New Research on TREATMENT RESISTENT GONORRHEA

[bcohen7719]

First time I've seen warnings of a new

untreatable superbug.

 

BC

 

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Antimicrob. Agents Chemother.

Copyright © 2011,American Society for Microbiology and/or the Listed

Authors/Institutions. All Rights Reserved.

 

 

Article

Is Neisseria gonorrhoeae initiating a future era of untreatable gonorrhea? Detailed characterization of the first high-level ceftriaxone resistant strain.

Makoto Ohnishi1, Daniel Golparian2, Ken Shimuta1, Takeshi Saika3, Shinji Hoshina4, Kazuhiro Iwasaku5, Shu-ichi Nakayama1, Jo Kitawaki5, and Magnus Unemo2,*

 

1 National Institute of Infectious Diseases, Tokyo, Japan, 2 Swedish Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Microbiology, Örebro University Hospital, Örebro, Sweden, 3 Mitsubishi Chemical Medience Corporation, Tokyo, Japan, 4 Hoshina Clinic, Kyoto, Japan, 5 Kyoto Prefectural University of Medicine, Kyoto, Japan

 

ABSTRACT

 

Recently, the first Neisseria gonorrhoeae strain (H041) that is highly resistant to the extended-spectrum cephalosporin (ESC) ceftriaxone, the last remaining option for empirical first-line treatment, was isolated. We performed a detailed characterization of H041, phenotypically and genetically, to confirm the finding, examine its antimicrobial resistance (AMR) and elucidate the resistance mechanisms. H041 was examined using seven species-confirmatory tests, antibiograms (30 antimicrobials), porB sequencing, N. gonorrhoeae multi-antigen sequence typing (NG-MAST), multilocus sequence typing (MLST) and sequencing of ESC-resistance determinants (penA, mtrR, penB, ponA and pilQ). Transformation, using appropriate recipient strains, was performed to confirm the ESC-resistance determinants. H041 was assigned serovar Bpyust, MLST ST7363 and the new NG-MAST ST4220. H041 proved highly resistant to ceftriaxone (2-4 µg/ml, which is 4-8-fold higher than any previously described isolate) and all other cephalosporins, as well as most other antimicrobials tested. A new penA mosaic allele caused the ceftriaxone resistance. In conclusion, N. gonorrhoeae has now shown its ability to develop also ceftriaxone resistance. Despite that the biological fitness of ceftriaxone resistance in N. gonorrhoeae remains unknown, N. gonorrhoeae may soon become a true superbug causing untreatable gonorrhea. A reduction in global gonorrhea burden by enhanced disease control activities combined with wider strategies for general AMR control and enhanced understanding of mechanisms of emergence and spread of AMR, which need to be monitored globally, and public health response plans for global (and national) perspectives are important. Ultimately, new drugs are necessary to develop for efficacious gonorrhea treatment.

 

* Corresponding author. Mailing address: Swedish Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Microbiology, Örebro University Hospital, SE-701 85 Örebro, Sweden. Phone: +46 (19) 602 1520. Fax: +46 (19) 127 416. E-mail: [email protected].