Knapp J S, Wongba C, Limpakarnjanarat K, Young N L, Parekh M C, Neal S W, Buatiang A, Chitwarakorn A, Mastro T D
Division of AIDS, STD, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Sex Transm Dis. 1997 Mar;24(3):142-8. doi: 10.1097/00007435-199703000-00004.
Failure of uncomplicated gonococcal infections acquired in the Far East to respond to doses of ciprofloxacin and ofloxacin recommended by the Centers for Disease Control and Prevention have been identified in Australia, the United Kingdom, and the United States. In the Republic of the Philippines, 54.3% of strains exhibited decreased susceptibility to fluoroquinolones; 12% of strains were resistant to ciprofloxacin. This study was undertaken to compare the antimicrobial susceptibilities of gonococcal isolates in Bangkok, Thailand, with those in the Republic of the Philippines.
To determine the frequency and diversity of antimicrobial resistance, particularly to fluoroquinolones, in gonococcal strains in Bangkok, Thailand.
Strains of Neisseria gonorrhoeae isolated from 101 patients with uncomplicated gonorrhea in Bangkok, Thailand, in July, 1994 (46 strains) and November, 1994 to July, 1995 (55 strains), were characterized by auxotype/serovar class, antimicrobial susceptibilities, and plasmid profile. Susceptibilities were determined to penicillin G, tetracycline, ceftriaxone, cefixime, cefoxitin, ciprofloxacin, ofloxacin, norfloxacin, erythromycin, kanamycin, and thiamphenicol.
Of 101 strains, 89.1% (90/101) were resistant to penicillin or tetracycline. Plasmid-mediated resistance to penicillin or tetracycline was identified in 33.7% (34/101) of the isolates: penicillinase-producing Neisseria gonorrhoeae (17.8%; 18/101), tetracycline-resistant Neisseria gonorrhoeae (7.9%; 8/101), and penicillinase-producing/tetracycline-resistant Neisseria gonorrhoeae (7.9%; 8/101). Most penicillinase-producing strains (96.2%; 25/26) possessed the 4.4-megadalton (Md) beta-lactamase plasmid; one strain possessed the 3.2-Md beta-lactamase plasmid. Chromosomally mediated resistance to penicillin and tetracycline was exhibited by 51.5% (52/101) of strains, and 4.0% (4/101) were tetracycline resistant. All strains were susceptible to spectinomycin. Of 21.8% (22/101) strains exhibiting decreased susceptibility to ciprofloxacin (minimal inhibitory concentration [MIC] > or = 0.125 microgram/ml), one strain (ciprofloxacin MIC, 0.5 microgram/ml; ciprofloxacin inhibition zone diameter of 23 mm) had MICs of 2.0 and 8.0 micrograms/ml for ofloxacin and norfloxacin, respectively, indicating resistance to these agents. Decreased susceptibility to ciprofloxacin was identified in strains with chromosomally mediated resistance to penicillin or tetracycline and in penicillinase-producing strains.
In Bangkok, Thailand, gonococcal isolates exhibit resistance to penicillin, tetracycline, kanamycin, and thiamphenicol. Decreased susceptibility to fluoroquinolones is emerging in a variety of strains of N. gonorrhoeae. Thus, all gonococcal infections should be treated with antimicrobial therapies known to be active against all gonococcal strains to reduce the spread of strains exhibiting decreased susceptibilities to fluoroquinolones.
在澳大利亚、英国和美国，已发现从远东地区获得的单纯性淋球菌感染对美国疾病控制与预防中心推荐剂量的环丙沙星和氧氟沙星无反应。在菲律宾共和国，54.3%的菌株对氟喹诺酮类药物的敏感性降低；12%的菌株对环丙沙星耐药。本研究旨在比较泰国曼谷淋球菌分离株与菲律宾共和国淋球菌分离株的抗菌药敏性。
确定泰国曼谷淋球菌菌株中抗菌药物耐药性的频率和多样性，尤其是对氟喹诺酮类药物的耐药性。
1994年7月（46株）以及1994年11月至1995年7月（55株）从泰国曼谷101例单纯性淋病患者中分离出的淋病奈瑟菌菌株，通过辅助型/血清型分类、抗菌药敏性和质粒图谱进行特征分析。测定了对青霉素G、四环素、头孢曲松、头孢克肟、头孢西丁、环丙沙星、氧氟沙星、诺氟沙星、红霉素、卡那霉素和甲砜霉素的药敏性。
101株菌株中，89.1%（90/101）对青霉素或四环素耐药。在33.7%（34/101）的分离株中鉴定出质粒介导的对青霉素或四环素的耐药性：产青霉素酶淋病奈瑟菌（17.8%；18/101）、耐四环素淋病奈瑟菌（7.9%；8/101）以及产青霉素酶/耐四环素淋病奈瑟菌（7.9%；8/101）。大多数产青霉素酶菌株（96.2%；25/26）拥有4.4兆道尔顿（Md）的β-内酰胺酶质粒；一株菌株拥有3.2-Md的β-内酰胺酶质粒。51.5%（52/101）的菌株表现出染色体介导的对青霉素和四环素的耐药性，4.0%（4/101）对四环素耐药。所有菌株对大观霉素敏感。在21.8%（22/101）对环丙沙星敏感性降低（最低抑菌浓度[MIC]≥0.125微克/毫升）的菌株中，一株菌株（环丙沙星MIC为0.5微克/毫升；环丙沙星抑菌圈直径为23毫米）对氧氟沙星和诺氟沙星的MIC分别为2.0和8.0微克/毫升，表明对这些药物耐药。在具有染色体介导的对青霉素或四环素耐药性的菌株以及产青霉素酶菌株中发现了对环丙沙星敏感性降低的情况。
在泰国曼谷，淋球菌分离株对青霉素、四环素、卡那霉素和甲砜霉素耐药。多种淋病奈瑟菌菌株中对氟喹诺酮类药物的敏感性正在降低。因此，所有淋球菌感染都应用已知对所有淋球菌菌株有效的抗菌疗法进行治疗，以减少对氟喹诺酮类药物敏感性降低的菌株的传播。
