Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Division of HIV, STD, and Viral Hepatitis Prevention, Indiana Department of Health, Indianapolis, Indiana, USA.
Clin Infect Dis. 2021 Sep 7;73(5):808-815. doi: 10.1093/cid/ciab132.
Since 2014, Neisseria gonorrhoeae azithromycin (AZM) susceptibility has declined in the United States, but high-level AZM resistance (HL-AZMR) has been infrequent and sporadic. We describe a cluster of 14 N. gonorrhoeae isolates with HL-AZMR identified in Indianapolis over 13 months.
N. gonorrhoeae culture specimens (genital and extragenital) were collected from attendees of the Bell Flower Clinic. Isolates underwent antimicrobial susceptibility testing (AST) using Etest. AZM minimum inhibitory concentrations ≥256 µg/mL were classified as HL-AZMR. Local disease intervention specialists interviewed patients whose isolates demonstrated HL-AZMR and conducted partner services. Relatedness of isolates was investigated by genomic analyses.
During 2017-2018, AST was performed in 1016 N. gonorrhoeae isolates collected at the Bell Flower Clinic. Fourteen isolates (1.4%) from 12 men collected over 13 months demonstrated HL-AZMR; all were cephalosporin susceptible. Of the 12 men, 9 were white and reported male sex partners. Nine of the men were able to be retested; all were cured with 250-mg ceftriaxone plus 1-g AZM. Two men named each other as partners; no other partners in common were reported. Genomic analysis demonstrated close relatedness of the HL-AZMR isolates and a novel combination of a mosaic-mtrR promoter along with 23S ribosomal RNA mutations that appear to have emerged from circulating strains.
The close genetic relatedness with limited epidemiologic linkages between patients highlights the challenges of gonorrhea partner investigations and suggests undetected local transmission. Local AST, rapid public health action, and epidemiologic investigations combined with genomic analysis provides a multipronged approach to understanding an outbreak of sexually transmitted disease.
自 2014 年以来，美国淋病奈瑟菌对阿奇霉素（AZM）的敏感性下降，但高水平 AZM 耐药（HL-AZMR）罕见且呈散发性。我们描述了在印第安纳波利斯发现的 14 株淋病奈瑟菌 HL-AZMR 分离株的聚集。
从贝尔花诊所的患者中采集淋病奈瑟菌培养标本（生殖和非生殖）。使用 Etest 对分离物进行抗菌药物敏感性试验（AST）。AZM 最低抑菌浓度≥256µg/mL 被归类为 HL-AZMR。当地疾病干预专家采访了分离物显示 HL-AZMR 的患者，并提供了伴侣服务。通过基因组分析研究了分离物的相关性。
在 2017-2018 年期间，在贝尔花诊所采集的 1016 株淋病奈瑟菌分离物中进行了 AST。12 名男性在 13 个月内采集的 14 株（1.4%）分离物显示 HL-AZMR；所有分离物均对头孢菌素敏感。在 12 名男性中，9 名是白人，报告有男性性伴侣。9 名男性能够接受再次检测；所有患者均用 250mg 头孢曲松加 1g AZM 治愈。两名男性互相指认为伴侣；没有报告其他共同的伴侣。基因组分析表明，HL-AZMR 分离物密切相关，以及一种新型的 mtrR 启动子马赛克与 23S 核糖体 RNA 突变的组合，似乎源自循环株。
患者之间遗传上的密切关系与有限的流行病学联系突出了淋病伴侣调查的挑战，并表明存在未被发现的本地传播。局部 AST、快速公共卫生行动以及结合基因组分析的流行病学调查提供了一种多管齐下的方法来了解性传播疾病的爆发。
