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Mechanisms of Resistance

Emergence and Spread of Neisseria gonorrhoeae Strains with High-Level Resistance to Azithromycin in Taiwan from 2001 to 2018

Yen-Hung Liu, Ya-Hui Wang, Chun-Hsing Liao, Po-Ren Hsueh
Yen-Hung Liu
Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, TaiwanDepartment of Internal Medicine, Cardinal Tien Hospital, Taipei, Taiwan
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Ya-Hui Wang
Medical Research Center, Cardinal Tien Hospital and School of Medicine, Taipei, TaiwanCollege of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
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Chun-Hsing Liao
Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei County, TaiwanDepartment of Medicine, Yang-Ming University, Taipei, Taiwan
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Po-Ren Hsueh
Department of Laboratory Medicine, College of Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, TaiwanDepartment of Internal Medicine, College of Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
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DOI: 10.1128/AAC.00773-19
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ABSTRACT

A total of 598 Neisseria gonorrhoeae isolates obtained from patients in Taiwan from 2001 to 2018 were evaluated. The MICs of ceftriaxone (CRO) and azithromycin (AZM) against the isolates were determined by the agar dilution method. N. gonorrhoeae isolates with AZM MICs of ≥1 μg/ml were identified and characterized by the presence of AZM resistance determinants. For high-level AZM-resistant (AZM-HLR) isolates (MIC ≥ 256 μg/ml), genotyping was performed using multilocus sequence typing (MLST) and N. gonorrhoeae multiantigen sequence typing (NG-MAST). Among the N. gonorrhoeae isolates studied, 8.7% (52/598) exhibited AZM MICs of ≥1 μg/ml. Thirteen of the 52 isolates contained A2059G (23S rRNA NG-STAR type 1) or C2611T (23S rRNA NG-STAR type 2) mutations. The prevalence of the A2059G mutation was higher in AZM-HLR isolates (P < 0.001). The −35A deletion in the promoter region of the mtrR gene did not differ between AZM-HLR isolates (100%, 10/10) and the isolates with AZM MICs of 1 μg/ml to 64 μg/ml (95.2%, 40/42) (P = 1.000). The presence of mutations in the mtrR coding region was significantly different between these two groups at 90% (9/10) and 26.2% (11/42), respectively (P < 0.001). The AZM-HLR isolates, all carrying four mutated A2059G alleles, a −35A deletion, and G45D, were classified as MLST 12039/10899 and NG-MAST 1866/16497. In conclusion, Taiwan is among the countries reporting gonococci with high-level resistance to AZM so that a single dose of 1 g ceftriaxone intramuscularly as the first choice for management of N. gonorrhoeae infection should be evaluated.

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Emergence and Spread of Neisseria gonorrhoeae Strains with High-Level Resistance to Azithromycin in Taiwan from 2001 to 2018
Yen-Hung Liu, Ya-Hui Wang, Chun-Hsing Liao, Po-Ren Hsueh
Antimicrobial Agents and Chemotherapy Aug 2019, 63 (9) e00773-19; DOI: 10.1128/AAC.00773-19

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Emergence and Spread of Neisseria gonorrhoeae Strains with High-Level Resistance to Azithromycin in Taiwan from 2001 to 2018
Yen-Hung Liu, Ya-Hui Wang, Chun-Hsing Liao, Po-Ren Hsueh
Antimicrobial Agents and Chemotherapy Aug 2019, 63 (9) e00773-19; DOI: 10.1128/AAC.00773-19
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KEYWORDS

Neisseria gonorrhoeae
Taiwan
azithromycin resistance
ceftriaxone

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