Treatment failure with 2 g of azithromycin (extended-release formulation) in gonorrhoea in Japan caused by the international multidrug-resistant ST1407 strain of Neisseria gonorrhoeae
2014 (English)In: Journal of Antimicrobial Chemotherapy, ISSN 0305-7453, E-ISSN 1460-2091, Vol. 69, no 8, 2086-2090 p.Article in journal (Refereed) Published
Antimicrobial resistance in Neisseria gonorrhoeae is a major public health concern globally. We report the first verified treatment failure of gonorrhoea with 2 g of azithromycin (extended-release formulation) in Japan and characteristics of the corresponding N. gonorrhoeae isolates.
Pre- and post-treatment isolates (naEuroS=aEuroS4) were investigated by Etest for antimicrobial susceptibility. The isolates were examined for molecular epidemiology by multilocus sequence typing (MLST), N. gonorrhoeae multi-antigen sequence typing (NG-MAST) and multiple-locus variable-number tandem repeat analysis (MLVA), and for the presence of azithromycin resistance determinants (23S rRNA gene mutations, erm genes and mtrR mutations).
All isolates were resistant to azithromycin (MIC 4 mg/L) and ciprofloxacin, but remained susceptible to cefixime, ceftriaxone and spectinomycin. All isolates were assigned to MLST ST1901 and NG-MAST ST1407 and three of four isolates possessed MLVA profile 8-3-21-16-1. All isolates contained the previously described C2599T mutation (N. gonorrhoeae numbering) in all four 23S rRNA alleles and the previously described single-nucleotide (A) deletion in the mtrR promoter region.
This verified treatment failure occurred in a patient infected with an MLST ST1901/NG-MAST ST1407 strain of N. gonorrhoeae. While this international strain commonly shows resistance or decreased susceptibility to multiple antimicrobials, including extended-spectrum cephalosporins, the strain reported here remained fully susceptible to the latter antimicrobials. Hence, two subtypes of azithromycin-resistant gonococcal MLST ST1901/NG-MAST ST1407 appear to have evolved and to be circulating in Japan. Azithromycin should not be recommended as a single antimicrobial for first-line empirical treatment of gonorrhoea.
Place, publisher, year, edition, pages
Oxford University Press, 2014. Vol. 69, no 8, 2086-2090 p.
N, gonorrhoeae, gonorrhoeae multi-antigen sequence typing, NG-MAST, antimicrobial resistance, 23S rRNA, test of cure
Infectious Medicine Microbiology in the medical area Pharmacology and Toxicology
IdentifiersURN: urn:nbn:se:oru:diva-56656DOI: 10.1093/jac/dku118ISI: 000340068600010PubMedID: 24777907ScopusID: 2-s2.0-84904581813OAI: oai:DiVA.org:oru-56656DiVA: diva2:1083474
Ministry of Health, Labor and Welfare of Japan H23-Shinkou-Shitei-020 H24-Shinko-Ippan-0042017-03-212017-03-212017-03-21Bibliographically approved