High Prevalence of Azithromycin-Resistant Neisseria gonorrhoeae Isolates With a Multidrug Resistance Phenotype in Fukuoka, Japan. Issue 6 (June 2015)

• Record Type: Journal Article
• Authors: Tanaka, Masatoshi; Furuya, Ryusaburo; Irie, Shinichiro; Kanayama, Akiko; Kobayashi, Intetsu
• Is Part Of: Sexually transmitted diseases. Volume 42:Issue 6(2015)
• Publication Date: 2015-06
• Subjects: Sexually transmitted diseases -- Periodicals; Sexual health -- Periodicals; 616.951005
• DOI: 10.1097/OLQ.0000000000000279
• Languages: English
• ISSNs: 0148-5717

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background</title> <p>The current guidelines recommend a combination of ceftriaxone and azithromycin as a first-line treatment of gonorrhea in the United States and Europe. Despite not being recommended as a first-line regimen in Japan, an oral 2-g dose of azithromycin did become available for gonococcal infections in 2009. Recently, the emergence of azithromycin-resistant <italic>Neisseria gonorrhoeae</italic> isolates has been reported in several countries, including Japan.</p> </sec> <sec> <title>Methods</title> <p>Antimicrobial susceptibility testing was performed on a total of 677 clinical isolates of <italic>N. gonorrhoeae</italic> obtained from January 2010 to December 2013 in Fukuoka, Japan. A molecular analysis by <italic>N. gonorrhoeae</italic> multiantigen sequence typing was conducted on the azithromycin-resistant isolates.</p> </sec> <sec> <title>Results</title> <p>The proportion of azithromycin-resistant isolates (minimum inhibitory concentration > 0.5 μg/mL) increased significantly from 1.8% in 2010 to 22.6% in 2013 (<italic>P</italic> < 0.001). Among 50 azithromycin-resistant isolates, 30 (60%) exhibited a resistant phenotype to multiple drugs including cefixime. The 2 predominant sequence types (STs) identified by <italic>N. gonorrhoeae</italic> multiantigen sequence typing were ST6798 (<italic>por</italic> allele 4033 and <italic>tbpB</italic> allele 110) and ST1407 (<italic>por</italic> allele 908 and <italic>tbpB</italic> allele 110) at 40.0% (20/50) and 12.0% (6/50), respectively. There was a statistically significant increase of the proportion of ST6798 from 0% (0/19) in 2010–2012 to 64.5% (20/31) in 2013 (<italic>P</italic> < 0.001).</p> </sec> <sec> <title>Conclusions</title> <p>Over the previous 4 years, an increasing prevalence of azithromycin-resistant <italic>N. gonorrhoeae</italic> isolates with a multidrug-resistant phenotype was observed. Furthermore, the azithromycin-resistant isolates seemed to belong to 2 predominant STs. As a result, continued surveillance of gonococci resistant to antimicrobial agents, including azithromycin in Fukuoka, Japan, is necessary.</p> </sec> </abstract>