to cefixime have failed to respond to therapy with a 200-mg dose of cefixime, which is one-half of the dose recommended in the United (7), and azithromycin is not recommended for use for the primary treatment of uncomplicated gonococcal infections because of the gastrointestinal intolerance of the 2-g dose (9). In addition, isolates with azithromycin MICs exceeding 1.0 g/ml have been isolated in the continental United States and Cuba, which suggests that this agent should not be recommended for use for the primary treatment of gonorrhea (17,24). Our study describes a QRNG outbreak in California that started in 2000 in which the main outbreak isolate was also CMRNG and had azithromycin MICs of 0.5 g/ml.…”

Section: Discussionmentioning

confidence: 94%

Strain Typing and Antimicrobial Resistance of Fluoroquinolone-Resistant Neisseria gonorrhoeae Causing a California Infection Outbreak

Morris

Moore²,

Hannah³

et al. 2009

J Clin Microbiol

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Antimicrobial-resistant Neisseria gonorrhoeae is an emerging public health problem as a result of the alarming limitation in treatment options. We examined an outbreak in California of fluoroquinolone-resistant Neisseria gonorrhoeae (QRNG) by evaluation of a combination of routine isolates from the Gonococcal Isolate Surveillance Project and isolates collected by expanded surveillance performed between April 2000 and June 2002. QRNG isolates were characterized by two methods: (i) determination of a combination of antibiogram, auxotype, serovar, Lip type, and patterns of amino acid alteration in the quinolone resistance-determining region of GyrA and ParC (ASLGP) and (ii) pulsed-field gel electrophoresis (PFGE). Strain typing was used to describe the QRNG outbreak strains and the associated antimicrobial resistance profiles. Among 79 isolates that were completely characterized, we identified 20 different ASLGP strain types, and 2 of the types were considered to belong to outbreak strains that comprised 65% (51/79) of the isolates. By PFGE typing, there were 24 different strain types, and 4 of these were considered outbreak types and comprised 66% (52/79) of the isolates. The overall agreement between the typing methods in distinguishing outbreak strains and nonoutbreak strains was 84% (66/79). The most common QRNG ASLGP strain type had chromosomally mediated resistance to penicillin and tetracycline and an azithromycin MIC of 0.5 g/ml. The occurrence of an outbreak caused by QRNG strains that could fail to be eradicated by most antibiotic classes reinforces the serious problem with antimicrobial resistance in Neisseria gonorrhoeae that the public health system faces. Adherence to a regimen with the recommended antibiotics at the appropriate dose is critical, and monitoring for antimicrobial susceptibility needs to be actively maintained to adapt treatment guidelines appropriately.

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Section: Discussionmentioning

confidence: 94%

Strain Typing and Antimicrobial Resistance of Fluoroquinolone-Resistant Neisseria gonorrhoeae Causing a California Infection Outbreak

Morris

Moore²,

Hannah³

et al. 2009

J Clin Microbiol

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“…A possible alternative, spectinomycin, is not uniformly available. Currently, even in the developing countries, the overwhelming majority of the strains are still susceptible [166,168,169,172,180,182], but resistance, once used extensively, develops easily [183] making the drug an unlikely candidate as the first line treatment. Azithromycin could also be used, but resistance already exists, therefore, it is also unlikely to represent a safe choice in a much feared post-cephalosporin era [164].…”

Section: Neisseria Gonorrhoeaementioning

confidence: 99%

Update on Antibacterial Resistance in Low-Income Countries: Factors Favoring the Emergence of Resistance

Vilà

Pál

2010

TOIDJ

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Antimicrobial resistance has increased drastically in recent years in the developing countries, and it has rapidly become a leading public health concern. The prevalence of antimicrobial resistance varies greatly between and within countries and between different pathogens. However, overall a trend to the increase of the resistance to those antimicrobial agents more often used in these countries has been observed. Several factors can contribute to the rapid emergence and dissemination of antimicrobial resistance. In this paper, the current antimicrobial resistance in different microorganisms from different countries as well as the factors contributing to the emergence and spread of resistance in developing countries will be reviewed.

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“…This initial study is promising, and further work may support the use of azithromycin monotherapy for the treatment of anaerobic PID. However, azithromycin is not an optimal regimen for the treatment of gonococcal PID, as increasing resistance is being reported [74][75][76][77][78][79][80]. Furthermore, although M. genitalium is susceptible to macrolides, azithromycin-resistant strains have recently been identified [49].…”

Section: Resultsmentioning

confidence: 99%

Diagnosis and Treatment of Pelvic Inflammatory Disease

Haggerty

Ness

2008

Womens Health (Lond Engl)

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Pelvic inflammatory disease (PID), the infection and inflammation of the female upper genital tract, is a common cause of infertility, chronic pain and ectopic pregnancy. Diagnosis and management are challenging, largely resulting from varying signs and symptoms and a polymicrobial etiology that is not fully delineated. Owing to the potential for serious sequelae, a low threshold for diagnosis and treatment is recommended. As PID has a multimicrobial etiology, including Neisseria gonorrhoeae, Chlamydial trachomatis and anaerobic and mycoplasmal bacteria, treatment of PID should consist of a broad spectrum antiobiotic regimen. Recent treatment trials have focused on shorter duration regimens, such as azithromycin, and monotherapies including ofloxacin, but data are sparse. Research comparing sequelae development by differing antimicrobial regimens is extremely limited, but will ultimately shape future treatment guidelines.

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High Percentages of Resistance to Tetracycline and Penicillin and Reduced Susceptibility to Azithromycin Characterize the Majority of Strain Types of Neisseria gonorrhoeae Isolates in Cuba, 1995???1998

Cited by 25 publications

References 31 publications

Strain Typing and Antimicrobial Resistance of Fluoroquinolone-Resistant Neisseria gonorrhoeae Causing a California Infection Outbreak

Strain Typing and Antimicrobial Resistance of Fluoroquinolone-Resistant Neisseria gonorrhoeae Causing a California Infection Outbreak

Update on Antibacterial Resistance in Low-Income Countries: Factors Favoring the Emergence of Resistance

Diagnosis and Treatment of Pelvic Inflammatory Disease

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