Molecular epidemiological typing within the European Gonococcal Antimicrobial Resistance Surveillance Programme reveals predominance of a multidrug-resistant clone

Abstract

Treatment of gonorrhoea is threatened by antimicrobial resistance, and decreased susceptibility and resistance to recommended therapies is emerging in Europe. Current associations between resistance and molecular type remain poorly understood. Gonococcal isolates (n=1,066) collected for the 2009 and 2010 European Gonococcal Antimicrobial Surveillance Programme were typed by Neisseria gonorrhoeae multi-antigen sequence typing (NG-MAST). A total of 406 sequence types (STs) were identified, 125 of which occurred in ≥two isolates. Seven major genogroups of closely related STs (varying by ≤1% at just one of the two target loci) were defined. Genogroup 1407 (G1407), observed in 20/21 countries and predominant in 13/21 countries, accounted for 23% of all isolates and was associated with decreased susceptibility to cefixime and resistance to ciprofloxacin and raised minimum inhibitory concentrations for ceftriaxone and azithromycin. Genogroup 225 (G225), associated with ciprofloxacin resistance, was observed in 10% of isolates from 19/21 countries. None of the other genogroups were associated with antimicrobial resistance. The predominance of a multidrug-resistant clone (G1407) in Europe is worrying given the recent reports of recommended third generation cephalosporins failing to treat infections with this clone. Identifying associations between ST and antimicrobial resistance aids the understanding of the dissemination of resistant clones within a population and could facilitate development of targeted intervention strategies.

Prevalence of and factors associated with MDR Neisseria gonorrhoeae in England and Wales between 2004 and 2015: analysis of annual cross-sectional surveillance surveys

“…The fact that these elevated ceftriaxone MICs in the MDR isolates were observed in 2014-15 as well as 2011-13 suggests this finding is unlikely to be solely due to the cefixime-resistant ST1407 strains which also have elevated ceftriaxone MICs and were prevalent during 2011-2013. 25 Although the risk factor analysis found MDR-NG was more common among isolates from some groups, including heterosexual men and older patients, absolute differences in prevalence were small, providing little basis for targeted treatment strategies. These findings highlight the importance of continued surveillance and prevention efforts, given the severely limited treatment options available to those with MDR-NG.…”

“…This project seeks to fill this knowledge gap by investigating the prevalence, resistance profile, and risk factors for MDR-NG in England and Wales in order to understand implications for the future treatment of gonorrhoea, and contribute to the scant epidemiological literature on MDR-NG. 7,[22][23][24][25][26][27]…”

Antimicrobial resistance and molecular epidemiological typing of Neisseria gonorrhoeae isolates from Kyrgyzstan in Central Asia, 2012 and 2017

“…Notably, the single isolate resistant to azithromycin (MIC = 6 mg/L) belonged to ST15952 (G5488), while the single isolate resistant to cefixime (MIC = 0.5 mg/L) was assigned as ST15999 (non-groupable). No isolate belonged to the internationally spreading ST1407 [ 28 , 30 , 32 ].…”

Culture-Independent Genotyping Revealed 3 Strain Clusters in a Potential Neisseria gonorrhoeae Outbreak in Young Heterosexuals (<25 Years), the Netherlands, October 2017 to March 2019

“…19 Genogroups were used to ensure robust statistical analysis as proposed by Chisholm et al and because some known sexual contacts do not have identical NG-MAST sequence types. 19,20 Geospatial coordinates (residence) of outbreak cases were extracted using the R-package "nlgeocoder" version 0.1.3. We visualized residence areas of patients, based on their 4-digit postcode, per outbreak cluster in a geographical map using Qgis 2.18.28.…”