Antimicrobial susceptibility of Neisseria gonorrhoeae isolates from three Caribbean countries: Trinidad, Guyana, and St. Vincent

BACKGROUND: The percentage of Neisseria gonorrhoeae isolates resistant to antimicrobial agents commonly used for treatment is unknown in many Caribbean countries. GOAL: To determine the antimicrobial susceptibility of N gonorrhoeae isolates from Trinidad (144 isolates), Guyana (70 isolates), and St. Vincent (68 isolates) so baseline data can be established for further studies, and to assist in establishing effective treatment guidelines. STUDY DESIGN: Consecutive urethral and endocervical specimens from several clinics were collected and identified as N gonorrhoeae. Isolates of N gonorrhoeae were tested for their susceptibility to penicillin, tetracycline, ceftriaxone, ciprofloxacin, spectinomycin, and azithromycin. The presumptive identification of penicillinase-producing N gonorrhoeae and/or tetracycline-resistant N gonorrhoeae isolates based on MIC was confirmed by plasmid and tetM content analysis. RESULTS: High percentages of penicillin and/or tetracycline resistance were observed in N gonorrhoeae isolates from Guyana (92.9%), St. Vincent (44.1%), and Trinidad (42.4%). Isolates from all three countries were susceptible to ceftriaxone, ciprofloxacin, and spectinomycin. One penicillinase-producing N gonorrhoeae/tetracycline-resistant N gonorrhoeae from Guyana had an MIC of 0.5 microg/l to ciprofloxacin. This and nine other isolates from Guyana also were resistant to azithromycin (defined as MIC > or = 2.0 microg/ml) as well as penicillin and tetracycline. A reduced susceptibility to azithromycin was displayed by 16% of the isolates from St. Vincent and 72% of the isolates from Guyana (MIC, 0.25-1.0 microg/ml). Most penicillinase-producing N gonorrhoeae isolates carried Africa-type plasmids (61/90), with 28 of 90 having Toronto-type plasmids and a single isolate carrying an Asia-type plasmid. The tetM determinant in tetracycline-resistant N gonorrhoeae isolates was predominantly of the Dutch type (68/91). CONCLUSIONS: The high prevalence of N gonorrhoeae isolates from 3 of 21 English- and Dutch-speaking Caricom countries in the Caribbean with either plasmid-mediated or chromosomal resistance to penicillin and tetracycline supports international observations that these drugs should not be used to treat gonococcal infections. The detection of isolates with reduced susceptibility to drugs such as azithromycin, which currently are recommended for treatment in the region, attest to the importance of the continued monitoring of gonococcal antimicrobial susceptibility for the maintenance of effective treatment guidelines.     

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.     

Antimicrobial susceptibilities of Neisseria gonorrhoeae strains isolated in Java,Indonesia

BACKGROUND: Despite the rapid spread of antibiotic resistance in gonococci all over Southeast Asia, there is only limited surveillance for antibiotic susceptibility in Indonesia. GOAL: This study was undertaken to determine the frequency and diversity of antimicrobial resistance in gonococcal isolates from cohorts of female commercial sex workers in Bandung and Jakarta, Indonesia, and to characterize the Tet M plasmid among the tetracycline-resistant strains N gonorrhoeae. STUDY DESIGN: The antimicrobial susceptibility of 267 strains (85 strains from Bandung and 182 from Jakarta) to penicillin, spectinomycin, tetracycline, ciprofloxacin, cefotaxime, thiamphenicol, kanamycin, azithromycin, and trimethoprim-sulfamethoxazole (TMP-SMZ) was determined by agar dilution. Typing of the Tet M plasmid in tetracycline-resistant isolates was performed by PCR. RESULTS: Prevalence of penicillin and tetracycline resistance was extremely high: 60.0% of the isolates from Bandung and 70.9% of the isolates from Jakarta were resistant to penicillin. Of these, 60.0% and 62.1%, respectively, were penicillinase-producing N gonorrhoeae (PPNG). All the isolates from Bandung and 98.4% from Jakarta were resistant to tetracycline. All tetracycline-resistant isolates from Bandung and 97.8% from Jakarta carried a PCR fragment characteristic of the "Dutch" type Tet M plasmid. One isolate from Jakarta showed chromosomal resistance to tetracycline (0.6%). Chromosomal resistance to thiamphenicol (MIC, >/=2.0 microg/ml) was significantly higher in Jakarta than in Bandung (P < 0.05). All gonococcal isolates were susceptible to kanamycin, spectinomycin, cefotaxime, ciprofloxacin, and azithromycin. CONCLUSION: Spectinomycin, fluoroquinolones, and azithromycin are still useful primary drugs for treatment of gonococcal infections in Indonesia. Continued surveillance of antimicrobial susceptibility should be part of gonorrhea control in Indonesia.     

Analysis of the antibiotic sensitivity of Neisseria gonorrhoeae in Guangzhou, Peoples Republic of China

BACKGROUND: Sexually transmitted diseases began to re-emerge in China in the mid 1980s. During the last one and a half decades, Neisseria gonorrhoeae infection has become one of the three most common sexually transmitted diseases in China. At present, resistant strains of N. gonorrhoeae are increasing each year. This study was undertaken to better understand the sensitivity of five antibiotics to N. gonorrhoeae isolates in Guangzhou, China. GOAL: To determine the frequency and diversity of antibiotic resistance, particularly to penicillin and tetracycline, on gonococcal strains in Guangzhou. STUDY DESIGN: Strains of N. gonorrhoeae isolates from 203 patients with uncomplicated urethral gonococcal infections from Guangzhou, China were reviewed from September 1997 to August 1998. All strains were characterized with five different antimicrobials for sensitivity, including penicillin, tetracycline, spectinomycin, ciprofloxacin, and ceftriaxone. RESULTS: Penicillin resistance was present in 121 of 203 isolated strains (59.6%). The plasmid-mediated strains and chromosome-mediated strains among the penicillin-resistant strains that were resistance to penicillin were 5.8% and 94.2%, respectively. Plasmid-mediated strains resistant to penicillin and tetracycline were each 3.4%. Most isolated strains were resistant to ciprofloxacin, accounting for 60.6%. All strains were sensitive to spectinomycin and ceftriaxone. CONCLUSION: N. gonorrhoeae isolates exhibited a high rate of resistance to penicillin and ciprofloxacin. Spectinomycin highly effective for penicillin-producing N. gonorrhoeae, tetracycline-resistant N. gonorrhoeae and the highly resistant strains of ciprofloxacin.     

Alarming increase in ciprofloxacin- and penicillin-resistant Neisseria gonorrhoeae isolates in New Delhi,India

BACKGROUND: Resistance of ciprofloxacin has been reported in several regions of the world, including India. In India, ciprofloxacin is still being used as single-dose treatment for gonorrhea. GOAL: The aim of the study was to determine the antimicrobial susceptibility of Neisseria gonorrhoeae isolates from patients with acute gonococcal urethritis in New Delhi. STUDY DESIGN: By means of disc diffusion, we determined the susceptibility profiles of N gonorrhoeae isolates, determined the MICs of ciprofloxacin, penicillin, and ceftriaxone, and compared our data with previous findings. RESULTS: On the basis of MIC values, 35.3% and 52.9% of strains were found to be resistant and less sensitive, respectively, to penicillin; 67.3% and 28.2% strains were observed to be resistant and less sensitive, respectively, to ciprofloxacin. Only one isolate (5.9%) was found to be less sensitive to ceftriaxone. CONCLUSION: The significant increase in ciprofloxacin resistance in the current study indicates that resistance has developed under selective antibiotic pressure.     

Reduced susceptibility to azithromycin and high percentages of penicillin and tetracycline resistance in Neisseria gonorrhoeae isolates from Manaus, Brazil, 1998

BACKGROUND: The identification of Neisseria gonorrhoeae isolates resistant to antimicrobial agents currently recommended for the treatment of gonococcal infections continues to escalate globally. Thus, in some areas, resistance to fluoroquinolone drugs is commonplace; several reports document resistance to third-generation cephalosporins, and the sporadic isolation of spectinomycin-resistant isolates continues unabated. Gonococcal resistance to azithromycin, an antibiotic used for the primary treatment of gonococcal infections in some Latin American countries, also has been described. Because the prevalence of resistant isolates is insufficiently documented in many areas of Latin America, the efficacy of locally recommended therapies for gonococcal infections is often unknown. GOAL: To determine the antimicrobial susceptibility and strain types of N gonorrhoeae isolates collected in Manaus, Brazil. These data will establish antimicrobial susceptibility baseline data for the region as a reference point for future surveillance. STUDY DESIGN: Consecutive N gonorrhoeae isolates from urethral and endocervical specimens were collected and examined for identity, antimicrobial susceptibility, and strain type (plasmid content, tetM type, auxotype, and serovar). RESULTS: Most of the isolates (65/81; 85.2%) were resistant to tetracycline, penicillin, or both, with the majority (n = 62) carrying plasmid-mediated resistance to tetracycline (tetracycline-resistant N gonorrhoeae [TRNG]). All of the TRNG contained the Dutch-type tetM plasmid, and 18 were A/S class NR/IA-02. Penicillinase-producing N gonorrhoeae comprised 8.2% (7/81) of the isolates. Of these seven isolates, four also were TRNG, and two carried chromosomal resistance to tetracycline. The isolates were susceptible to ciprofloxacin, spectinomycin, and ceftriaxone. However, 23 isolates were characterized by reduced susceptibility to azithromycin (MIC, 0.25-0.5 microg/ml), and one isolate had reduced susceptibility to ciprofloxacin (MIC, 0.25 microg/ml). CONCLUSIONS: This study supports the continued use of third-generation cephalosporins, spectinomycin, and fluoroquinolone drugs for the primary treatment of gonococcal infections in Manaus. The occurrence of isolates with reduced susceptibility to azithromycin and ciprofloxacin underscores the importance of ongoing antimicrobial susceptibility monitoring to support decisions regarding appropriate drugs for the treatment of gonococcal infections.     

1993～ 1998年中国十城市分离的淋球菌对抗生素的敏感性监测

目的 研究我国1993－1998年分离的淋球菌对青霉素、四环素、环丙沙星、大观霉素和头孢曲松的敏感性,作为制定治疗方案和防治对策的参考依据。方法 测定菌株对抗生素的敏感性用琼脂稀释法,测定产霉素酶淋球菌菌株用纸片酸度法。结果 6年来,共检测了3186株淋球菌对抗生素的敏感性。发现青霉素的耐药菌百分率为66．70％,产青霉素酶淋球菌菌株占8．14％;对四环素的耐药菌株占93．02％,高度耐药的四环素耐药淋球菌菌株占4．65％。结论 我国近6年分离的淋球菌对青霉素、四环素和环丙沙星耐经菌百分率较高,对大观霉素和头孢曲松仍较敏感。     

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.     

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

BACKGROUND: In many regions the susceptibility of Neisseria gonorrhoeae isolates to antimicrobial agents is rarely tested. The Gonococcal Antimicrobial Surveillance Program (GASP) in Cuba was established as part of a larger regional GASP program to facilitate the collection and reporting of antimicrobial susceptibility data for N gonorrhoeae isolates. GOAL: The goal was to retrospectively determine the antimicrobial susceptibility and molecular epidemiology of 91 isolates of N gonorrhoeae isolated from 11 centers in Cuba. STUDY DESIGN: Isolates of N gonorrhoeae were collected and presumptively identified from 11 Cuban provincial health centers. They were then forwarded to the National Laboratory of Pathogenic Neisseria Havana for confirmatory identification and were subsequently analyzed at the Center for GASP in Ottawa. Isolates were tested for susceptibility to penicillin, tetracycline, spectinomycin, ceftriaxone, ciprofloxacin, and azithromycin by the agar dilution method. To establish baseline data for molecular epidemiologic profiles, the auxotype (A), serovar (S), plasmid content (P), and TetM type of the isolates were determined. Certain A/S/P classes were further analyzed by pulsed field gel electrophoresis (PFGE). RESULTS: High percentages of the 91 N gonorrhoeae isolates were resistant to penicillin (68%) and tetracycline (83.5%), with 56% being penicillinase-producing (PPNG) and 64% carrying plasmid-mediated tetracycline resistance (TRNG; 50% were PP/TRNG). An additional 14% of the isolates carried chromosomal resistance (CMRNG) to either tetracycline or penicillin or both antibiotics. All isolates were susceptible to spectinomycin, ceftriaxone, and ciprofloxacin. However, nine isolates were resistant to azithromycin (MIC, > or = 1.0 microgram/ml), and 43 other isolates displayed reduced susceptibility to this antibiotic (MIC, 0.25-0.5 microgram/ml). Although a total of 21 different A/S classes were identified, most of the isolates (61) belonged to three A/S classes: NR/IA-6 (35 isolates), NR/IB-1 (15 isolates), and P/IA-6 (11 isolates). Thirty-two of 45 PP/TRNG were A/S class NR/IA-6, and nine of the P/IA-6 isolates were TRNG. By contrast, most of A/S class NR/IB-1 (8) were CMRNG. PFGE analysis following digestion with NheI or SpeI further clustered the isolates into separate groups. CONCLUSIONS: This study demonstrates high percentages of N gonorrhoeae isolates with penicillin and tetracycline resistance in Cuba. As has been noted in other studies in the Caribbean region and Latin America, resistance and reduced susceptibility to azithromycin are developing as emerging problems. Since penicillin and tetracycline continue to be widely used for the treatment of gonococcal infections in Cuba, this study indicates the importance of antimicrobial susceptibility surveillance so that effective antibiotics may be recommended for treatment of gonococcal infections.     

Antimicrobial susceptibility of Neisseria gonorrhoeae isolates from a military population in San Diego

Neisseria gonorrhoeae isolates were studied to determine their patterns of antimicrobial susceptibility and possible chemotherapeutic implications. Of 370 consecutive isolates, 32 (8.7%) were penicillinase-producing N. gonorrhoeae (PPNG). The remaining 338 were subjected to disk-diffusion tests, and those apparently resistant to penicillin, tetracycline, or spectinomycin were tested by an agar-dilution method. The dilution test showed that 5.4% (20/370) were penicillin-resistant, non-PPNG strains, of which 100%, 90%, and 45% were also resistant to tetracycline, cefoxitin, and erythromycin, respectively. No resistance to spectinomycin or ceftriaxone was demonstrated, although there was an association between minimum inhibitor concentrations (MICs) of penicillin of greater than or equal to 1.0 microgram/ml and increased MICs of ceftriaxone. The overall incidence of penicillin resistant isolates, including PPNG, was 14.1% (52/370). Of the 20 penicillin-resistant, non-PPNG strains, all were also resistant to tetracycline, and another 21 exhibited tetracycline resistance but were sensitive to penicillin. The in-vitro data suggested that: (1) neither penicillin, tetracycline, nor cefoxitin were acceptable drugs for routine treatment of gonorrhea in our population during the study period; (2) spectinomycin and ceftriaxone continue to demonstrate adequate in-vitro activity against N. gonorrhoeae despite increasing in-vitro resistance to penicillin; and (3) non-plasmid-mediated resistance to penicillin may predict future resistance to ceftriaxone.     

Fluoroquinolone-resistant Neisseria gonorrhoeae in Bali, Indonesia: 2004

OBJECTIVES: In the mid-1990s, fluoroquinolones were introduced in Indonesia for the management of gonorrhea and are now part of the national recommended treatment guidelines. We recently documented introduction of ciprofloxacin-resistant Neisseria gonorrhoeae strains in female sex workers (FSWs) in Timika, Indonesia, 5 years after treating gonococcal cervicitis with ciprofloxacin and periodically monitoring antimicrobial susceptibility of isolates. To assess the importance of this observation, we determined antimicrobial susceptibilities and strain types of N. gonorrhoeae isolates from FSWs seen in a sexually transmitted infection (STI) clinic in Denpasar, Bali, Indonesia. GOAL: The goal of this study was to determine antimicrobial susceptibilities and strain types among N. gonorrhoeae isolated from FSWs in Denpasar, Bali. STUDY DESIGN: FSWs in Denpasar were screened for N. gonorrhoeae by standard culture. Endocervical isolates were frozen in Microbank tubes and sent to the University of California at San Francisco on dry ice. Antimicrobial susceptibility testing using a Clinical Laboratory Standards Institute-recommended agar dilution method was performed at the Centers for Disease Control and Prevention. Isolates were characterized by beta-lactamase production, antimicrobial resistance phenotypes, and auxotype/serovar class. RESULTS: One hundred forty-seven N. gonorrhoeae isolates were characterized. All isolates were highly resistant to tetracycline (minimum inhibitory concentration, >or=16.0 microg/mL): 117 (79.1%) were beta-lactamase-positive (PP-TR), 3 (2.0%) exhibited chromosomally mediated resistance to penicillin (PenR-TRNG), and 27 (18.2%) were susceptible to penicillin (TRNG). All isolates were susceptible to ceftriaxone, cefixime, and spectinomycin; lack of interpretive criteria do not allow interpretation of susceptibilities of cefoxitin, cefpodoxime, or azithromycin. Fifty-nine (40.1%) isolates were ciprofloxacin-resistant; 35 (59.3%) of the ciprofloxacin-resistant isolates exhibited high-level resistance to ciprofloxacin (Cip-HLR; minimum inhibitory concentration, >or=4.0 microg/mL of ciprofloxacin). Three (2.0%) isolates were intermediate to ciprofloxacin. Twenty-two strain types were identified among these isolates; small clusters were identified with 3 strain types. CONCLUSIONS: N. gonorrhoeae isolates from FSWs in Denpasar were resistant to penicillin and tetracycline; 40.1% of the isolates were fluoroquinolone-resistant. With gonorrhea prevalence of 35% at this clinic (by nucleic acid amplified tests), ongoing surveillance for antimicrobial resistance will be needed to appropriately choose treatment for infections caused by these resistant organisms.     

淋球菌耐药监测15年

目的:了解我国1987～2001年淋病流行中的淋球菌对抗生素的敏感性,为修改淋病治疗方案和制订防治策略提供依据.方法:用琼脂稀释法检测淋球菌对WHO规定的5种核心抗生素的敏感性,用纸片酸度法测定淋球菌产青霉素酶(PPNG)菌株.结果:15年来用琼脂稀释法共检测了7583株菌,青霉素耐药株5399株,占71.20%;PPNG株占17.71%(1056/5964).四环素的耐药株占92.61%(1090/1177);由质粒介导的高度耐四环素淋球茵茵株(TRNG)占14.03%(811/5779).对环丙沙星的耐药性迅速增高,占61.12%(3311/5417).对大观霉素和头孢曲松的耐药菌百分率较低,分别为0.41%(26/6342)和0.39%(23/5853).对南京地区1993～1995年和1999～2001年大观霉素和头孢曲松对淋球菌的MIC50作了比较,结果显示MIC50值并无明显变化.结论:我国近15年流行的淋球菌对青霉素、四环素和环丙沙星的耐药性相当高,而对大观霉素和头孢曲松仍较敏感.为了防止淋球菌耐药菌株的进一步传播应强调对淋病病人进行范围治疗.     

Resistance of Neisseria gonorrhoeae epidemic strains to antibiotics: report of resistant isolates and surveillance in Zhanjiang, China: 1998 to 1999

BACKGROUND: Antibiotics are widely used to treat gonorrhea. Changes in the susceptibility of Neisseria gonorrhoeae to these agents may influence their use. GOAL: To measure the antibiotic susceptibility of N gonorrhoeae epidemic strains in Zhanjiang (Guangdong) and to evaluate the prevalence of strains with reduced susceptibility. STUDY DESIGN: A total of 98 gonococcal isolates obtained from 1998 through 1999 in Zhanjiang were tested for antibiotic susceptibility based on the systemic identification. The inhibitory zone diameters (mm) and the MICs of penicillin, tetracycline, spectinomycin, ceftriaxone, and ciprofloxacin were determined using disk-diffusion and agar-dilution methods, respectively. The susceptibilities of these isolates were defined using criteria of the National Committee for Clinical Laboratory Standards. RESULTS: The percentages of gonococci-resistant strains to penicillin, tetracycline, spectinomycin, ceftriaxone, and ciprofloxacin were 32.65%, 69.39%, 8.16%, 13.27%, 82.65% by disk-diffusion method and 23.91%, 49.46 %, 11.11%, 16.48%, 59.34% by agar-dilution method, respectively. CONCLUSIONS: The resistant strains of contemporary gonococci in Zhanjiang were serious, especially for ciprofloxacin resistance. Continued active surveillance is needed to detect and control the spread of ceftriaxone-resistant and spectinomycin-resistant N gonorrhoeae.     

Temporal trends in gonococcal antibiotic resistance in Baltimore.

Each month from August 1986 through July 1990, clinical and laboratory data were evaluated for the first 25 urethral isolates of Neisseria gonorrhoeae from men attending a Baltimore sexually transmitted disease (STD) clinic as part of an effort to understand factors that contribute to changes in gonococcal antimicrobial susceptibility. During the 48-month study period, 1193 gonococcal isolates were evaluated; the proportion of penicillinase-producing N. gonorrhoeae (PPNG) isolates steadily increased, the prevalence of tetracycline-resistant N. gonorrhoeae (TRNG) remained relatively stable, and chromosomally mediated penicillin resistance increased steadily during the first 5 6-month intervals, then decreased, only to increase again during the final 2 6-month intervals. Changes in antibiotic treatment regimens for gonorrhea were associated with changes in the prevalence of chromosomally mediated penicillin resistance. In a supplementary study to characterize patterns of antibiotic use among men and women attending the STD clinics, 9% of patients reported antibiotic use in the 2 weeks prior to clinic visit. Antibiotics were taken prior to clinic attendance by 65% of patients reporting antibiotic use, because of concerns regarding possible STD or STD exposure. These patients were significantly less likely to be culture positive for N. gonorrhoeae when compared with patients who did not report antibiotic use. Temporal trends in N. gonorrhoeae antibiotic resistance appear to be influenced by many factors, including treatment regimens and self medication.     

Antimicrobial susceptibility of Neisseria gonorrhoeae in Cuba (1995-1999): implications for treatment of gonorrhea

BACKGROUND: Antibiotic-resistant strains of Neisseria gonorrhoeae, especially those resistant to penicillin and tetracycline, have spread with remarkable rapidity in many Caribbean countries. GOAL: The goal of the study was to survey the antibiotic susceptibilities of N gonorrhoeae strains isolated from 1995 to 1999 in Cuba and to discuss the impact of antimicrobial resistance on the management of gonorrhea in the country. STUDY DESIGN: Susceptibility of the strains to penicillin, tetracycline, cefuroxime, ceftriaxone, ciprofloxacin, spectinomycin, and azithromycin were determined by an agar dilution method. RESULTS: Penicillin and tetracycline resistance was noted in 60.8% and 54.2%, respectively, of the N gonorrhoeae strains tested. A total of 63.35 (76/120) of the N gonorrhoeae strains exhibited plasmid-mediated resistance to penicillin, tetracycline, or both. Strains with chromosomally mediated resistance to these antibiotics accounted for 10% (12/120) of the strains. The strains were susceptible to ceftriaxone, cefuroxime, spectinomycin, and ciprofloxacin. One strain's ciprofloxacin MIC was 0.125 mircog/ml. Of the 52 strains tested, 23.1% displayed intermediate resistance to azithromycin. CONCLUSIONS: N gonorrhoeae strains exhibited a high frequency of resistance and multiresistance to penicillin and tetracycline. Therefore, these antibiotics should no longer be used to treat gonococcal infections in Cuba and should be substituted with effective drugs such as third-generation cephalosporins, spectinomycin, and fluoroquinolones. The detection of intermediate resistance to azithromycin and ciprofloxacin underlines the importance of periodic surveillance for susceptibility of N gonorrhoeae strains to antimicrobials agents used as primary therapy for gonorrhea.     

广东省汕头市92株淋球菌药物敏感性检测

目的：了解汕头地区2009年淋球菌对多种抗菌药物耐药的发生率及产β-内酰胺酶淋球菌（PPNG）和四环素高度耐药淋球菌（TRNG）的流行状况.方法：采用琼脂稀释法测定5种抗菌药物最低抑菌浓度（MIC）,纸片酸度法测定青霉素产β-内酰胺酶菌株.结果：92株淋球菌对青霉素耐药率为84.8%、四环素耐药率为89.1%、环丙沙星耐药率为92.4%;未发现大观霉素及头孢曲松耐药菌株.检出PPNG高达31株（33.7%）.TRNG为47株（51.1%）.青霉素﹑四环素和环丙沙星的MIC50及MIC90均已超过耐药标准.结论：大观霉素和头孢曲松为汕头地区治疗淋病的首选药物.     

淋球菌对抗生素耐药性研究

目的:研究广州地区2001年度分离的淋球菌对青霉素、四环素、壮观霉素、头孢曲松和环丙沙星的耐药性。分析耐药菌株的流行特点。方法:采用琼脂稀释法测定菌株对5种抗生素的最小抑菌浓度(MIC),判断敏感性按WHO西太区淋球菌耐药性监测统一标准。用纸片酸度法检测产青霉素酶淋球菌(PPNG)菌株。结果:153株淋球菌中检出127株对青霉素耐药(83.0％),产青霉素酶淋球菌(PPNG)占17.0％(26/153);四环素耐药129株(84.3％);其中质粒介导高度耐四环素淋球菌菌株(TRNG)占总数的24.1％(37/153);环丙沙星耐药117株(76.5％),其中92株同时对青霉素和四环素有耐药性,三重耐药占60.1％;壮观霉素和头孢曲松敏感性最高,分别为100.0％和81.0％。结论:淋球菌对青霉素、四环素和环丙沙星耐药率较高;壮观霉素和头孢曲松敏感,应作为临床的首选药物。     

Antimicrobial susceptibility profile of resistance phenotypes of Neisseria gonorrheae in India

BACKGROUND AND OBJECTIVES: Regular monitoring of antimicrobial resistance of Neisseria gonorrheae needs to be established in the country. The aim of the study was to determine the trend of resistance phenotypes of N. gonorrheae in India, and to assess the susceptibility profile of resistance phenotypes. METHODS: Antimicrobial susceptibilities of N. gonorrheae isolates to penicillin, tetracycline, ceftriaxone, ciprofloxacin, and spectinomycin were determined by in terms of minimum inhibitory concentrations using Etest. World Health Organization reference strains were used as control strains. Phenotypic characterization of N. gonorrheae isolates was carried out on the basis of plasmid and chromosomally mediated resistance to penicillin and tetracycline. RESULTS: Of 382 isolates, 172 (45.0%) belonged to 6 resistance phenotype i.e., penicillinase-producing N. gonorrheae (PPNG) (16.5%), tetracycline resistant N. gonorrheae (TRNG) (8.9%), PPNG-TRNG (4.7%), chromosomally mediated tetracycline resistant N. gonorrheae (11.2%), and chromosomally mediated penicillin resistant N. gonorrheae (3.7%). Chromosomally mediated penicillin and tetracycline resistant N. gonorrheae isolates were not detected. Chromosomally mediated penicillin resistant N. gonorrheae and chromosomally mediated tetracycline resistant N. gonorrheae decreased from 2002 to 2006 whereas TRNG strains increased during the study period. Ciprofloxacin resistant and ceftriaxone less sensitive strains were more frequent among the resistance phenotypes. CONCLUSIONS: The high rates of plasmid and chromosomally mediated resistance to penicillin, tetracycline along with high rates of resistance to ciprofloxacin among all the resistance phenotypes underlines the necessity for continuous surveillance of antimicrobial resistance to help in controlling the spread of gonorrhoea.     

南宁地区2009-2011年淋球菌抗生素耐药性的检测结果分析

目的了解淋球菌对5种抗生素的耐药情况,为制定淋病合理有效的治疗方案提供理论依据。方法对2009-2011年广西南宁地区分离的96株淋球菌,在系统鉴定的基础上,根据世界卫生组织(WHO)标准判定其敏感、中度敏感及耐药。结果 96株淋球菌中β-内酰胺酶(+)菌株为28株;质粒介导的高度耐四环素淋球菌TRNG(+)57株。环丙沙星耐药率为98.96%。头孢曲松和大观霉素未发现耐药菌株。结论南宁地区淋球菌耐药以环丙沙星为甚,四环素和青霉素次之。     

1988-2002年上海分离的淋球菌对抗菌药的敏感性监测

目的 了解上海地区1988-2002年淋球菌对多种抗菌药耐药的发生率、流行情况和耐药特征.方法 采用琼脂稀释法测定抗菌药耐药性,纸片酸度定量法测定青霉素产β-内酰胺酶菌株(PPNG).结果 青霉素敏感性从1988年的11.28%降至2002年的0,MIC50和MIC90分别增加了8倍和4倍,2002年的耐药率达到94.29%,PPNG株达到了50.95%;高度耐四环素株(TRNG)从1995年的0上升到2002年的20.95%;头孢曲松敏感株已由1995年的100%下降至2002年的23.80%;大观霉素的敏感性维持在高点(>97%);环丙沙星敏感性有较大幅度下降,其耐药率在2002年达到了99.05%.分析多重耐药株,同为耐青霉素、环丙沙星和四环素3种药物的菌株从2001年的20.87%上升到2002年的23.30%.同为耐青霉素和环丙沙星2种药物的菌株近2年都已接近70%.结论 近15年来,淋球菌对多种药物产生了耐药,耐药率逐年提高.建议上海地区将大观霉素和头孢曲松作为治疗淋病的首选药物,并且尽早研制出对淋球菌敏感的抗菌药.