Sexually Transmitted Bacteria Reference Laboratory, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, UK.
J Antimicrob Chemother. 2011 Nov;66(11):2509-12. doi: 10.1093/jac/dkr332. Epub 2011 Aug 16.
The third-generation cephalosporins recommended in national guidelines are amongst the last remaining effective agents for treatment of gonorrhoea. This study characterizes gonococcal isolates with decreased cefixime susceptibility from England and Wales.
A total of 96 isolates of Neisseria gonorrhoeae exhibiting cefixime MICs of ≥0.125 mg/L, either collected as part of the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) between 2005 and 2008 (54 from a total of 4649 isolates) or referred to the national reference laboratory in 2008 and 2009 (42 isolates), were tested for susceptibility to a range of antimicrobial agents and were typed using N. gonorrhoeae multiantigen sequence typing (NG-MAST).
All 96 isolates were also resistant to tetracycline (MIC ≥2 mg/L) and ciprofloxacin (MIC ≥16 mg/L) and 56% showed low-level chromosomal resistance to penicillin. Where data were available, the mean patient age was 31 years, and 88% (83/94) of patients were men. Isolates referred through GRASP were predominantly from men who have sex with men (MSM; 29/44, 66%) and from patients of white British ethnicity (25/43, 58%). The majority of isolates belonged either to sequence type (ST) 1407 (71/96, 74%) or to a highly related ST that shares the tpbB allele (allele 110), but with a different por allele (20/96, 21%). ST1407 was found in both MSM (22/29, 76%) and heterosexual patients (12/15, 80%) and among all eight isolates from patients reporting sex abroad.
The emergence of a clonal group of gonococci showing decreased susceptibility to cefixime in England and Wales highlights the need for continued surveillance.
国家指南推荐的第三代头孢菌素是治疗淋病的最后几种有效药物之一。本研究描述了英国和威尔士分离的对头孢克肟敏感性降低的淋病奈瑟菌。
共收集了 96 株对头孢克肟 MIC 值≥0.125mg/L 的淋病奈瑟菌分离株，这些分离株要么是 2005 年至 2008 年期间作为抗菌药物耐药监测计划（GRASP）的一部分收集的（共 4649 株中的 54 株），要么是 2008 年和 2009 年提交给国家参考实验室的（42 株），对这些分离株进行了一系列抗菌药物敏感性检测，并使用淋病奈瑟菌多位点序列分型（NG-MAST）进行了分型。
所有 96 株分离株均对四环素（MIC≥2mg/L）和环丙沙星（MIC≥16mg/L）耐药，56%的分离株对青霉素表现出低水平的染色体耐药性。在有数据的情况下，患者的平均年龄为 31 岁，88%（83/94）的患者为男性。通过 GRASP 转介的分离株主要来自男男性接触者（MSM；29/44，66%）和白种英国人种（25/43，58%）的患者。大多数分离株属于 ST1407 型（71/96，74%）或与 tpbB 等位基因（等位基因 110）相同但 por 等位基因不同的高度相关 ST 型（20/96，21%）。ST1407 型在 MSM（22/29，76%）和异性恋患者（12/15，80%）以及所有 8 例国外性接触患者中均有发现。
英国和威尔士出现了对头孢克肟敏感性降低的淋病奈瑟菌克隆群，这突出表明需要持续监测。
