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Antimicrobial Agents and Chemotherapy, October 2008, p. 3564-3567, Vol. 52, No. 10
0066-4804/08/$08.00+0     doi:10.1128/AAC.00198-08
Copyright © 2008, American Society for Microbiology. All Rights Reserved.

Ceftibuten Resistance and Treatment Failure of Neisseria gonorrhoeae Infection{triangledown}

Janice Y. C. Lo,1* K. M. Ho,2 Anna O. C. Leung,1 Felisa S. T. Tiu,1 Grand K. L. Tsang,1 Angus C. T. Lo,1 and John W. Tapsall3

Microbiology Division, Public Health Laboratory Services Branch,1 Social Hygiene Service, Public Health Services Branch, Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region,2 WHO Collaborating Centre for STD, Microbiology Department, South Eastern Area Laboratory Services, Prince of Wales Hospital, Sydney, New South Wales, Australia3

Received 11 February 2008/ Returned for modification 30 April 2008/ Accepted 22 July 2008

Neisseria gonorrhoeae infections have been empirically treated in Hong Kong with a single oral 400-mg dose of ceftibuten since 1997. Following anecdotal reports of the treatment failure of gonorrhea with oral extended-spectrum cephalosporins, the current study was undertaken to determine the antimicrobial susceptibility pattern and molecular characteristics of isolates of N. gonorrhoeae among patients with putative treatment failure in a sexually transmitted disease clinic setting. Between October 2006 and August 2007, 44 isolates of N. gonorrhoeae were studied from patients identified clinically to have treatment failure with empirical ceftibuten. The ceftibuten MICs for three strains were found to have been 8 mg/liter. These strains were determined by N. gonorrhoeae multiantigen sequence typing to belong to sequence type 835 (ST835) or the closely related ST2469. The testing of an additional eight archived ST835 strains revealed similarly elevated ceftibuten MICs. The penA gene sequences of these 11 isolates all had the mosaic pattern previously described as pattern X. Of note is that the ceftriaxone susceptibility results of these strains all fell within the susceptible range. It is concluded that ceftibuten resistance may contribute to the empirical treatment failure of gonorrhea caused by strains harboring the mosaic penA gene, which confers reduced susceptibility to oral extended-spectrum cephalosporins. Screening for such resistance in the routine clinical laboratory may be undertaken by the disk diffusion test. The continued monitoring of antimicrobial resistance and molecular characteristics of N. gonorrhoeae isolates is important to ensure that control and prevention strategies remain effective.

* Corresponding author. Mailing address: Microbiology Division, Public Health Laboratory Centre, 382 Nam Cheong Street, Shek Kip Mei, Kowloon, Hong Kong SAR. Phone: (852) 2319 8254. Fax: (852) 2776 5758. E-mail: janicelo{at}dh.gov.hk

{triangledown} Published ahead of print on 28 July 2008.

Antimicrobial Agents and Chemotherapy, October 2008, p. 3564-3567, Vol. 52, No. 10
0066-4804/08/$08.00+0     doi:10.1128/AAC.00198-08
Copyright © 2008, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

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