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Abstract

We describe a multidrug-resistant infection with ceftriaxone resistance and azithromycin intermediate resistance in a heterosexual man in Denmark, 2017. Whole genome sequencing of the strain GK124 identified MSLT ST1903, NG-MAST ST1614 and all relevant resistance determinants including similar penA resistance mutations previously described in ceftriaxone-resistant gonococcal strains. Although treatment with ceftriaxone 0.5 g plus azithromycin 2 g was successful, increased awareness of spread of gonococcal strains threatening the recommended dual therapy is crucial.

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/content/10.2807/1560-7917.ES.2017.22.42.17-00659
2017-10-19
2024-11-08
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2017.22.42.17-00659
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References

  1. Unemo M, Golparian D, Nicholas R, Ohnishi M, Gallay A, Sednaoui P. High-level cefixime- and ceftriaxone-resistant Neisseria gonorrhoeae in France: novel penA mosaic allele in a successful international clone causes treatment failure. Antimicrob Agents Chemother. 2012;56(3):1273-80.  https://doi.org/10.1128/AAC.05760-11  PMID: 22155830 
  2. Lahra MM, Ryder N, Whiley DM. A new multidrug-resistant strain of Neisseria gonorrhoeae in Australia. N Engl J Med. 2014;371(19):1850-1.  https://doi.org/10.1056/NEJMc1408109  PMID: 25372111 
  3. Cámara J, Serra J, Ayats J, Bastida T, Carnicer-Pont D, Andreu A, et al. Molecular characterization of two high-level ceftriaxone-resistant Neisseria gonorrhoeae isolates detected in Catalonia, Spain. J Antimicrob Chemother. 2012;67(8):1858-60.  https://doi.org/10.1093/jac/dks162  PMID: 22566592 
  4. Unemo M, Shafer WM. Antimicrobial resistance in Neisseria gonorrhoeae in the 21st century: past, evolution, and future. Clin Microbiol Rev. 2014;27(3):587-613.  https://doi.org/10.1128/CMR.00010-14  PMID: 24982323 
  5. Ohnishi M, Golparian D, Shimuta K, Saika T, Hoshina S, Iwasaku K, et al. Is Neisseria gonorrhoeae initiating a future era of untreatable gonorrhea?: detailed characterization of the first strain with high-level resistance to ceftriaxone. Antimicrob Agents Chemother. 2011;55(7):3538-45.  https://doi.org/10.1128/AAC.00325-11  PMID: 21576437 
  6. Gianecini R, Oviedo C, Stafforini G, Galarza P. Neisseria gonorrhoeae resistant to ceftriaxone and cefixime, Argentina. Emerg Infect Dis. 2016;22(6):1139-41.  https://doi.org/10.3201/eid2206.152091  PMID: 27191699 
  7. Nakayama S, Shimuta K, Furubayashi K, Kawahata T, Unemo M, Ohnishi M. New ceftriaxone- and multidrug-resistant Neisseria gonorrhoeae strain with a novel mosaic penA gene isolated in Japan. Antimicrob Agents Chemother. 2016;60(7):4339-41.  https://doi.org/10.1128/AAC.00504-16  PMID: 27067334 
  8. Unemo M. Current and future antimicrobial treatment of gonorrhoea - the rapidly evolving Neisseria gonorrhoeae continues to challenge. BMC Infect Dis. 2015;15(1):364.  https://doi.org/10.1186/s12879-015-1029-2  PMID: 26293005 
  9. Wi T, Lahra MM, Ndowa F, Bala M, Dillon JR, Ramon-Pardo P, et al. Antimicrobial resistance in Neisseria gonorrhoeae: Global surveillance and a call for international collaborative action. PLoS Med. 2017;14(7):e1002344.  https://doi.org/10.1371/journal.pmed.1002344  PMID: 28686231 
  10. Golparian D, Ohlsson A, Janson H, Lidbrink P, Richtner T, Ekelund O, et al. Four treatment failures of pharyngeal gonorrhoea with ceftriaxone (500 mg) or cefotaxime (500 mg), Sweden, 2013 and 2014. Euro Surveill. 2014;19(30):20862.  https://doi.org/10.2807/1560-7917.ES2014.19.30.20862  PMID: 25108533 
  11. World Health Organization (WHO). Global action plan to control the spread and impact of antimicrobial resistance in Neisseria gonorrhoeae. Geneva: WHO; 2012. Available from: http://www.who.int/reproductivehealth/publications/rtis/9789241503501/en/
  12. European Centre for Disease Prevention and Control (ECDC). Response plan to control and manage the threat of multidrug-resistant gonorrhoea in Europe. Stockholm: ECDC; 2012. Available from: https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/1206-ECDC-MDR-gonorrhoea-response-plan.pdf
  13. Tomberg J, Unemo M, Ohnishi M, Davies C, Nicholas RA. Identification of amino acids conferring high-level resistance to expanded-spectrum cephalosporins in the penA gene from Neisseria gonorrhoeae strain H041. Antimicrob Agents Chemother. 2013;57(7):3029-36.  https://doi.org/10.1128/AAC.00093-13  PMID: 23587946 
  14. Bignell C, Unemo MEuropean STI Guidelines Editorial Board. 2012 European guideline on the diagnosis and treatment of gonorrhoea in adults. Int J STD AIDS. 2013;24(2):85-92.  https://doi.org/10.1177/0956462412472837  PMID: 24400344 
  15. Fifer H, Natarajan U, Jones L, Alexander S, Hughes G, Golparian D, et al. Failure of dual antimicrobial therapy in treatment of gonorrhea. N Engl J Med. 2016;374(25):2504-6.  https://doi.org/10.1056/NEJMc1512757  PMID: 27332921 
  16. Cole MJ, Spiteri G, Jacobsson S, Woodford N, Tripodo F, Amato-Gauci AJ, et al. Overall low extended-spectrum cephalosporin resistance but high azithromycin resistance in Neisseria gonorrhoeae in 24 European countries, 2015. BMC Infect Dis. 2017;17(1):617.  https://doi.org/10.1186/s12879-017-2707-z  PMID: 28893203 
  17. Anbefalinger om forebyggelse, diagnose og behandling af sexuelt overførbare infektioner. [Recommendations on prevention, diagnosis and treatment of sexually transmitted infections]. Copenhagen: Sundhedsstyrelsen; 2015. Danish. Available from: https://www.sst.dk/da/udgivelser/2015/~/media/9881BB0E837B41DAAE0954A1A8D798B9.ashx
  18. European Committee on Antimicrobial Susceptibility Testing (EUCAST). Antimicrobial wild type distributions of Neisseria gonorrhoeae MICs. Växjö: EUCAST. [Accessed 21 Sep 2017]. Available from: https://mic.eucast.org/Eucast2/SearchController/search.jsp?action=performSearch&BeginIndex=0&Micdif=mic&NumberIndex=50&Antib=-1&Specium=169
  19. Bartels MD, Larner-Svensson H, Meiniche H, Kristoffersen K, Schonning K, Nielsen JB, et al. Monitoring meticillin resistant Staphylococcus aureus and its spread in Copenhagen, Denmark, 2013, through routine whole genome sequencing. Euro Surveill. 2015;20(17):21112.  https://doi.org/10.2807/1560-7917.ES2015.20.17.21112  PMID: 25955776 
  20. Unemo M, Golparian D, Sánchez-Busó L, Grad Y, Jacobsson S, Ohnishi M, et al. The novel 2016 WHO Neisseria gonorrhoeae reference strains for global quality assurance of laboratory investigations: phenotypic, genetic and reference genome characterization. J Antimicrob Chemother. 2016;71(11):3096-108.  https://doi.org/10.1093/jac/dkw288  PMID: 27432602 
  21. Statens Serum Institut. Gonorré 2016. [Gonorrhoea 2016]. EPI-NYT. 2017;18. Danish. Available from: http://www.ssi.dk/Aktuelt/Nyhedsbreve/EPI-NYT/2017/Uge 18 - 2017.aspx
  22. Läkemedelsverket. Sexuellt överförbara bakteriella infektioner-behandlingsrekommendation. [Sexually transmitted bacterial infections - treatment recommendation]. Information från Läkemedelsverket. 2015;1:16-31. Swedish. Available from: https://lakemedelsverket.se/upload/halso-och-sjukvard/behandlingsrekommendationer/Sexuellt_overforbara_bakteriella_infektioner_behandlingsrekommendation_webb.pdf
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