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Boiko, I., Golparian, D., Krynytska, I., Bezkorovaina, H., Frankenberg, A., Onuchyna, M., . . . Unemo, M. (2019). Antimicrobial susceptibility of Neisseria gonorrhoeae isolates and treatment of gonorrhoea patients in Ternopil and Dnipropetrovsk regions of Ukraine, 2013-2018. Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), 127(7), 503-509
Open this publication in new window or tab >>Antimicrobial susceptibility of Neisseria gonorrhoeae isolates and treatment of gonorrhoea patients in Ternopil and Dnipropetrovsk regions of Ukraine, 2013-2018
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2019 (English)In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 127, no 7, p. 503-509Article in journal (Refereed) Published
Abstract [en]

Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a major public health concern globally. However, recent gonococcal AMR data from Eastern Europe are extremely limited and no AMR data for strains spreading in Ukraine have ever been internationally published. We investigated the AMR of N. gonorrhoeae isolates in two regions of Ukraine (Ternopil 2013-2018, Dnipropetrovsk 2013-2014), and, where information was available, the treatment administered to the corresponding gonorrhoea patients. Determination of minimum inhibitory concentration (MIC) of eight antimicrobials was performed using Etest and resistance breakpoints from the European Committee on Antimicrobial Susceptibility Testing (EUCAST) were applied. Overall, 9.3% of the examined 150 isolates were resistant to ciprofloxacin, 6.0% to tetracycline, 2.0% to azithromycin, and 0.7% to benzylpenicillin. No isolates were resistant to ceftriaxone, cefixime, spectinomycin, or gentamicin. However, one (0.7%) isolate showed a MIC value of 0.125 mg/L for both ceftriaxone and cefixime, i.e., bordering resistance. Eighty-eight (67.2%) of 131 patients were administered dual therapy (ceftriaxone 1 g plus doxycycline/clarithromycin/azithromycin/ofloxacin) and 22 (16.8%) ceftriaxone 1 g monotherapy. Worryingly, 21 (16.0%) patients received monotherapy with clarithromycin/doxycycline/azithromycin/ofloxacin/benzylpenicillin. In conclusion, the antimicrobial susceptibility of gonococcal strains spreading in Ternopil and Dnipropetrovsk, Ukraine during 2013-2018 was high. Low levels of resistance to ciprofloxacin, tetracycline, azithromycin, and benzylpenicillin were found, but no resistance to the internationally recommended ceftriaxone, cefixime, or spectinomycin. Ceftriaxone 1 g should remain as empiric first-line treatment, in dual therapy with azithromycin or doxycycline or in monotherapy. Continued and expanded gonococcal AMR surveillance in Ukraine is essential to monitor the susceptibility to particularly extended-spectrum cephalosporins, azithromycin and doxycycline.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
Neisseria gonorrhoeae, Gonorrhoea, antimicrobial resistance (AMR), ceftriaxone, azithromycin, Ukraine
National Category
Immunology in the medical area Microbiology in the medical area
Identifiers
urn:nbn:se:oru:diva-75208 (URN)10.1111/apm.12948 (DOI)000473620900002 ()30903707 (PubMedID)
Available from: 2019-07-26 Created: 2019-07-26 Last updated: 2019-07-26Bibliographically approved
Bruni, M. P., Freitas da Silveira, M., Stauffert, D., Bicca, G. L., Caetano Dos Santos, C., da Rosa Farias, N. A., . . . Unemo, M. (2019). Aptima Trichomonas vaginalis assay elucidates significant underdiagnosis of trichomoniasis among women in Brazil according to an observational study. Sexually Transmitted Infections, 95(2), 129-132
Open this publication in new window or tab >>Aptima Trichomonas vaginalis assay elucidates significant underdiagnosis of trichomoniasis among women in Brazil according to an observational study
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2019 (English)In: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 95, no 2, p. 129-132Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Trichomonas vaginalis (TV) infection is the most common non-viral STI globally and can result in adverse pregnancy outcomes and exacerbated HIV acquisition/transmission. Nucleic acid amplification tests (NAATs) are the most sensitive diagnostic tests, with high specificity, but TV NAATs are rarely used in Brazil. We investigated the TV prevalence and compared the performance of the US Food and Drug Association-cleared Aptima TV assay with microscopy (wet mount and Gram-stained) and culture for TV detection in women in Pelotas, Brazil in an observational study.

METHODS: From August 2015 to December 2016, 499 consecutive asymptomatic and symptomatic sexually active women attending a Gynaecology and Obstetrics Outpatient Clinic were enrolled. Vaginal fluid and swab specimens were collected and wet mount microscopy, Gram-stained microscopy, culture and the Aptima TV assay performed.

RESULTS: The median age of enrolled women was 36.5 years (range: 15-77). The majority were white, had a steady sexual partner and low levels of education. The TV detection rate was 4.2%, 2.4%, 1.2% and 0% using the Aptima TV assay, culture, wet mount microscopy and Gram-stained microscopy, respectively. The sensitivity of culture and wet mount microscopy was only 57.1% (95% CI 36.5 to 75.5) and 28.6% (95% CI 13.8 to 50.0), respectively.

CONCLUSIONS: was found among women in Pelotas, Brazil and the routine diagnostic test (wet mount microscopy) and culture had low sensitivities. More sensitive diagnostic tests (NAATs) and enhanced testing of symptomatic and asymptomatic at-risk women are crucial to mitigate the transmission of TV infection, TV-associated sequelae and enhanced HIV acquisition and transmission.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
Keywords
Aptima, Brazil, culture, nucleic acid amplification test (NAAT), trichomonas infection, trichomonas vaginalis, wet mount microscopy
National Category
Obstetrics, Gynecology and Reproductive Medicine Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-68678 (URN)10.1136/sextrans-2018-053635 (DOI)000471868700012 ()30154157 (PubMedID)2-s2.0-85052888876 (Scopus ID)
Note

Funding Agencies:

Programa de Apoio a Pos-Graduacao (PROAP)  

Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES), Brasilia, DF, Brazil  

Örebro County Council Research Committee  

Foundation for Medical Research at Örebro University Hospital, Örebro, Sweden 

Available from: 2018-09-03 Created: 2018-09-03 Last updated: 2019-07-22Bibliographically approved
Gianecini, R. A., Golparian, D., Zittermann, S., Litvik, A., Gonzalez, S., Oviedo, C., . . . Galarza, P. (2019). Genome-based epidemiology and antimicrobial resistance determinants of Neisseria gonorrhoeae isolates with decreased susceptibility and resistance to extended-spectrum cephalosporins in Argentina in 2011-16. Journal of Antimicrobial Chemotherapy, 74(6), 1551-1559
Open this publication in new window or tab >>Genome-based epidemiology and antimicrobial resistance determinants of Neisseria gonorrhoeae isolates with decreased susceptibility and resistance to extended-spectrum cephalosporins in Argentina in 2011-16
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2019 (English)In: Journal of Antimicrobial Chemotherapy, ISSN 0305-7453, E-ISSN 1460-2091, Vol. 74, no 6, p. 1551-1559Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Our aim was to describe the molecular epidemiology and antimicrobial resistance determinants of isolates of Neisseria gonorrhoeae with decreased susceptibility and resistance to extended-spectrum cephalosporins (ESCs) in Argentina in 2011-16.

METHODS: Gonococcal isolates (n = 158) with decreased susceptibility and resistance to ESCs collected in 2011-16 across Argentina were subjected to WGS and antimicrobial susceptibility testing for six antimicrobials.

RESULTS: In total, 50% of the isolates were resistant to cefixime, 1.9% were resistant to ceftriaxone, 37.3% were resistant to azithromycin and 63.9% of the isolates showed an MDR phenotype. Resistance and decreased susceptibility to ESCs was mainly associated with isolates possessing the mosaic penA-34.001, in combination with an mtrR promoter A deletion, and PorB1b amino acid substitutions G120K/A121N. Phylogenetic analysis revealed two main clades of circulating strains, which were associated with the N. gonorrhoeae multiantigen sequence typing (NG-MAST) ST1407 and closely related STs, and characterized by a high prevalence rate, wide geographical distribution and temporal persistence.

CONCLUSIONS: N. gonorrhoeae isolates with decreased susceptibility and resistance to ESCs in Argentina have emerged and rapidly spread mainly due to two clonal expansions after importation of one or two strains, which are associated with the international MDR NG-MAST ST1407 clone. The identification of the geographical dissemination and characteristics of these predominant clones may help to focus action plans and public health policies to control the spread of ESC resistance in Argentina. Dual antimicrobial therapy (ceftriaxone plus azithromycin) for gonorrhoea needs to be considered in Argentina.

Place, publisher, year, edition, pages
Oxford University Press, 2019
National Category
Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-72874 (URN)10.1093/jac/dkz054 (DOI)000482076800014 ()30820563 (PubMedID)2-s2.0-85066839578 (Scopus ID)
Note

Funding Agencies:

Programa de Becas de Formacion en el Exterior en Ciencia y Tecnologia (Grant Bec.Ar - CIT 2017), Argentina  

Örebro County Council Research Committee  

Foundation for Medical Research at Örebro University Hospital, Örebro, Sweden 

Available from: 2019-03-04 Created: 2019-03-04 Last updated: 2019-08-29Bibliographically approved
Boiko, I., Golparian, D., Krynsytska, I. & Unemo, M. (2019). High prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae and particularly Trichomonas vaginalis diagnosed using US FDA-approved Aptima molecular tests and evaluation of conventional routine diagnostic tests in Ternopil, Ukraine. Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), 127(9), 627-634
Open this publication in new window or tab >>High prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae and particularly Trichomonas vaginalis diagnosed using US FDA-approved Aptima molecular tests and evaluation of conventional routine diagnostic tests in Ternopil, Ukraine
2019 (English)In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 127, no 9, p. 627-634Article in journal (Refereed) Published
Abstract [en]

Sexually transmitted infections (STIs) remain major public health problems globally. Appropriate laboratory diagnosis of STIs is rare in Ukraine. We investigated the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) using the US FDA-approved Aptima Combo 2 and Aptima TV assays and compared the results with the conventional routine diagnostic tests (CDTs) in Ukraine. Urogenital swabs from consecutive mostly symptomatic females (n = 296) and males (n = 159) were examined. The prevalences were as follows: 10% (n = 47) of TV, 5.3% (n = 24) of CT and 1.5% (n = 7) of NG. The specificity of some CDTs was high, for example, 100% for NG culture, TV IgG ELISA, CT IgM ELISA and CT microscopy, but lower for other CDTs, that is, from 44% to 99.8%. The sensitivity of all CDTs was suboptimal, that is, 71% (n = 5) for NG microscopy, 57% (n = 4) for NG culture, 53% (n = 8) for CT IgG ELISA, 33% (n = 1) for TV IgG ELISA, 28% (n = 13) for TV microscopy, 25% (n = 1) for CT IgA ELISA, 20% (n = 3) for CT IgM ELISA and 0% (n = 0) for CT microscopy. The prevalences of particularly TV and CT were high, but substantial also for NG, in Ternopil, Ukraine. The sensitivities of all CDTs were low, and widespread implementation of validated, quality-assured and cost-effective molecular diagnostic STI tests in Ukraine is imperative.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2019
Keywords
Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Aptima Combo 2 assay, Aptima Trichomonas vaginalis assay, Ukraine
National Category
Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-74783 (URN)10.1111/apm.12975 (DOI)000481445100004 ()31225920 (PubMedID)2-s2.0-85070737441 (Scopus ID)
Available from: 2019-06-25 Created: 2019-06-25 Last updated: 2019-09-04Bibliographically approved
Sánchez-Busó, L., Golparian, D., Corander, J., Grad, Y. H., Ohnishi, M., Flemming, R., . . . Harris, S. R. (2019). The impact of antimicrobials on gonococcal evolution. Nature Microbiology
Open this publication in new window or tab >>The impact of antimicrobials on gonococcal evolution
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2019 (English)In: Nature Microbiology, E-ISSN 2058-5276Article in journal (Refereed) Epub ahead of print
Abstract [en]

The sexually transmitted pathogen Neisseria gonorrhoeae is regarded as being on the way to becoming an untreatable superbug. Despite its clinical importance, little is known about its emergence and evolution, and how this corresponds with the introduction of antimicrobials. We present a genome-based phylogeographical analysis of 419 gonococcal isolates from across the globe. Results indicate that modern gonococci originated in Europe or Africa, possibly as late as the sixteenth century and subsequently disseminated globally. We provide evidence that the modern gonococcal population has been shaped by antimicrobial treatment of sexually transmitted infections as well as other infections, leading to the emergence of two major lineages with different evolutionary strategies. The well-described multidrug-resistant lineage is associated with high rates of homologous recombination and infection in high-risk sexual networks. A second, multisusceptible lineage is more associated with heterosexual networks, with potential implications for infection control.

Place, publisher, year, edition, pages
Nature Publishing Group, 2019
National Category
Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-75565 (URN)10.1038/s41564-019-0501-y (DOI)31358980 (PubMedID)
Available from: 2019-08-09 Created: 2019-08-09 Last updated: 2019-08-09Bibliographically approved
Ryan, L., Golparian, D., Fennelly, N., Rose, L., Walsh, P., Lawlor, B., . . . Crowley, B. (2018). Antimicrobial resistance and molecular epidemiology using whole-genome sequencing of Neisseria gonorrhoeae in Ireland, 2014-2016: focus on extended-spectrum cephalosporins and azithromycin. European Journal of Clinical Microbiology and Infectious Diseases, 37(9), 1661-1672
Open this publication in new window or tab >>Antimicrobial resistance and molecular epidemiology using whole-genome sequencing of Neisseria gonorrhoeae in Ireland, 2014-2016: focus on extended-spectrum cephalosporins and azithromycin
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2018 (English)In: European Journal of Clinical Microbiology and Infectious Diseases, ISSN 0934-9723, E-ISSN 1435-4373, Vol. 37, no 9, p. 1661-1672Article in journal (Refereed) Published
Abstract [en]

High-level resistance and treatment failures with ceftriaxone and azithromycin, the first-line agents for gonorrhoea treatment are reported and antimicrobial-resistant Neisseria gonorrhoeae is an urgent public health threat. Our aims were to determine antimicrobial resistance rates, resistance determinants and phylogeny of N. gonorrhoeae in Ireland, 2014-2016. Overall, 609 isolates from four University Hospitals were tested for susceptibility to extended-spectrum cephalosporins (ESCs) and azithromycin by the MIC Test Strips. Forty-three isolates were whole-genome sequenced based on elevated MICs. The resistance rate to ceftriaxone, cefixime, cefotaxime and azithromycin was 0, 1, 2.1 and 19%, respectively. Seven high-level azithromycin-resistant (HLAzi-R) isolates were identified, all susceptible to ceftriaxone. Mosaic penA alleles XXXIV, X and non-mosaic XIII, and G120K plus A121N/D/G (PorB1b), H105Y (MtrR) and A deletion (mtrR promoter) mutations, were associated with elevated ESC MICs. A2059G and C2611T mutations in 23S rRNA were associated with HLAzi-R and azithromycin MICs of 4-32 mg/L, respectively. The 43 whole-genome sequenced isolates belonged to 31 NG-MAST STs. All HLAzi-R isolates belonged to MLST ST1580 and some clonal clustering was observed; however, the isolates differed significantly from the published HLAzi-R isolates from the ongoing UK outbreak. There is good correlation between previously described genetic antimicrobial resistance determinants and phenotypic susceptibility categories for ESCs and azithromycin in N. gonorrhoeae. This work highlights the advantages and potential of whole-genome sequencing to be applied at scale in the surveillance of antibiotic resistant strains of N. gonorrhoeae, both locally and internationally.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
High-level azithromycin-resistant Neisseria gonorrhoeae, Ireland, MLST, NG-MAST, Neisseria gonorrhoeae, Resistance determinants
National Category
Infectious Medicine Microbiology in the medical area
Identifiers
urn:nbn:se:oru:diva-67217 (URN)10.1007/s10096-018-3296-5 (DOI)000442571200010 ()29882175 (PubMedID)2-s2.0-85048086357 (Scopus ID)
Note

Funding Agencies:

Department of Microbiology. St James's Hospital, Dublin  

Irish Research Council fellowship  EPSPD/2015/32 

Available from: 2018-06-11 Created: 2018-06-11 Last updated: 2018-09-06Bibliographically approved
Golparian, D., Donà, V., Sánchez-Busó, L., Foerster, S., Harris, S., Endimiani, A., . . . Unemo, M. (2018). Antimicrobial resistance prediction and phylogenetic analysis of Neisseria gonorrhoeae isolates using the Oxford Nanopore MinION sequencer. Scientific Reports, 8(1), Article ID 17596.
Open this publication in new window or tab >>Antimicrobial resistance prediction and phylogenetic analysis of Neisseria gonorrhoeae isolates using the Oxford Nanopore MinION sequencer
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2018 (English)In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 8, no 1, article id 17596Article in journal (Refereed) Published
Abstract [en]

Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is common, compromising gonorrhoea treatment internationally. Rapid characterisation of AMR strains could ensure appropriate and personalised treatment, and support identification and investigation of gonorrhoea outbreaks in nearly real-time. Whole-genome sequencing is ideal for investigation of emergence and dissemination of AMR determinants, predicting AMR, in the gonococcal population and spread of AMR strains in the human population. The novel, rapid and revolutionary long-read sequencer MinION is a small hand-held device that generates bacterial genomes within one day. However, accuracy of MinION reads has been suboptimal for many objectives and the MinION has not been evaluated for gonococci. In this first MinION study for gonococci, we show that MinION-derived sequences analysed with existing open-access, web-based sequence analysis tools are not sufficiently accurate to identify key gonococcal AMR determinants. Nevertheless, using an in house-developed CLC Genomics Workbench including de novo assembly and optimised BLAST algorithms, we show that 2D ONT-derived sequences can be used for accurate prediction of decreased susceptibility or resistance to recommended antimicrobials in gonococcal isolates. We also show that the 2D ONT-derived sequences are useful for rapid phylogenomic-based molecular epidemiological investigations, and, in hybrid assemblies with Illumina sequences, for producing contiguous assemblies and finished reference genomes.

Place, publisher, year, edition, pages
Nature Publishing Group, 2018
National Category
Bioinformatics and Systems Biology
Identifiers
urn:nbn:se:oru:diva-70622 (URN)10.1038/s41598-018-35750-4 (DOI)000452084600004 ()30514867 (PubMedID)2-s2.0-85057604734 (Scopus ID)
Note

Funding Agencies:

Orebro County Council Research Committee  

Foundation for Medical Research at Orebro University Hospital, Orebro, Sweden  

SwissTransMed initiative (Translational Research Platforms in Medicine) from the Rectors' Conference of the Swiss Universities (CRUS)  25/2013 

Pathogen Informatics Group at the Wellcome Sanger Institute  

Wellcome Grant  098051 

Available from: 2018-12-10 Created: 2018-12-10 Last updated: 2018-12-21Bibliographically approved
Unemo, M., Salado-Rasmussen, K., Hansen, M., Olsen, A. O., Falk, M., Golparian, D., . . . Jensen, J. S. (2018). Clinical and analytical evaluation of the new Aptima Mycoplasma genitalium assay, with data on M. genitalium prevalence and antimicrobial resistance in M. genitalium in Denmark, Norway and Sweden in 2016. Clinical Microbiology and Infection, 24(5), 533-539
Open this publication in new window or tab >>Clinical and analytical evaluation of the new Aptima Mycoplasma genitalium assay, with data on M. genitalium prevalence and antimicrobial resistance in M. genitalium in Denmark, Norway and Sweden in 2016
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2018 (English)In: Clinical Microbiology and Infection, ISSN 1198-743X, E-ISSN 1469-0691, Vol. 24, no 5, p. 533-539Article in journal (Refereed) Published
Abstract [en]

Objectives: Mycoplasma genitalium (MG) causes urethritis and cervicitis, potentially causing reproductive complications. Resistance in MG to first-line (azithromycin) and second-line (moxifloxacin) treatment has increased. We examined the clinical and analytical performance of the new Conformite Europeene (CE)/in vitro diagnostics (IVD) Aptima Mycoplasma genitalium assay (CE/IVD AMG; Hologic); the prevalence of MG, Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG); and MG resistance to azithromycin and moxifloxacin in Denmark, Norway and Sweden in 2016.

Methods: From February 2016 to February 2017, urogenital and extragenital (only in Denmark) specimens from consecutive attendees at three sexually transmitted disease clinics were tested with the CE/ IVD AMG, the research-use-only MG Alt TMA-1 assay (Hologic), Aptima Combo 2 (CT/NG) assay and a laboratory-developed TaqMan real-time mgpB quantitative real-time PCR (qPCR). Resistance-associated mutations were determined by sequencing. Strains of MG and other mycoplasma species in different concentrations were also tested.

Results: In total 5269 patients were included. The prevalence of MG was 7.2% (382/5269; 4.9-9.8% in the countries). The sensitivity of the CE/IVD AMG, MG Alt TMA-1 and mgpB qPCR ranged 99.13-100%, 99.13 -100% and 73.24-81.60%, respectively, in the countries. The specificity ranged 99.57-99.96%, 100% and 99.69-100%, respectively. The prevalence of resistance-associated mutations for azithromycin and moxifloxacin was 41.4% (120/290; 17.7-56.6%) and 6.6% (18/274; 4.1-10.2%), respectively. Multidrug resistance was found in all countries (2.7%; 1.1-4.2%).

Conclusions: Both transcription-mediated amplification (TMA)-based MG assays had a highly superior sensitivity compared to the mgpB qPCR. The prevalence of MG and azithromycin resistance was high. Validated and quality-assured molecular tests for MG, routine resistance testing of MG-positive samples and antimicrobial resistance surveillance are crucial.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
16S rRNA, 23S rRNA, Antimicrobial resistance, Aptima, Azithromycin, Hologic, Moxifloxacin, Mycoplasma genitalium, parC
National Category
Infectious Medicine Microbiology in the medical area
Identifiers
urn:nbn:se:oru:diva-66889 (URN)10.1016/j.cmi.2017.09.006 (DOI)000430656300015 ()28923377 (PubMedID)2-s2.0-85032198941 (Scopus ID)
Note

Funding Agencies:

Örebro County Council Research Committee  

Foundation for Medical Research at Örebro University Hospital, Örebro, Sweden  

Available from: 2018-05-08 Created: 2018-05-08 Last updated: 2018-08-30Bibliographically approved
Eyre, D. W., Sanderson, N. D., Lord, E., Regisford-Reimmer, N., Chau, K., Barker, L., . . . Andersson, M. I. (2018). Gonorrhoea treatment failure caused by a Neisseria gonorrhoeae strain with combined ceftriaxone and high-level azithromycin resistance, England, February 2018. Eurosurveillance, 23(27), 2-7, Article ID 1800323.
Open this publication in new window or tab >>Gonorrhoea treatment failure caused by a Neisseria gonorrhoeae strain with combined ceftriaxone and high-level azithromycin resistance, England, February 2018
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2018 (English)In: Eurosurveillance, ISSN 1025-496X, E-ISSN 1560-7917, Vol. 23, no 27, p. 2-7, article id 1800323Article in journal (Refereed) Published
Place, publisher, year, edition, pages
European Centre for Disease Prevention and Control (ECDC), 2018
National Category
Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-68133 (URN)10.2807/1560-7917.ES.2018.23.27.1800323 (DOI)000437991000001 ()29991383 (PubMedID)
Note

Funding Agencies:

National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford  

Public Health England (PHE)  

NIHR Biomedical Research Centre Oxford 

Available from: 2018-07-25 Created: 2018-07-25 Last updated: 2018-07-25Bibliographically approved
Jönsson, A., Foerster, S., Golparian, D., Hamasuna, R., Jacobsson, S., Lindberg, M., . . . Unemo, M. (2018). In vitro activity and time-kill curve analysis of sitafloxacin against a global panel of antimicrobial-resistant and multidrug-resistant Neisseria gonorrhoeae isolates. Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), 126(1), 29-37
Open this publication in new window or tab >>In vitro activity and time-kill curve analysis of sitafloxacin against a global panel of antimicrobial-resistant and multidrug-resistant Neisseria gonorrhoeae isolates
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2018 (English)In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 126, no 1, p. 29-37Article in journal (Refereed) Published
Abstract [en]

Treatment of gonorrhoea is a challenge worldwide because of emergence of resistance in N. gonorrhoeae to all therapeutic antimicrobials available and novel antimicrobials are imperative. The newer-generation fluoroquinolone sitafloxacin, mostly used for respiratory tract infections in Japan, can have a high in vitro activity against gonococci. However, only a limited number of recent antimicrobial-resistant isolates from Japan have been examined. We investigated the sitafloxacin activity against a global gonococcal panel (250 isolates cultured in 1991-2013), including multidrug-resistant geographically, temporally and genetically diverse isolates, and performed time-kill curve analysis for sitafloxacin. The susceptibility to sitafloxacin (agar dilution) and seven additional therapeutic antimicrobials (Etest) was determined. Sitafloxacin was rapidly bactericidal, and the MIC range, MIC50 and MIC90 was ≤0.001-1, 0.125 and 0.25 mg/L, respectively. There was a high correlation between the MICs of sitafloxacin and ciprofloxacin; however, the MIC50 and MIC90 of sitafloxacin were 6-fold and >6-fold lower, respectively. Sitafloxacin might be an option for particularly dual antimicrobial therapy of gonorrhoea and for cases with ceftriaxone resistance or allergy. However, further in vitro and particularly in vivo evaluations of potential resistance, pharmacokinetics/pharmacodynamics and ideal dosing for gonorrhoea, as well as performance of randomized controlled clinical, trials are crucial.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2018
Keywords
Gonorrhoea, bactericidal, fluoroquinolone, gyrA, in vitro potency, quinolone resistance-determining region, time-kill curve analysis
National Category
Infectious Medicine Immunology in the medical area
Identifiers
urn:nbn:se:oru:diva-64051 (URN)10.1111/apm.12777 (DOI)000418846700005 ()29154480 (PubMedID)2-s2.0-85034566762 (Scopus ID)
Note

Funding Agencies:

Örebro County Council Research Committee 

Foundation for Medical Research at Örebro University Hospital, Sweden 

Available from: 2018-01-12 Created: 2018-01-12 Last updated: 2018-08-31Bibliographically approved
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