Antimicrobial susceptibilities of Neisseria gonorrhoeae in Kigali, Rwanda, and trends of resistance between 1986 and 2000

BACKGROUND: Plasmid-mediated and chromosomal-mediated resistance of Neisseria gonorrhoeae to penicillin, tetracycline, thiamphenicol, and trimethoprim-sulfamethoxazole has spread dramatically in Africa. Monitoring of antimicrobial susceptibility is a key element in the control of sexually transmitted diseases. GOAL: To document antimicrobial susceptibilities of gonococci isolated during the past 15 years in Kigali, Rwanda. STUDY DESIGN: Minimal inhibitory concentrations of recently collected gonococcal isolates of eight antimicrobials were determined. The results were compared with data collected for isolates obtained since 1986. RESULTS: In 1986, 35% of the gonococcal isolates were penicillinase-producing N gonorrhoeae. Tetracycline-resistant N gonorrhoeae appeared in 1989. The prevalence of penicillinase-producing N gonorrhoeae and tetracycline-resistant N gonorrhoeae increased significantly to 70.5% and 89.2%, respectively. Chromosomal resistance to penicillin, tetracycline, and thiamphenicol increased temporarily, then decreased significantly. Chromosomal resistance to trimethoprim-sulfamethoxazole appeared in 1988 and increased to 21.6%. All the isolates were susceptible to ceftriaxone, ciprofloxacin, spectinomycin, and kanamycin. CONCLUSIONS: This study illustrated the rapidly increasing frequencies of penicillinase-producing N gonorrhoeae and tetracycline-resistant N gonorrhoeae. Chromosomal resistance to thiamphenicol and trimethoprim-sulfamethoxazole excludes these drugs as alternative treatment. Programs for antimicrobial susceptibility surveillance of N gonorrhoeae should urgently be established in Africa.     

Auxotypes and antimicrobial susceptibilities of Neisseria gonorrhoeae in black and white patients

Isolates of Neisseria gonorrhoeae from 100 white and 113 black patients attending a venereal disease clinic were examined for their susceptibility to ampicillin, penicillin, tetracycline, and spectinomycin. The isolates were also characterised by gonococcal auxotyping. Gonococcal isolates from black patients were more resistant to the antibiotics than those from white patients, since the former were infected with the more antibiotic-resistant auxotypes (Pro, Zero, and Arg) whereas the latter were infected with the more antibiotic-susceptible auxotypes (AHU and others). These data indicate a preferential infection by sub-populations of Neisseria gonorrhoeae in two racial groups.     

Auxotypes and antimicrobial susceptibilities of Neisseria gonorrhoeae in black and white patients.

Isolates of Neisseria gonorrhoeae from 100 white and 113 black patients attending a venereal disease clinic were examined for their susceptibility to ampicillin, penicillin, tetracycline, and spectinomycin. The isolates were also characterised by gonococcal auxotyping. Gonococcal isolates from black patients were more resistant to the antibiotics than those from white patients, since the former were infected with the more antibiotic-resistant auxotypes (Pro, Zero, and Arg) whereas the latter were infected with the more antibiotic-susceptible auxotypes (AHU and others). These data indicate a preferential infection by sub-populations of Neisseria gonorrhoeae in two racial groups.     

In vitro antimicrobial sensitivity of Neisseria gonorrhoeae from Rwanda.

The in vitro sensitivity of 104 isolates of Neisseria gonorrhoeae to six antimicrobial agents was tested. More than 50% of the isolates produced penicillinase. Of those that did not produce penicillinase, 26% were resistant (minimum inhibitory concentration (MIC)) greater than or equal to 0.5 mg/l), and 68% showed a decreased sensitivity for penicillin G (0.06 less than or equal to MIC less than or equal to 0.25 mg/l). Twenty six per cent and 50% of the strains, respectively, showed a decreased sensitivity to thiamphenicol (MIC greater than or equal to 1 mg/l) and tetracycline (MIC greater than or equal to 2 mg/l). All isolates were sensitive to spectinomycin, kanamycin, and norfloxacin. Of 20 penicillinase producing N gonorrhoeae (PPNG) isolates examined, seven contained the 3.4 megadalton R-plasmid, another seven contained both the 3.4 megadalton and 22.5 megadalton plasmids, five the 4.3 megadalton and 22.5 megadalton plasmids, and one isolate harboured both the 3.4 and 4.3 R-plasmids, together with the 22.5 megadalton plasmid. A disturbing increase in resistance to penicillin has been observed since the publication of earlier surveys, and the clinical implications of these findings are discussed.     

Antibiotic resistance, plasmid profile, auxotypes and serovars of Neisseria gonorrhoeae strains isolated in Sevilla (Spain).

The antibiotics resistance pattern, the plasmid profile, the auxotypes and serotypes of 116 Neisseria gonorrhoeae clinical isolates obtained in one year were examined. The incidence of penicillinase producing (PPNG) strains was 12% (14 strains). The most frequent plasmid pattern was the combination of 4.5, 2.6 and 24.5 MDa plasmids. The conjugative plasmid of 24.5 MDa showed a high prevalence (32% of the total strains), and almost all the PPNG strains harboured this plasmid. The strains with the 4.5 MDa plasmid belonged to the auxotypes Pro-, Zero and Pro-Hyx-Ura-, whereas that with the 3.2 MDa plasmid was of auxotype Pro-Hyx-His-. The serotypes Aedih/Arst (WI serogroup) and Bak/Bropt, Back/Bropyt and Bak/Bropyt (WII/III serogroup) were predominant.     

Auxotypes of Neisseria gonorrhoeae isolated from heterosexual men, homosexual men, and heterosexual women

During 1979-1984 we auxotyped 1822 strains of Neisseria gonorrhoeae and recorded the site of isolation and sexual orientation of the patients. Auxotypes were determined by the growth requirements of strains for proline (Pro-), uracil (Ura-), hypoxanthine (Hyx-), citrulline (Cit-), or citrulline replaceable by ornithine (Orn-). Of all isolates from homosexual men, 96% belonged to three auxotypes: nonrequiring (NR), Pro-, or Orn-, and only 1.5% belonged to the Pro-, Cit-, Ura- and Orn-, Ura-, Hyx- auxotypes. Of the isolates from women, 49.9% belonged to these latter two auxotypes. Of the strains isolated from male homosexuals, 19.5% were resistant to 1.0 microgram of erythromycin/ml, whereas only 9.6% of strains from other men and 2.6% of strains from women were resistant to this concentration. We suggest that strains of N. gonorrhoeae infecting homosexual men tend to be less demanding in their nutritional requirements and more resistant to erythromycin than strains infecting heterosexual men and women.     

Trends of chromosomally mediated antimicrobial resistance in Neisseria gonorrhoeae in Canada: 1994-1999

BACKGROUND AND OBJECTIVES: We monitored the trends of chromosomally mediated resistant Neisseria gonorrhoeae (CMRNG) in Canada. Chromosomally resistant N. gonorrhoeae (CMRNG) were defined as having resistance to 3 antibiotics: penicillin (minimum inhibitory concentration [MIC] > or =2.0 mg/L), tetracycline (MIC > or =2.0 mg/L and < or =8.0 mg/L), and erythromycin (MIC > or =2.0 mg/L). GOAL: The goal was to provide surveillance data for public health interventions for the control of gonococcal infections. STUDY DESIGN: Antibiotic susceptibility tests were performed on N. gonorrhoeae isolates obtained from 1994 to 1999 in Canada. Strains were further characterized by auxotype (A), serovar (S), and plasmid profile (P). RESULTS: Between 1994 and 1999, 19.2% of strains were CMRNG, 12.9% had a combined resistance to tetracycline and erythromycin, and 4.7% were resistant to tetracycline. The incidence of ciprofloxacin resistance and azithromycin resistance was 2.3% and 0.8%, respectively. CONCLUSION: This survey of N. gonorrhoeae provides strain characterization data and temporal trends of strains in the Canadian population. CMRNG strains are on the rise, and the continual monitoring and characterization of these strains is important for the evaluation of current recommended antibiotic therapies used in Canada.     

587株淋球菌对青霉素等7种抗生素耐药观察

目的:对2016-2018年我院分离的587株淋球菌对青霉素等7种抗生素的耐药性监测结果进行分析,了解本地区淋球菌的耐药状况。方法:对2016年1月-2018年12月分离的587株淋球菌,采用微量肉汤稀释法测定对青霉素、环丙沙星、四环素、大观霉素、阿奇霉素、头孢克肟和头孢曲松的最低抑菌浓度(MIC),并采用纸片酸度法测定产β-内酰胺酶淋球菌(PPNG)菌株,判断标准按WHO西太区淋球菌耐药性监测统一标准。结果:587株淋球菌中,共检出PPNG 226株,占38.5%(226/587);TRNG 218株,占37.1%(218/587)。三年间PPNG(2=3.51,P>0.05)和TRNG(2=3.26,P>0.05)的流行率均无统计学差异。青霉素、环丙沙星、四环素、阿奇霉素的耐药率分别为73.8%、99.7%、95.6%、17.9%,未发现头孢曲松、头孢克肟和大观霉素耐药株,但头孢曲松和头孢克肟的低敏率分别为6.5%和9.9%。结论:587株淋球菌对青霉素、环丙沙星、四环素耐药状况严重,但对头孢曲松、头孢克肟、大观霉素敏感性较高。对淋球菌进行持续耐药监测,有助于了解流行菌株的耐药情况,为临床经验用药和合理用药提供依据。     

Antimicrobial resistance patterns (1999-2002) and characterization of ciprofloxacin-resistant Neisseria gonorrhoeae in Korea

BACKGROUND: Antimicrobial susceptibilities of Neisseria gonorrhoeae were monitored during 4 years. In Korea, ciprofloxacin-resistant N. gonorrhoeae has dramatically increased after recommendation as a therapeutic drug. GOAL: The goal of this study was to determine the resistance patterns and characterize Korean ciprofloxacin-resistant N. gonorrhoeae. STUDY DESIGN: Antimicrobial susceptibilities were performed. PFGE profile and DNA sequencing of gyrA and parC genes were used to characterize the ciprofloxacin-resistant isolates in Korea. RESULTS: Tetracycline, ofloxacin, ciprofloxacin-resistant isolates were increased and among them, the proportion of isolates resistant to ciprofloxacin increased remarkably from 1% in 1999 to 48.8% in 2002. Fifteen different types by PFGE profile were identified. Major alteration type was M12 (67%), which have amino acid substitution in gyrA (S-91-->F, D-95-->G) and parC (S-87-->A). CONCLUSION: We could conclude that resistance for ciprofloxacin was remarkably increased during 4 years. Ciprofloxacin-resistant N. gonorrhoeae was supposed by the spread of several strains that had a small number of origins.     

Surveillance of antimicrobial susceptibilities in Neisseria gonorrhoeae in Nanjing, China, 1999-2006

OBJECTIVE: To monitor the frequency and types of antibiotic resistance of Neisseria gonorrhoeae in Nanjing, China, between 1999 and 2006. METHODS: beta-Lactamase production was determined by paper acidometric testing. Minimum inhibitory concentrations (MICs) to penicillin, ceftriaxone, tetracycline, ciprofloxacin, and spectinomycin were determined by agar plate dilution. Plasmid types were determined for TRNG and PPNG isolates by PCR. RESULTS: One-thousand two-hundred and eight N. gonorrhoeae isolates were examined. The rate of PPNG rose from 8.0% (9 of 112) in 1999 to 57.36% (113 of 197) in 2004, and declined to 44.44% (88 of 198) in 2006. Prevalence of TRNG increased from 1.8% (2 of 112) in 1999 to 32.82% (65 of 198) in 2006. 99.23% (258 of 260) of TRNG contained the Dutch-type tetM gene and 2 strains contained the American-type tetM gene. All PPNG examined contained the Asian type plasmid. Among non-PPNG, chromosomally mediated resistance to penicillin varied from 57.84% (59 of 102) to 87.80% (72 of 82). Chromosomal resistance to ciprofloxacin (QRNG) was detected in 83.93% (94 of 112) of the strains in 1999 and 98.99% (196 of 198) in 2006. Eight spectinomycin-resistant N. gonorrhoeae strains were detected between 2001 and 2006. None of the gonococcal isolates tested was resistant to ceftriaxone but decreased susceptibility was observed in some strains. CONCLUSIONS: Among N. gonorrhoeae strains isolated in Nanjing, China, plasmid mediated resistance including PPNG and TRNG increased significantly between 1999 and 2006. Chromosomally mediated resistance to both penicillin and ciprofloxacin was also high during this period. Spectinomycin resistance of N. gonorrhoeae was sporadic. Ceftriaxone and spectinomycin can be considered effective antimicrobial agents for the treatment of gonorrhea in Nanjing at the present time.     

1999-2006年南京地区淋球菌对环丙沙星耐药现状的分析

目的 了解南京地区1999-2006年淋球菌对环丙沙星的耐药现状.方法 对1999-2006年在南京地区性病门诊患者中分离到的1208株淋球菌,采用琼脂稀释法测定环丙沙星的最小抑菌浓度(MIC).结果 对环丙沙星耐药(MIC 1mg/L)的淋球菌率由1999年的83.93%(94/112)上升至2006年的98.99%(196/198),平均总耐药率为96.61%(1167/1208).其中环丙沙星高度耐药(MIC≥4mg/L)的淋球菌比率达71.61%(865/1208).结论 南京地区流行的淋球菌对环丙沙星的耐药情况极其严重.     

Trends in resistance of Neisseria gonorrhoeae to antimicrobial agents in the United States

Resistance of Neisseria gonorrhoeae to antimicrobial agents is increasing in the United States. The number of cases of gonorrhea caused by beta-lactamase-producing strains of N. gonorrhoeae (PPNG) increased for the second consecutive year, and 16,608 were reported in 1986; these accounted for greater than 1.6% of all cases of gonorrhea. PPNG is endemic in Florida, New York City, and Los Angeles, and these areas may serve as foci for spread of PPNG strains in the United States. In 1985 N. gonorrhoeae strains that exhibited high-level resistance to tetracycline (TRNG; MIC, greater than or equal to 16.0 micrograms/ml) were reported. Tetracycline resistance was due to the tetM determinant in a 25.2-MDa tetM-conjugative plasmid. The prevalence of TRNG infections was greater than 4% in at least two communities. Strains with chromosomally-mediated resistance to several antimicrobial agents have been isolated more often; 399 cases were reported during the first half of 1986. Spectinomycin-resistant strains have been isolated in several cities, and strains with decreased susceptibility to ceftriaxone have been isolated. Phenotypic characterizations of strains of N. gonorrhoeae by auxotype and serovar, plasmid content, and antibiograms have permitted more detailed study of the heterogeneity and dynamics of strain populations. Characterization of outbreaks caused by resistant strains and surveillance of regional and temporal changes in antimicrobial resistance in gonococcal strain populations may be used in design of innovative strategies for gonorrhea control and for making anticipatory changes in recommended therapies for gonorrhea.     

Auxotypes and sensitivity to 6 antibiotics of strains of Neisseria gonorrhoeae isolated at Strasbourg in 1977-1978 (author's transl)]

We have studied 386 strains of Neisseria gonorrhoeae isolated in our laboratory from July 1977 to October 1978, with the Catlin's auxotyping method. The distribution of the four main auxotypes, i. e. (+), (PRO-), (ARG-), (ARG-, HYX-, URA-), is different from those reported by others (in U. S. A. and Sweden). In Strasbourg, the auxotype (+) is prevalent. We have noticed some differences among classes of population. For example (ARG-) and (ARG-, HYX-, URA-) are scarcely isolated from prostitutes and we have found less (ARG-) strains in women than in men. The determination of the minimum inhibitory concentration of 6 antibiotics has shown there was no differences between the auxotypes except for the (ARG-, HYX-, URA-) strains which are more susceptible to all the antibiotics, but spectinomycin. Since August 1978, we have also noticed an increasing of the resistance which is mainly due to (PRO-) strains.     

Auxotypes and serogroups of penicillinase producing and non-producing strains of Neisseria gonorrhoeae isolated in Franceville, Gabon.

The auxotypes and serogroups of 250 consecutive isolates of Neisseria gonorrhoeae from Franceville, Gabon, including 33 penicillinase producing (PPNG) strains, were identified and the results tabulated for four periods. The PPNG and certain non-PPNG strains were isolated in clusters against a relatively stable pattern of non-PPNG biotypes. Most of the non-PPNG strains were non-requiring or proline requiring strains of serogroup WII or non-requiring strains that could not be grouped with commercially available antisera. No strain requiring arginine, hypoxanthine, and uracil was observed. The PPNG strains were all serogroup WI or ungroupable and non-requiring or proline or arginine dependent auxotypes. Only one non-PPNG strain required proline or arginine and was not serogroup WII.     

南京地区1999-2006年淋球菌青霉素耐药性及耐药质粒基因型研究

目的了解南京地区淋球菌青霉素耐药状况及产青霉素酶淋球菌的质粒基因型的流行情况。方法采用琼脂稀释法检测淋球菌对青霉素的最小抑菌浓度采用纸片酸度定量法检测菌株是否产青霉素酶。采用单管PCR方法对产青霉素酶淋球菌耐药质粒进行基因分型。结果8年间共检测1208株淋球菌，青霉素总耐药率为84．02％（1015／1208）。非产青霉素酶淋球菌中，染色体介导的耐青霉素淋球菌占74．02％（550/743）。产青霉素酶淋球菌占38．49％（465／1208），其中177（38．06％）株同时为质粒介导的耐四环素淋球菌即质粒介导的高度耐四环素淋球菌。产青霉素酶淋球菌阳性率自1999（8．04％）年起逐年增加，至2004年达最高（57．36％），2005、2006年略有下降。质粒PCR分型显示，所测菌株均携带亚洲型质粒。结论南京地区耐青霉素淋球菌始终维持在较高水平，产青霉素酶淋球菌近年增加较快，携带亚洲型质粒的产青霉素酶淋球菌在南京地区流行，未发现其他类型的质粒。     

威海地区抗淋球菌药物敏感性研究

目的:研究威海地区淋病奈瑟菌(简称淋球菌)对抗菌药物的敏感性。方法:用淋球菌快速定量检测法,检测82株淋球菌对15种抗菌药物的体外药物敏感度,同时应用纸片扩散法(Kirby-Bauer法)进行对照。结果:82株淋球菌中检出11株PPNG菌株(13.41%)。耐青霉素的淋球菌耐药性已达62.2%。用纸片法测得四环素、青霉素和红霉素的耐药率分别为58.5%、52.4%和92.1%。1.2%的菌株耐大观霉素(MIC≥64μg/mL),但所有菌株均对头孢曲松敏感。对环丙沙星的耐药率为74.4%(MIC≥1μg/mL),对头孢噻甲羧肟及头孢呋肟的耐药率均为11.0%(MIC≥32μg/mL)。结论:头孢曲松及大观霉素对淋球菌抗菌活性最强,可作为首选药。