Department of Laboratory Medicine, Kwandong University College of Medicine, Goyang, Korea.
Sex Transm Dis. 2011 Nov;38(11):1082-6. doi: 10.1097/OLQ.0b013e31822e60a4.
The recent emergence and spread of antimicrobial-resistant Neisseria gonorrhoeae has compromised treatment and control of gonorrhea. We determined recent trends in antimicrobial susceptibility of the isolates, analyzed recent use of antigonococcal agents, and investigated the relationship between fluoroquinolone nonsusceptibility and amino acid substitutions within the fluoroquinolone resistance-determining regions in Korea.
The antimicrobial susceptibilities of 977 isolates of N. gonorrhoeae collected from 2000 to 2006 in Korea were determined with penicillin, ceftriaxone, spectinomycin, tetracycline, and ciprofloxacin disks. Some of the randomly selected isolates were tested by the Clinical and Laboratory Standards Institute agar dilution method, to determine subtle changes in susceptibility to the above antibiotics and cefixime. β-lactamase was detected using a cefinase disk.
All of the isolates exhibited plasmid- or chromosomally mediated resistance to penicillin; however, the proportions of penicillinase-producing N. gonorrhoeae decreased rapidly from 64% in 2000 to 21% in 2006. All isolates were susceptible to third-generation cephalosporins, except for 1 isolate that was not susceptible to cefixime. The proportion of ciprofloxacin-resistant isolates increased from 26% in 2000 to 83% in 2006. Of 7 substitution types, 5 (Ser-91-Phe in Gyrase A (GyrA), Ser-87-Arg in ParC subunit of topoisomerase IV (ParC); Ser-91-Phe and Asp-95-Ala in GyrA, and Ser-87-Asn in ParC; Ser-91-Phe and Asp-95-Gly in GyrA, and Asp-86-Asn in ParC; Ser-91-Tyr in GyrA; Ser-91-Phe in GyrA, and Asp-86-Asn in ParC) were new ones not identified in our 2004 study. All isolates were susceptible to spectinomycin. About half of the patients in our current study (52.6%-58.1%, depending on the year) received spectinomycin treatment. Majorities were resistant to tetracycline, and the rate of highly tetracycline-resistant N. gonorrhoeae increased from 3% in 2000 to 9% in 2006.
The incidence of penicillinase-producing N. gonorrhoeae declined significantly, but none of the isolates were susceptible to penicillin G. All isolates were susceptible to spectinomycin, in contrast majority were resistant to tetracycline. Inappropriate use of fluoroquinolone was frequent. The minimum inhibitory concentrations of ceftriaxone were within the susceptible range for all isolates, but those of cefixime were slightly higher, and it was 0.5 μg/mL (nonsusceptible) for 1 isolate.
最近出现和传播的耐抗生素淋病奈瑟菌已经影响了淋病的治疗和控制。我们确定了最近淋病奈瑟菌分离株的抗生素敏感性趋势，分析了最近抗淋病药物的使用情况，并调查了韩国氟喹诺酮类药物不敏感与氟喹诺酮耐药决定区氨基酸取代之间的关系。
2000 年至 2006 年期间，在韩国收集了 977 株淋病奈瑟菌的分离株，使用青霉素、头孢曲松、壮观霉素、四环素和环丙沙星药敏纸片检测其抗菌敏感性。随机选择部分分离株，用临床和实验室标准协会琼脂稀释法检测上述抗生素和头孢克肟敏感性的细微变化。使用头孢菌素酶纸片检测β-内酰胺酶。
所有分离株均表现出对青霉素的质粒或染色体介导的耐药性；然而，产青霉素酶淋病奈瑟菌的比例从 2000 年的 64%迅速下降到 2006 年的 21%。除 1 株对头孢克肟不敏感外，所有分离株均对第三代头孢菌素敏感。2000 年至 2006 年间，环丙沙星耐药分离株的比例从 26%增加到 83%。在 7 种取代类型中，有 5 种（GyrA 中的 Ser-91-Phe 和 ParC 亚单位拓扑异构酶 IV 的 Ser-87-Arg；GyrA 中的 Ser-91-Phe 和 Asp-95-Ala，以及 ParC 中的 Ser-87-Asn；GyrA 中的 Ser-91-Phe 和 Asp-95-Gly，以及 ParC 中的 Asp-86-Asn；GyrA 中的 Ser-91-Tyr；GyrA 中的 Ser-91-Phe 和 ParC 中的 Asp-86-Asn）是我们 2004 年研究中未发现的新类型。所有分离株均对大观霉素敏感。我们目前的研究中有一半左右的患者（取决于年份，为 52.6%-58.1%）接受了大观霉素治疗。大多数分离株对四环素耐药，高度耐四环素淋病奈瑟菌的比例从 2000 年的 3%增加到 2006 年的 9%。
产青霉素酶淋病奈瑟菌的发病率显著下降，但没有分离株对青霉素 G 敏感。所有分离株均对大观霉素敏感，而大多数对四环素耐药。氟喹诺酮类药物的使用不当很常见。所有分离株的头孢曲松最小抑菌浓度均在敏感范围内，但头孢克肟的最小抑菌浓度略高，其中 1 株为 0.5μg/ml（不敏感）。
