Charles R. Drew University of Medicine and Sciences.
Department of Medicine, David Geffen School of Medicine.
Clin Infect Dis. 2020 Mar 3;70(6):1169-1175. doi: 10.1093/cid/ciz365.
Neisseria gonorrhoeae (NG) infections are a global health burden. NG resistance to cephalosporins, which is increasingly reported, is an imminent threat to public health. Many hypothesize that commensal Neisseria species are an important reservoir for genetic material conferring antimicrobial resistance in NG; however, clinical data are lacking.
Men who have sex with men (MSM) in Hanoi, Vietnam, completed a questionnaire regarding antibiotic use. We collected pharyngeal specimens, cultured Neisseria species, and measured minimum inhibitory concentrations (MICs) to ciprofloxacin, cefixime, ceftriaxone, and cefpodoxime. Using MIC criteria for antimicrobial susceptibility in NG, we categorized the Neisseria species and compared mean MIC levels between different antibiotic user groups.
Of 207 participants, 38% used at least 1 antibiotic in the past 6 months; 52% without a prescription. A median of 1 Neisseria species was cultured from each participant (range, 1-4) with 10 different Neisseria species identified overall. The proportion of Neisseria with reduced susceptibility to ciprofloxacin was 93%, cefpodoxime 84%, cefixime 31%, and ceftriaxone 28%. Antibiotic use within the past month was strongly associated with Neisseria species having increased MICs to cefixime, ceftriaxone, and cefpodoxime (mean MIC ratios of 6.27, 4.11, and 7.70, respectively), compared with those who used antibiotics between 1 and 6 months prior (P < .05, all comparisons).
MSM in our study often used antibiotics without a prescription. At least 1 commensal Neisseria species colonized all men. Recent use of any antibiotics may select for oropharyngeal Neisseria species with antimicrobial resistance. The normal flora of the oropharynx may be an important source of antimicrobial resistance in Neisseria gonorrhoeae.
淋病奈瑟菌（NG）感染是全球健康负担。NG 对头孢菌素的耐药性越来越受到关注，这对公共健康构成了严重威胁。许多人假设共生奈瑟菌是赋予 NG 抗微生物药物耐药性的遗传物质的重要储库；然而，临床数据却缺乏。
越南河内的男男性行为者（MSM）完成了一份关于抗生素使用的问卷。我们采集了咽拭子标本，培养了奈瑟菌属，并测量了环丙沙星、头孢克肟、头孢曲松和头孢泊肟的最小抑菌浓度（MIC）。根据 NG 中抗微生物药物敏感性的 MIC 标准，我们对奈瑟菌属进行了分类，并比较了不同抗生素使用者组之间的平均 MIC 水平。
在 207 名参与者中，38%的人在过去 6 个月内至少使用了 1 种抗生素；52%的人没有处方。每位参与者培养出的奈瑟菌中位数为 1 种（范围为 1-4 种），总共鉴定出 10 种不同的奈瑟菌属。对环丙沙星、头孢泊肟、头孢克肟和头孢曲松的敏感性降低的奈瑟菌属比例分别为 93%、84%、31%和 28%。与在过去 1 个月内使用抗生素的参与者相比，在过去 1 至 6 个月内使用抗生素的参与者的奈瑟菌属对头孢克肟、头孢曲松和头孢泊肟的 MIC 增加（分别为平均 MIC 比值 6.27、4.11 和 7.70），差异有统计学意义（P<0.05，所有比较）。
我们研究中的 MSM 经常在没有处方的情况下使用抗生素。至少有 1 种共生奈瑟菌定植于所有男性。最近使用任何抗生素都可能选择具有抗微生物药物耐药性的口咽部奈瑟菌属。口咽部的正常菌群可能是淋病奈瑟菌抗微生物药物耐药性的重要来源。
