Public Health Laboratory Services Branch, Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region, China.
J Antimicrob Chemother. 2012 Jun;67(6):1422-6. doi: 10.1093/jac/dks036. Epub 2012 Feb 14.
To undertake laboratory and clinical surveillance of gonococcal antimicrobial susceptibility to various therapeutic agents in Hong Kong, so as to monitor for emerging resistance and to inform on appropriate choice of empirical therapy.
Trends in susceptibility of gonococci to ceftriaxone, spectinomycin, ceftibuten and azithromycin were monitored over time. Isolates with reduced susceptibility to oral extended-spectrum cephalosporins were further characterized by detection of the mosaic penA gene and typing by Neisseria gonorrhoeae multi-antigen sequence typing (NG-MAST). Correlation with clinical and epidemiological findings was undertaken on isolates positive for the mosaic penA gene.
Trends in susceptibility of gonococci to ceftriaxone, spectinomycin and ceftibuten remained stable between 2005 and 2010. In 2010, 30.3% of tested strains were not susceptible to azithromycin. The percentage of gonococcal strains harbouring the mosaic penA gene increased from 1.0% during April to December 2010 to 8.2% during January to September 2011 (P < 0.0001). Review of available clinical records showed that, out of 35 patients infected by strains positive for the mosaic penA gene, 30 had laboratory-documented treatment failure.
This study showed that ceftriaxone and spectinomycin remained effective against gonorrhoea in Hong Kong. There was an alarming increase in strains with reduced susceptibility to oral extended-spectrum cephalosporins associated with clinical treatment failure. One-third of gonococcal isolates were non-susceptible to azithromycin. The need to switch to agents other than oral extended-spectrum cephalosporins for empirical treatment is imminent. Continued surveillance with strain characterization is essential to monitor the effectiveness of currently recommended therapy.
在香港对各种治疗药物的淋病奈瑟菌的抗菌敏感性进行实验室和临床监测，以监测新出现的耐药性，并为经验性治疗提供适当的选择。
随着时间的推移，监测淋病奈瑟菌对头孢曲松、壮观霉素、头孢布烯和阿奇霉素的敏感性趋势。对口服扩展谱头孢菌素敏感性降低的分离株进一步通过检测镶嵌 penA 基因和淋病奈瑟菌多抗原序列分型（NG-MAST）进行特征描述。对镶嵌 penA 基因阳性的分离株进行与临床和流行病学发现的相关性研究。
2005 年至 2010 年期间，淋病奈瑟菌对头孢曲松、壮观霉素和头孢布烯的敏感性趋势保持稳定。2010 年，30.3%的测试菌株对阿奇霉素不敏感。携带镶嵌 penA 基因的淋病奈瑟菌菌株的比例从 2010 年 4 月至 12 月的 1.0%增加到 2011 年 1 月至 9 月的 8.2%（P<0.0001）。对现有临床记录的审查显示，在 35 名感染携带镶嵌 penA 基因的菌株的患者中，有 30 名患者的实验室治疗结果失败。
本研究表明，头孢曲松和壮观霉素在香港对淋病仍然有效。与临床治疗失败相关的，对口服扩展谱头孢菌素敏感性降低的菌株数量令人震惊地增加。三分之一的淋病奈瑟菌分离株对阿奇霉素不敏感。需要改用其他口服扩展谱头孢菌素以外的药物进行经验性治疗。继续进行菌株特征描述的监测对于监测目前推荐的治疗方法的有效性至关重要。
