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Antimicrobial resistance and molecular epidemiology using whole-genome sequencing of Neisseria gonorrhoeae in Ireland, 2014-2016: focus on extended-spectrum cephalosporins and azithromycin
Department of Clinical Microbiology, St James’s Hospital, Dublin, Ireland.
Örebro University, School of Medical Sciences. WHO Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections, Department of Laboratory Medicine, Clinical Microbiology, Örebro University Hospital, Örebro, Sweden.
Department of Clinical Microbiology, St James’s Hospital, Dublin, Ireland.
Department of Clinical Microbiology, St James’s Hospital, Dublin, Ireland.
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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. Vol. 37, no 9, p. 1661-1672
Keywords [en]
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: urn:nbn:se:oru:diva-67217DOI: 10.1007/s10096-018-3296-5ISI: 000442571200010PubMedID: 29882175Scopus ID: 2-s2.0-85048086357OAI: oai:DiVA.org:oru-67217DiVA, id: diva2:1216377
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

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Golparian, DanielUnemo, Magnus

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