Department of Clinical Microbiology, Karolinska University Hospital, Karolinska Institutet, SE-141 86, Stockholm, Sweden.
Eur J Clin Microbiol Infect Dis. 2023 Sep;42(9):1073-1079. doi: 10.1007/s10096-023-04633-6. Epub 2023 Jul 13.
The aim of this study was to investigate the genomic epidemiology and antimicrobial susceptibilities of N. gonorrhoeae isolates in Stockholm, Sweden. In total, 6723 isolates detected in Stockholm, Sweden, from January 2016 to September 2022, were examined for antimicrobial susceptibilities by using E-test. Whole-genome sequencing (WGS) was applied to isolates in sentinel surveillance and isolates resistant to extended-spectrum cephalosporins (ESCs) or high-level azithromycin (HLAzi-R, MIC ≥ 256 mg/L). As sentinel surveillance, consecutive clinical isolates (n = 396) detected every 4th week from January 2021 to September 2022 were enrolled in the study. Of the 6723 isolates investigated, 33 isolates (< 1%) were found to be resistant to cefixime, one of which was co-resistant to ceftriaxone and ciprofloxacin and was detected in September 2022. Ten isolates presented a high level of azithromycin resistance. Resistant rates to ciprofloxacin varied from 32 in 2017 to 68-69% in 2021-2022. Elevated MIC and MIC of azithromycin were observed over the years. No resistance to spectinomycin was identified. The most frequently occurring MLST in the sentinel surveillance was ST9362 (23%), followed by ST11706 (9%), ST7359 (8%), ST10314 (7%), and ST11422 (6%). The ceftriaxone-resistant isolate belonged to ST8130 and the novel NG-STAR ST4859. Genomic resistance traits found in this strain included mutations in genes mtrR (A39T), parC (S87N), and gyrA (S91F and D95A), as well as the presence of blaTEM-135 and tetM genes. A predominance of ST9362 was observed in Stockholm. The high number of azithromycin and ciprofloxacin-resistant isolates and the emergence of a strain with a novel NG-STAR are of great concern.
本研究旨在调查瑞典斯德哥尔摩地区淋病奈瑟菌的基因组流行病学和抗菌药物敏感性。研究共检测了 2016 年 1 月至 2022 年 9 月期间在瑞典斯德哥尔摩地区检出的 6723 株淋病奈瑟菌，采用 E 试验检测抗菌药物敏感性。全基因组测序（WGS）应用于哨点监测中的分离株和对头孢菌素类药物（ESCs）或高水平阿奇霉素（HLAzi-R，MIC≥256mg/L）耐药的分离株。作为哨点监测，本研究纳入了 2021 年 1 月至 2022 年 9 月每 4 周连续检测的临床分离株（n=396）。在研究的 6723 株分离株中，发现 33 株（<1%）对头孢克肟耐药，其中 1 株对头孢曲松和环丙沙星也耐药，该株分离株于 2022 年 9 月检出。10 株分离株表现出高水平的阿奇霉素耐药性。对环丙沙星的耐药率从 2017 年的 32%到 2021-2022 年的 68-69%不等。多年来，阿奇霉素的 MIC 和 MIC 值均升高。未发现对大观霉素的耐药性。哨点监测中最常见的 MLST 型别是 ST9362（23%），其次是 ST11706（9%）、ST7359（8%）、ST10314（7%）和 ST11422（6%）。头孢曲松耐药株属于 ST8130 和新型 NG-STAR ST4859。该菌株的基因组耐药特征包括 mtrR（A39T）、parC（S87N）和 gyrA（S91F 和 D95A）基因的突变，以及 blaTEM-135 和 tetM 基因的存在。ST9362 在斯德哥尔摩地区占优势。大量的阿奇霉素和环丙沙星耐药株的出现以及新型 NG-STAR 菌株的出现令人担忧。
