Susceptibility of to Zoliflodacin and Quinolones in Hyogo Prefecture, Japan.

The DNA synthesis inhibitor zoliflodacin (ZFD) is expected to be effective against strains resistant to therapeutic agents for infection. In addition to ZFD, we investigated the susceptibility of strains to ceftriaxone (CTRX), ciprofloxacin (CPFX), garenoxacin (GRNX), and sitafloxacin (STFX). Minimum inhibitory concentration values for ZFD and four other drugs were determined for 147 strains of isolated at medical institutions in Hyogo Prefecture, Japan, from 2015 to 2022. Amino acid alterations in , , , and were examined by polymerase chain reaction and sequencing analysis. Sequence type (ST) was determined for epidemiological analysis, and strains were classified. The non-susceptibility rate was not observed in CTRX. The lowest non-susceptibility rate was observed in ZFD (39.5%) compared to CPFX (80.3%), GRNX (83.7%), and STFX (65.3%) (all < 0.0001). The most common amino acid alterations in and had non-susceptibility rates exceeding 80% to quinolones except ZFD, suggesting that these alterations may have influenced the resistance trend. STs were different between isolates in 2015 and those in 2020 and later. ZFD showed potent antimicrobial activity against strains that are highly resistant to quinolones. It may become a new option in the treatment of gonococcal infections.