Typing of Neisseria gonorrhoeae Isolates in Shenzhen, China, from 2014 to 2018 Reveals the Shift of Genotypes Significantly Associated with Antimicrobial Resistance

Abstract

The growing antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a serious global threat to gonococcal therapy. Molecular typing is an ideal tool to reveal the association between specific genotype and resistance phenotype that provides effective data for tracking the transmission of resistant clones of N. gonorrhoeae. In our study, we aimed to describe the molecular epidemiology of AMR and the distribution of resistance-associated genotypes in Shenzhen during 2014–2018. In total, 909 isolates were collected from Shenzhen from 2014–2018. Two typing schemes, multilocus sequence typing (MLST) and N. gonorrhoeae Sequence Typing for Antimicrobial Resistance (NG-STAR), were performed for all isolates. The distribution of resistance-associated genotypes was described using goeBURST analysis combined with data of logistic regression. Among 909 isolates, ST8123, ST7363, ST1901, ST7365, and ST7360 were most the common MLST sequence types (STs), and ST348, ST2473, ST497, and ST199 were the most prevalent NG-STAR STs. The logistic regression analysis showed that NG-STARST497, MLSTST7365, and MLSTST7360 were typically associated with decreased susceptibility to ceftriaxone. Furthermore, the internationally spreading ESC-resistant clone MLSTST1901 has been prevalent at least in 2014 in Shenzhen and showed a significant increase during 2014–2018. Additionally, MLSTST7363 owns the potential to become the next internationally spreading ceftriaxone-resistant ST. In conclusions, we performed a comprehensive epidemiological study to explore the correlation between AMR and specific STs, which provided important data for future studies of the molecular epidemiology of AMR in N. gonorrhoeae. Besides, these findings provide insight for adjusting surveillance strategies and therapy management in Shenzhen.

Emergence and Characterization of a Ceftriaxone-Resistant Neisseria gonorrhoeae FC428 Clone Evolving Moderate-Level Resistance to Azithromycin in Shenzhen, China

“…1 To date, the MDR N. gonorrhoeae isolates have been reported in Ireland, 2 Denmark, 3 UK 4 and Australia. 5 In China, N. gonorrhoeae isolates with decreased susceptibility or resistance to both CRO and AZM have been reported, [6][7][8] and here in Guangdong Province (South China), we describe a ceftriaxone-resistant N. gonorrhoeae FC428 clone with a higher level of macrolide resistance than previously reported.…”

“…Such variation can be explained by penA -60.001 allele recombined into isolates with certain MLST types associated with CRO decreased susceptibility, and in this case, recombination events happening in MLST ST1600 isolates may contribute to a higher MIC value. According to our previous study, 8 MLST ST7363 is associated with decreased ceftriaxone susceptibility. Moreover, phylogenetic analysis showed that MLST ST7363 isolates (SC18-68) were clustered with MLST ST1600 isolates, and that they share 6 identical loci with each other.…”

Detection of 10 cases of ceftriaxone-resistant Neisseria gonorrhoeae in the United Kingdom, December 2021 to June 2022

“…Within PathogenWatch, there are an additional 12 isolates reported from Vietnam, the UK, Guinea-Bissau and the United States [ 8 ]. However, there are reports of this being the most common ST in Shenzhen, China among isolates collected between 2014 and 2018 [ 11 ]. No WGS data were available from that study.…”

“…The isolate from Case 9, ST1901, is distinct from the other nine cases and is most closely related to a ceftriaxone-resistant isolate from a male from the Asia-Pacific detected in the UK in 2019. Sequence type 1901 is internationally disseminated and has been the prevalent ceftriaxone-resistant clone in Shenzhen, China since 2014 [ 11 ], with high prevalence also reported in South Korea [ 13 ], Argentina [ 14 ] and Japan [ 15 ] and with sporadic reports associated with treatment failures reported across Europe [ 16 - 18 ].…”

Dissemination of Neisseria gonorrhoeae with decreased susceptibility to extended-spectrum cephalosporins in Southern China, 2021: a genome-wide surveillance from 20 cities

“…In particular, ST7363 was most related to cefixime-DS strains, similar to the Japanese study, where 61.3% (46/76) of the cefixime-DS isolates were identified as ST7363 [ 27 ]. ST7363 showed a global spread and may become the next international cephalosporin-resistant clone after ST1903 [ 30 ]. ST7365 was also a common cephalosporin-DS strain, which should cause concern.…”