Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, Cardinal Tien Hospital, Taipei, Taiwan.
Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Laboratory Medicine, National Taiwan; University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
Int J Antimicrob Agents. 2018 May;51(5):768-774. doi: 10.1016/j.ijantimicag.2018.01.024. Epub 2018 Apr 3.
A high prevalence of gonococcal resistance to various antimicrobials and Neisseria gonorrhoeae isolates exhibiting resistance to extended-spectrum cephalosporins have been reported in the past few decades. A total of 226 N. gonorrhoeae isolates obtained from the National Taiwan University Hospital from 2001 to 2013 were evaluated. The minimum inhibitory concentrations (MICs) of the isolates to antimicrobials were determined by the agar dilution method and interpreted using the 2017 clinical breakpoints or epidemiological cut-off values recommended by the Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST). The genetic relatedness of these isolates was determined by multilocus sequence typing. None of the isolates was resistant to ceftriaxone and cefotaxime, and the resistance rates to cefixime, spectinomycin, cefpodoxime, ciprofloxacin, and penicillin were 0.4%, 0.4%, 13.3%, 91.6%, and 87.6%, respectively. The rate of isolates resistant to azithromycin was 14.6% (EUCAST criteria), which is higher than in previous surveillance studies. A total of 57 sequence types (ST) were identified, and ST1901, ST7365, and ST1927 prevailed. Isolates of ST8143 emerged after 2011. ST1901 isolates had relatively higher MIC values for ceftriaxone and azithromycin than those of the other STs. In conclusion, ceftriaxone remains an effective drug of choice for gonorrhoeal management in Taiwan. High rates of azithromycin resistance among N. gonorrhoeae isolates were found. The circulating ST1901 strains with high MIC values for ceftriaxone and azithromycin and the emerging ST8143 strains were alarming.
在过去的几十年中，已经报道了各种抗菌药物的淋病奈瑟菌耐药率高，以及对扩展谱头孢菌素耐药的淋病奈瑟菌分离株的出现。评估了 2001 年至 2013 年从台湾大学医院获得的总共 226 株淋病奈瑟菌分离株。采用琼脂稀释法测定分离株对抗微生物药物的最小抑菌浓度（MIC），并根据 2017 年临床折点或临床和实验室标准协会（CLSI）和欧洲抗菌药物敏感性测试委员会（EUCAST）推荐的流行病学临界值解释。这些分离株的遗传相关性通过多位点序列分型确定。没有分离株对头孢曲松和头孢噻肟耐药，对头孢克肟、壮观霉素、头孢泊肟、环丙沙星和青霉素的耐药率分别为 0.4%、0.4%、13.3%、91.6%和 87.6%。对阿奇霉素耐药的分离株率为 14.6%（EUCAST 标准），高于以往的监测研究。共鉴定出 57 种序列类型（ST），其中 ST1901、ST7365 和 ST1927 占主导地位。ST8143 分离株于 2011 年后出现。ST1901 分离株对头孢曲松和阿奇霉素的 MIC 值相对较高。总之，头孢曲松仍然是台湾淋病管理的有效首选药物。淋病奈瑟菌分离株对阿奇霉素的耐药率较高。具有较高头孢曲松和阿奇霉素 MIC 值的流行 ST1901 株和新出现的 ST8143 株令人警惕。
