Trees D L, Sandul A L, Neal S W, Higa H, Knapp J S
Division of Sexually Transmitted Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Sex Transm Dis. 2001 Jun;28(6):309-14. doi: 10.1097/00007435-200106000-00001.
Clinically significant resistance to Centers for Disease Control and Prevention (CDC)-recommended doses of fluoroquinolones (ciprofloxacin and ofloxacin) has been reported for Neisseria gonorrhoeae. In Hawaii, fluoroquinolone-resistant gonococcal isolates were first identified in 1991.
To assess the diversity, based on phenotypic and genotypic characterization, of gonococcal isolates exhibiting decreased susceptibility (CipI; MICs = 0.125-0.5 microg/ml) or clinically significant resistance (CipR; MICs > or = 1 microg/ml) to ciprofloxacin in Hawaii from 1991 through 1999.
Antimicrobial susceptibilities, auxotype/serovar (A/S) class, GyrA/ParC alteration patterns, and plasmid profiles were determined for gonococci isolated in Honolulu from 1991 through 1999 that exhibited intermediate or clinically significant resistance to ciprofloxacin. Strain phenotypes were defined by A/S class, GyrA/ParC alteration pattern, and penicillin-tetracycline resistance phenotype supplemented with plasmid profiles for beta-lactamase-producing isolates.
Altogether, 68 isolates exhibiting intermediate or clinically significant resistance to ciprofloxacin belonged to 23 and 19 strain phenotypes, respectively. Among the CipI and CipR isolates, 4 and 13 GyrA/ParC alterations patterns were identified, respectively. The 91,95/Asp-86 alteration pattern occurred most frequently among CipR isolates. Forty-four strain phenotypes were represented by only one isolate. In addition, seven pairs and two clusters of isolates were identified.
From 1991 through 1997, few gonococcal strains exhibiting intermediate or clinically significant resistance to CDC-recommended doses of fluoroquinolones were identified from Hawaii. Isolates belonged to a large number of phenotypic and genotypic types, suggesting that most cases were imported, with only a few instances in which isolate pairs indicated that secondary transmission of infections had occurred in Hawaii. Beginning in 1998, the number of CipR isolates increased markedly, and more isolates belonged to fewer phenotypic and genotypic types, suggesting either more frequent importation of fewer strain types or the possibility that the endemic spread of a few strains is beginning to occur.
据报道，淋病奈瑟菌对美国疾病控制与预防中心（CDC）推荐剂量的氟喹诺酮类药物（环丙沙星和氧氟沙星）产生了具有临床意义的耐药性。在夏威夷，1991年首次发现了耐氟喹诺酮类的淋球菌分离株。
基于表型和基因型特征，评估1991年至1999年期间夏威夷对环丙沙星敏感性降低（CipI；最低抑菌浓度[MICs]=0.125 - 0.5微克/毫升）或具有临床意义耐药性（CipR；MICs≥1微克/毫升）的淋球菌分离株的多样性。
对1991年至1999年在檀香山分离出的对环丙沙星表现出中度或具有临床意义耐药性的淋球菌，测定其抗菌药物敏感性、辅助型/血清型（A/S）类别、GyrA/ParC改变模式和质粒图谱。菌株表型由A/S类别、GyrA/ParC改变模式以及青霉素 - 四环素耐药表型定义，并补充产β-内酰胺酶分离株的质粒图谱。
总共68株对环丙沙星表现出中度或具有临床意义耐药性的分离株分别属于23种和19种菌株表型。在CipI和CipR分离株中，分别鉴定出4种和13种GyrA/ParC改变模式。91,95/Asp - 86改变模式在CipR分离株中出现频率最高。4种菌株表型仅由1株分离株代表。此外，鉴定出7对和2个分离株簇。
1991年至1997年期间，夏威夷很少发现对CDC推荐剂量氟喹诺酮类药物表现出中度或具有临床意义耐药性的淋球菌菌株。分离株属于大量的表型和基因型类型，这表明大多数病例是输入性的，只有少数病例中分离株对表明夏威夷发生了感染的二次传播。从1998年开始，CipR分离株数量显著增加，更多分离株属于较少的表型和基因型类型，这表明要么是较少菌株类型的输入更频繁，要么是少数菌株的本地传播开始发生。
