Department of Medical Microbiology, Post Graduate Institute of MedicalEducation and Research, Chandigarh, India.
BMC Infect Dis. 2013 Jan 24;13:35. doi: 10.1186/1471-2334-13-35.
Knowledge on antimicrobial drug resistance and genetic characteristics of Neisseria gonorrhoeae isolates circulating in India, Pakistan, and Bhutan is sorely lacking. In this paper, we describe the prevalence of antimicrobial resistance and molecular characteristics of N. gonorrhoeae isolates from India, Pakistan, and Bhutan in 2007-2011.
Antimicrobial susceptibility and β-lactamase production were tested for 65 N. gonorrhoeae isolates from India (n=40), Pakistan (n=18) and Bhutan (n=7) using Etest methodology (eight antimicrobials) and nitrocefin solution, respectively. Resistance determinants, i.e. penA, mtrR, porB1b, gyrA, and parC, were sequenced. N. gonorrhoeae multiantigen sequence typing (NG-MAST) was performed for molecular epidemiology.
The highest resistance level was observed for ciprofloxacin (94%), followed by penicillin G (68%), erythromycin (62%), tetracycline (55%), and azithromycin (7.7%). All the isolates were susceptible to ceftriaxone, cefixime, and spectinomycin. Thirty-four (52%) of the isolates were producing β-lactamase. No penA mosaic alleles or A501-altered alleles of penicillin-binding protein 2 were identified. Forty-nine NG-MAST STs were identified, of which 42 STs have not been previously described worldwide.
Based on this study, ceftriaxone, cefixime, and spectinomycin can be used as an empirical first-line therapy for gonorrhoea in India, Pakistan, and Bhutan, whereas ciprofloxacin, penicillin G, tetracycline, erythromycin, and azithromycin should not be. It is imperative to strengthen the laboratory infrastructure in this region, as well as to expand the phenotypic and genetic surveillance of antimicrobial resistance, emergence of new resistance, particularly, to extended-spectrum cephalosporins, and molecular epidemiology.
印度、巴基斯坦和不丹对流行的淋病奈瑟菌分离株的抗菌药物耐药性和遗传特征知之甚少。本文描述了 2007-2011 年印度、巴基斯坦和不丹淋病奈瑟菌分离株的抗菌药物耐药性和分子特征。
采用 Etest 法（8 种抗菌药物）和硝基头孢菌素溶液分别检测来自印度（n=40）、巴基斯坦（n=18）和不丹（n=7）的 65 株淋病奈瑟菌分离株的抗菌药物敏感性和β-内酰胺酶产生情况。测序耐药决定因子 penA、mtrR、porB1b、gyrA 和 parC。进行淋病奈瑟菌多抗原序列分型（NG-MAST）以进行分子流行病学研究。
最高的耐药水平见于环丙沙星（94%），其次是青霉素 G（68%）、红霉素（62%）、四环素（55%）和阿奇霉素（7.7%）。所有分离株均对头孢曲松、头孢克肟和大观霉素敏感。34 株（52%）分离株产β-内酰胺酶。未发现 penA 马赛克等位基因或青霉素结合蛋白 2 的 A501 改变等位基因。共鉴定出 49 种 NG-MAST ST，其中 42 种 ST 以前在全球尚未被描述。
根据本研究，头孢曲松、头孢克肟和大观霉素可作为印度、巴基斯坦和不丹淋病的经验性一线治疗药物，而环丙沙星、青霉素 G、四环素、红霉素和阿奇霉素不应使用。该地区必须加强实验室基础设施建设，并扩大对抗菌药物耐药性、新耐药性出现的表型和遗传监测，特别是对扩展谱头孢菌素的监测，以及分子流行病学监测。
