Increasing Incidence of High-Level Tetracycline-Resistant<i>Neisseria gonorrhoeae</i>due to Clonal Spread and Foreign Import

Lee, Hyukmin; Kim, Hyunsoo; Kim, Hyo Jin; Suh, Young Hee; Yong, Dongeun; Jeong, Seok Hoon; Lee, Kyung-Won; Chong, Yunsop

doi:10.3349/ymj.2016.57.2.350

Cited by 3 publications

(2 citation statements)

References 25 publications

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“…In contrast to syphilis, N. gonorrhea actively exchanges antibiotic resistance through plasmids, which are the means of genetic transmission. Therefore, tetracycline-resistant strains have also increased in Korea recently, which is a problematic issue [234]. Although gonorrhea was once the most common STI, it has been on a decreasing trend since 2003.…”

Section: Clinical Manifestation Of the Diseases In Koreamentioning

confidence: 99%

History of Syphilis and Gonorrhea in Korea

2019

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In Korea, systematic management of sexually transmitted infections (STIs), including syphilis and gonorrhea, began only after the end of the Korean War. Since the enactment of the Law on Prevention of Communicable Diseases of 1954, STI has been managed and regularly monitored in high risk group. However, the major turning point was the implementation of the Special Law on Prostitution, which was enacted in September 2004. The national policy on STI management had also changed from management of core groups by mandatory to voluntary examinations and treatment of patients by health examinations. The national surveillance system for STI was introduced in 2000 by the revision of the Prevention of Communicable Diseases Act of 1999. The incidence of STI had increased in the 1960s, but began to decline at the 1970s. In the 21st century, the incidence of STI has been increasing again. Currently, more thorough methods of STI management are needed in Korea.

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Section: Clinical Manifestation Of the Diseases In Koreamentioning

confidence: 99%

History of Syphilis and Gonorrhea in Korea

2019

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“…2 ). However, the other genetically dispersed TEM-135 PPNG isolates were also highly susceptible to ceftriaxone and cefixime, which may suggest that TEM-135 PPNG isolates originated in a low ceftriaxone selective pressure environment (similar to tetracycline-resistant N. gonorrhoeae [TRNG] that has increased recently in Korea [ 18 ]), compared with TEM-1 PPNG, which is less susceptible to ceftriaxone and cefixime.…”

Section: Discussionmentioning

confidence: 99%

Recent Increase in the Incidence of TEM-135 β-Lactamase-harboring Neisseria gonorrhoeae in Korea

et al. 2018

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BackgroundWe investigated the molecular epidemiological characteristics and antimicrobial susceptibility pattern of penicillinase-producing Neisseria gonorrhoeae (PPNG) isolates to monitor the change in distribution of blaTEM in Korea.MethodsWe collected 804 PPNG isolates from diverse hospitals and clinics mainly located in Seoul, Korea, over a period of 11 years (2005–2015). Isolate susceptibility to seven antimicrobials was determined using the agar dilution test. The molecular epidemiological characteristics of the isolates were determined by Sanger sequencing of blaTEM, N. gonorrhoeae multiantigen sequence typing (NG-MAST) and plasmid typing.ResultsAmong 72 fully sequenced PPNG isolates, sixteen (22.2%) possessed TEM-135. All TEM-135 isolates had a common silent mutation (c.18C>T), which was previously unreported. We observed a pattern of continuous increase in the number of TEM-135 isolates since 2012. The median and 90% minimum inhibitory concentration of azithromycin were substantially lower in the TEM-135 group than in the non-PPNG and TEM-1 groups. All TEM-135 isolates showed different NG-MAST types and predominantly harbored Toronto/Rio (75%) plasmids. A comprehensive comparative analysis of PPNG with TEM-135 according to NG-MAST, plasmid type, and year of isolation revealed a wide distribution.ConclusionsThe proportion of TEM-135 PPNG has continuously increased since 2012, in association with clonal spread. The difference at position 18 of the TEM-135 sequence can be interpreted as the existence of multiple clonal complexes. The possibility that TEM-135 was acquired via foreign plasmids requires careful follow-up and continuous monitoring of TEM-135 to ascertain whether it constitutes a step towards evolutionary change.

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Systematic review and survey of Neisseria gonorrhoeae ceftriaxone and azithromycin susceptibility data in the Asia Pacific, 2011 to 2016

et al. 2019

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Background Antimicrobial resistance in Neisseria gonorrhoeae is a global concern, with the ongoing emergence of ceftriaxone and azithromycin resistance threatening current treatment paradigms. To monitor the emergence of antimicrobial resistance in N . gonorrhoeae , the World Health Organization (WHO) Gonococcal Antimicrobial Surveillance Programme (GASP) has operated in the Western Pacific and South East Asian regions since 1992. The true burden of antimicrobial resistance remains unknown. In response, the objective of this study was to survey ceftriaxone and azithromycin susceptibility in N . gonorrhoeae across the western Pacific and south-east Asia, and interlink this data with systematically reviewed reports of ceftriaxone and azithromycin resistance. Methods and findings The WHO Collaborating Centre for Sexually Transmitted Infections and Antimicrobial Resistance, Sydney, coordinated annual surveys of gonococcal susceptibilities with participating laboratories, and additionally undertook a systematic review of reports detailing gonococcal ceftriaxone and azithromycin susceptibility data for locations geographically in the Asia Pacific from 2011 to 2016. It was found that surveillance of gonococcal antimicrobial resistance remains limited in the Asia Pacific, with weaker surveillance of azithromycin versus ceftriaxone. Ninety-three published reports were identified (including national reports) which documented susceptibility data for ceftriaxone and azithromycin. GASP survey data was available for 21 countries, territories or areas, and suggested MICs are increasing for ceftriaxone and azithromycin. Between 2011 and 2016, the percentage of locations reporting >5% of gonococcal isolates with MICs to ceftriaxone meeting WHO’s definition of decreased susceptibility (MIC ≥ 0.125 mg/L) increased from 14.3% to 35.3% and the percentage of locations reporting >5% of gonococcal isolates with azithromycin resistance (MIC ≥ 1 mg/L) increased from 14.3% to 38.9%. Published reports were available for several countries that did not provide GASP surveillance responses for ceftriaxone (n = 5) and azithromycin (n = 3) respectively. Over the study period, there was a 183% increase in the number of countries providing surveillance data for GASP for both ceftriaxone and azithromycin, and a 30.6% increase in ceftriaxone MIC testing across the Asia Pacific facilitated by this project. Conclusion This study provides the first comprehensive illustration of increasing MICs to ceftriaxone in the Asia Pacific. The survey and literature review additionally detail increasing resistance to azithromycin. Further surveillance system strengthening is required to monitor these trends in order to address and curb gonococcal AMR in the region.

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Increasing Incidence of High-Level Tetracycline-ResistantNeisseria gonorrhoeaedue to Clonal Spread and Foreign Import

Cited by 3 publications

References 25 publications

History of Syphilis and Gonorrhea in Korea

History of Syphilis and Gonorrhea in Korea

Recent Increase in the Incidence of TEM-135 β-Lactamase-harboring Neisseria gonorrhoeae in Korea

Systematic review and survey of Neisseria gonorrhoeae ceftriaxone and azithromycin susceptibility data in the Asia Pacific, 2011 to 2016

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