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Use of Whole Genome Sequencing for the Molecular Comparison of Neisseria gonorrhoeae Isolates With Decreased Susceptibility to Extended Spectrum Cephalosporins From 2 Geographically Different Regions in America

Gianecini, Ricardo A. MSc*; Zittermann, Sandra PhD; Oviedo, Claudia MSc*; Galas, Marcelo BSc; Pardo, Pilar Ramon MD; Allen, Vanessa G. MD; Galarza, Patricia MSc, MPH*; Melano, Roberto G. PhD

doi: 10.1097/OLQ.0000000000001011
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Background Neisseria gonorrhoeae isolates with reduced susceptibility or resistance to the recommended first-line antimicrobial therapy have been described in several countries. The purpose of this study was to use genome analyses to compare the molecular characteristics of N. gonorrhoeae isolates with decreased susceptibility to extended-spectrum cephalosporin from Ontario, Canada, and Argentina.

Methods A total of 128 N. gonorrhoeae isolates, collected in 2015, were included. The susceptibility to penicillin G, tetracycline, ciprofloxacin, cefixime, ceftriaxone, and azithromycin was determined using the agar dilution method. Isolates were subjected to whole genome sequencing, and an in silico analysis was performed to identify antimicrobial resistance determinants and for genotyping.

Results Decreased susceptibility to extended-spectrum cephalosporin was mainly associated with penA mosaic allele 34.001, together with an mtrR promoter A deletion and porB1b alterations G120K/A121N. N. gonorrhoeae multiantigen sequence typing ST1407 or closely related genotypes were identified circulating in both regions.

Conclusions An international multi-drug resistant clone of N. gonorrhoeae was associated with decreased susceptibility to extended-spectrum cephalosporin (ESC) in 2 different regions in America. Evidence of clonal dissemination of the organism in some regions suggests that the strength of surveillance programs and establishment of collaborative projects are essential.

A study of Neisseria gonorrhoeae isolates with decreased susceptibility to extended-spectrum cephalosporins found that an international multidrug-resistant clone is circulating in Argentina and Ontario, Canada.

From the *National Reference Laboratory of Sexually Transmitted Diseases, National Institute of Infectious Diseases-ANLIS “Dr. Carlos G. Malbrán,” Ciudad Autónoma de Buenos Aires, Argentina;

Public Health Ontario Laboratories, Toronto, Canada; and

Pan American Health Organization/World Health Organization (PAHO/ WHO), Washington, DC

Acknowledgments: The authors are grateful to Josefina Campos from the National Institute of Infectious Diseases (INEI)-ANLIS “Dr. Carlos G. Malbrán” for her assistance on DNA extractions. We also thank Melisa Soledad Gonzalez and Paula Cristaldo for their technical assistance.

R.A.G. and S.Z. are joint first authors.

P.G. and R.G.M. are joint senior authors.

Conflicts of interest: None declared.

Sources of Funding: The work was conducted as a collaborative project between the Public Health Ontario Laboratories, Toronto, Canada; and the collaborative center for Pan American Health Organization (PAHO/WHO), National Institute of Infectious Diseases-ANLIS “Dr. Carlos G. Malbrán,” Ciudad Autónoma de Buenos Aires, Argentina.

Correspondence: Roberto G. Melano, Public Health Ontario Laboratories, Toronto, Canada. E-mail: roberto.melano@oahpp.ca.

Received for publication February 4, 2019, and accepted April 21, 2019.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (http://www.stdjournal.com).

Online date: July 8, 2019

© Copyright 2019 American Sexually Transmitted Diseases Association