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Antimicrobial Agents and Chemotherapy, January 2005, p. 137-143, Vol. 49, No. 1
0066-4804/05/$08.00+0     doi:10.1128/AAC.49.1.137-143.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

Emergence and Spread of Neisseria gonorrhoeae Clinical Isolates Harboring Mosaic-Like Structure of Penicillin-Binding Protein 2 in Central Japan

Masayasu Ito,1 Takashi Deguchi,1* Koh-Suke Mizutani,1 Mitsuru Yasuda,1 Shigeaki Yokoi,1 Shin-Ichi Ito,1 Yoshito Takahashi,1 Satoshi Ishihara,1 Yoshiaki Kawamura,2 and Takayuki Ezaki2

Departments of Urology,1 Microbiology, Gifu University School of Medicine, Gifu, Japan2

Received 12 May 2004/ Returned for modification 3 August 2004/ Accepted 26 September 2004

Of 150 clinical isolates of Neisseria gonorrhoeae recovered in 2001, we examined 55 clinical isolates of N. gonorrhoeae for which cefixime MICs were ≥0.125 µg/ml and randomly selected 15 isolates for which cefixime MICs were ≤0.06 µg/ml for analysis of alterations in the penicillin-binding protein 2 (PBP 2) gene. We found insertion of an extra codon (Asp-345a) in the transpeptidase domain of PBP 2, and this insertion occurred alone or in conjunction with other amino acid substitutions. We also found a mosaic PBP 2 that was composed of fragments of the PBP 2 proteins from Neisseria cinera and Neisseria perflava. This mosaic PBP 2 was significantly associated with decreased susceptibilities to penicillin and cephalosporins, especially oral cephalosporins. For most of the isolates with a mosaic PBP 2, the cefixime MICs were ≥0.5 µg/ml and the cefdinir MICs were ≥1 µg/ml. Analysis of chromosomal DNA restriction patterns by pulsed-field gel electrophoresis revealed that most isolates with the mosaic PBP 2 were genetically similar. The recombination events that generated the mosaic PBP 2 would likely have contributed to the decreased sensitivities to cephalosporins. Isolates with the mosaic PBP 2 appear to threaten the efficacy of the currently recommended regimen with cefixime. The emergence of such strains may be the result of the in vivo generation of clones in which interspecies recombination occurred between the penA genes of N. gonorrhoeae and commensal Neisseria species.

* Corresponding author. Mailing address: Department of Urology, Gifu University School of Medicine, 1-1 Yanagido, Gifu City 501-1194, Japan. Phone: 81-58-230-6337. Fax: 81-58-230-6339. E-mail: deguchit{at}cc.gifu-u.ac.jp.

Antimicrobial Agents and Chemotherapy, January 2005, p. 137-143, Vol. 49, No. 1
0066-4804/05/$08.00+0     doi:10.1128/AAC.49.1.137-143.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.



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