Department of Microbiology and Parasitology, School of Medicine, Zhejiang University, Hangzhou, China.
Department of Infectious Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
J Antimicrob Chemother. 2021 Mar 12;76(4):936-939. doi: 10.1093/jac/dkaa526.
Ceftriaxone is currently the last-remaining empirical antimicrobial therapy for treatment of gonorrhoea. However, the high-level ceftriaxone-resistant gonococcal FC428 clone has shown transmission in China in recent years. Therefore, the aim of this study was to analyse ceftriaxone resistance among a collection of recent clinical isolates, with a specific focus on prevalence of the FC428 clone.
A total of 70 consecutive gonococcal isolates were collected between May and October 2019 from a single hospital in Hangzhou, China, and analysed for antimicrobial susceptibility by the agar dilution method. STs were determined by PCR and sequences and isolates related to the FC428 clone were further characterized by WGS and phylogenetic analysis.
Ceftriaxone resistance (MIC >0.125 mg/L) was observed in 21 (30%) isolates, while 14 (20%) isolates displayed a ceftriaxone MIC of 0.125 mg/L. Importantly, seven (10%) isolates were related to the gonococcal FC428 clone based on the presence of mosaic penA allele 60.001, displaying identical or closely related STs, and phylogenetic analysis after WGS. These seven isolates displayed high-level ceftriaxone resistance (MIC = 1 mg/L) and all associated gonorrhoea cases resulted in treatment failure because oral cephalosporins were initially prescribed. Subsequent re-treatment with a higher dose (2 g) of IV ceftriaxone appeared to be successful because all patients returning for test-of-cure became culture-negative.
Here, we report a high percentage of the internationally spreading gonococcal FC428 clone among clinical isolates from a single hospital in Hangzhou, China. A high dose of ceftriaxone is currently the only recommended and effective therapy.
头孢曲松目前是治疗淋病的最后一种经验性抗菌治疗药物。然而，近年来高水平头孢曲松耐药淋病 FC428 克隆已在中国传播。因此，本研究旨在分析最近收集的一组临床分离株中的头孢曲松耐药性，特别关注 FC428 克隆的流行情况。
2019 年 5 月至 10 月，从中国杭州的一家医院连续采集了 70 株淋病奈瑟菌分离株，采用琼脂稀释法进行抗菌药物敏感性分析。通过 PCR 确定 ST 型，对与 FC428 克隆相关的序列和分离株进行 WGS 和系统发育分析。
21 株（30%）分离株对头孢曲松耐药（MIC >0.125mg/L），14 株（20%）分离株对头孢曲松的 MIC 为 0.125mg/L。重要的是，基于 mosaic penA 等位基因 60.001 的存在，7 株（10%）分离株与淋病奈瑟菌 FC428 克隆有关，它们具有相同或密切相关的 ST 型，并在 WGS 后进行系统发育分析。这 7 株分离株对头孢曲松显示高水平耐药性（MIC=1mg/L），所有相关淋病病例均因最初处方口服头孢菌素而导致治疗失败。随后改用更高剂量（2g）的 IV 头孢曲松进行再治疗似乎是成功的，因为所有返回进行治愈性检测的患者均转为培养阴性。
本研究报告了在中国杭州的一家医院的临床分离株中，国际传播的淋病奈瑟菌 FC428 克隆的比例很高。目前，高剂量头孢曲松是唯一推荐和有效的治疗方法。
