Antimicrobial resistance and Neisseria gonorrhoeae multiantigen sequence typing (NG-MAST) genotypes in N. gonorrhoeae during 2012–2014 in Karachi, Pakistan

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

Globally, increasing antimicrobial resistance (AMR) in Neisseria gonorrhoea has led to decreased treatment options for gonorrhoea. Continuous monitoring of resistance is crucial to determine evolving resistance trends in Neisseria gonorrhoea and to suggest treatment recommendations. Quality assured gonococcal AMR data from Pakistan are mainly lacking. This study was performed to determine prevalence and trends of gonococcal AMR and molecular epidemiology of local strains during 2012–2014 in Karachi, Pakistan.

Methods

Gonococcal isolates ( n = 100) were obtained from urogenital specimens submitted to the Aga Khan University Laboratory, Karachi, Pakistan. Antimicrobial susceptibility was determined using Etest and molecular epidemiology was assessed by N. gonorrhoeae multiantigen sequence typing (NG-MAST). Quality control was performed using N. gonorrhoeae WHO reference strains C, F, G, K, L, M, N, O, and P, and ATCC 49226.

Results

Susceptibility to spectinomycin, ceftriaxone and cefixime was 100 % and to azithromycin was 99 %. All isolates had low ceftriaxone MICs, i.e., ≤0.032 mg/L. Resistance to ciprofloxacin, tetracycline and penicillin G were 86 %, 51 % and 43 %, respectively. NG-MAST analysis identified 74 different sequence types (STs).

Conclusions

A highly diversified gonococcal population, 74 NG-MAST STs (62 novel STs) with an increased resistance to penicillin G, ciprofloxacin and tetracycline circulated in Karachi, Pakistan. Fortunately, no resistance to ceftriaxone was detected. Accordingly, ceftriaxone can continuously be recommended as the treatment of choice. However it is recommended to increase the dose of ceftriaxone from 125 mg intramuscularly to 250 mg intramuscularly due to ceftriaxone MIC creep and emerging resistance reported in the region. Furthermore, due to the high level of resistance to ciprofloxacin (86 %) it is essential to exclude ciprofloxacin from the recommended first-line therapy. It is imperative to significantly broaden the gonococcal AMR monitoring with participation from other laboratories and cities in Pakistan.

Electronic supplementary material

The online version of this article (doi:10.1186/s12879-016-1673-1) contains supplementary material, which is available to authorized users.

Related collections

Most cited references 16

Record: found
Abstract: found
Article: not found

Antimicrobial resistance in Neisseria gonorrhoeae in the 21st century: past, evolution, and future.

Magnus Unemo, William M. Shafer (2014)

Neisseria gonorrhoeae is evolving into a superbug with resistance to previously and currently recommended antimicrobials for treatment of gonorrhea, which is a major public health concern globally. Given the global nature of gonorrhea, the high rate of usage of antimicrobials, suboptimal control and monitoring of antimicrobial resistance (AMR) and treatment failures, slow update of treatment guidelines in most geographical settings, and the extraordinary capacity of the gonococci to develop and retain AMR, it is likely that the global problem of gonococcal AMR will worsen in the foreseeable future and that the severe complications of gonorrhea will emerge as a silent epidemic. By understanding the evolution, emergence, and spread of AMR in N. gonorrhoeae, including its molecular and phenotypic mechanisms, resistance to antimicrobials used clinically can be anticipated, future methods for genetic testing for AMR might permit region-specific and tailor-made antimicrobial therapy, and the design of novel antimicrobials to circumvent the resistance problems can be undertaken more rationally. This review focuses on the history and evolution of gonorrhea treatment regimens and emerging resistance to them, on genetic and phenotypic determinants of gonococcal resistance to previously and currently recommended antimicrobials, including biological costs or benefits; and on crucial actions and future advances necessary to detect and treat resistant gonococcal strains and, ultimately, retain gonorrhea as a treatable infection. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

0 comments Cited 428 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Emergence of multidrug-resistant, extensively drug-resistant and untreatable gonorrhea.

Kevin R Nicholas, Magnus Unemo (2012)

The new superbug Neisseria gonorrhoeae has retained resistance to antimicrobials previously recommended for first-line treatment and has now demonstrated its capacity to develop resistance to the extended-spectrum cephalosporin, ceftriaxone, the last remaining option for first-line empiric treatment of gonorrhea. An era of untreatable gonorrhea may be approaching, which represents an exceedingly serious public health problem. Herein, we review the evolution, origin and spread of antimicrobial resistance and resistance determinants (with a focus on extended-spectrum cephalosporins) in N. gonorrhoeae, detail the current situation regarding verified treatment failures with extended-spectrum cephalosporins and future treatment options, and highlight essential actions to meet the large public health challenge that arises with the possible emergence of untreatable gonorrhea. Essential actions include: implementing action/response plans globally and nationally; enhancing surveillance of gonococcal antimicrobial resistance, treatment failures and antimicrobial use/misuse; and improving prevention, early diagnosis and treatment of gonorrhea. Novel treatment strategies, antimicrobials (or other compounds) and, ideally, a vaccine must be developed.

0 comments Cited 120 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Rapid sequence-based identification of gonococcal transmission clusters in a large metropolitan area.

Iona Martin, Catherine A. Ison, David Aanensen … (2004)

In large metropolitan areas, which typically have the highest rates of gonorrhea, the identification of chains of transmission by use of partner notification is problematic, and there is an increasing interest in applying molecular approaches, which would require new discriminatory high-throughput procedures for recognizing clusters of indistinguishable gonococci, procedures that identify local chains of transmission. Sequencing of internal fragments of 2 highly polymorphic loci, from 436 isolates recovered in London during a 3-month period, identified clusters of antibiotic-resistant and antibiotic-susceptible isolates with indistinguishable genotypes, the vast majority of which were also identical or closely related by other methods, and defined groups of individuals who typically had similar demographic characteristics. This discriminatory sequence-based approach produces unambiguous data that easily can be compared via the Internet and appears to be suitable for the identification of linked cases of gonorrhea and the timely identification of transmission of antibiotic-resistant strains, even within large cities.

0 comments Cited 104 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Kauser Jabeen: kausar.jabeen@aku.edu

Pushpa Bhawan Mal: pushpa.bhawan@aku.edu

Erum Khan: erum.khan@aku.edu

Saeeda Chandio: saeeda.chandia@aku.edu

Susanne Jacobsson: susanne.jacobsson@regionorebrolan.se

Magnus Unemo: magnus.unemo@regionorebrolan.se

Journal

Journal ID (nlm-ta): BMC Infect Dis

Journal ID (iso-abbrev): BMC Infect. Dis

Title: BMC Infectious Diseases

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2334

Publication date (Electronic): 22 July 2016

Publication date PMC-release: 22 July 2016

Publication date Collection: 2016

Volume: 16

Electronic Location Identifier: 353

Affiliations

[ ]Department of Pathology and Laboratory Medicine, Aga Khan University, Stadium Road, Karachi, Pakistan

[ ]WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden

Article

Publisher ID: 1673

DOI: 10.1186/s12879-016-1673-1

PMC ID: 4957325

PubMed ID: 27449234

SO-VID: e0ea8ad7-3211-4efa-b362-68d4f33ce40f

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 13 March 2016

Date accepted : 27 June 2016

Custom metadata

ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: neisseria gonorrhoeae,gonorrhoea,antimicrobial resistance,antimicrobial resistance surveillance,extended-spectrum cephalosporins (escs),ceftriaxone,treatment,n. gonorrhoeae multiantigen sequence typing (ng-mast),pakistan

Data availability:

ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: neisseria gonorrhoeae, gonorrhoea, antimicrobial resistance, antimicrobial resistance surveillance, extended-spectrum cephalosporins (escs), ceftriaxone, treatment, n. gonorrhoeae multiantigen sequence typing (ng-mast), pakistan

Antimicrobial resistance and Neisseria gonorrhoeae multiantigen sequence typing (NG-MAST) genotypes in N. gonorrhoeae during 2012–2014 in Karachi, Pakistan

Read this article at

Abstract

Background

Methods

Results

Conclusions

Electronic supplementary material

Related collections

Point-Of-Care Testing for AMR

Most cited references 16

Antimicrobial resistance in Neisseria gonorrhoeae in the 21st century: past, evolution, and future.

Emergence of multidrug-resistant, extensively drug-resistant and untreatable gonorrhea.

Rapid sequence-based identification of gonococcal transmission clusters in a large metropolitan area.

Author and article information

Contributors

Journal

Affiliations

Article

History

Categories

Custom metadata

Comments

Comment on this article

Similar content 170

Cited by 4

Most referenced authors 185