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J Antimicrob Chemother. 2016 Nov;71(11):3109-3116. Epub 2016 Jul 17.

WGS analysis and molecular resistance mechanisms of azithromycin-resistant (MIC >2 mg/L) Neisseria gonorrhoeae isolates in Europe from 2009 to 2014.

Author information

1
Örebro University, Örebro, Sweden.
2
Public Health England, London, UK.
3
European Centre for Disease Prevention and Control, Stockholm, Sweden.
4
Public Health Agency of Canada, Winnipeg, Canada.
5
Oslo University Hospital, Ullevål, Oslo, Norway.
6
National Institute of Health, Lisbon, Portugal.
7
St James's Hospital, Dublin, Ireland.
8
Institute of Tropical Medicine, Antwerp, Belgium.
9
Public Health Service Amsterdam, Amsterdam, The Netherlands.
10
Statens Serum Institut, Copenhagen, Denmark.
11
Institute of Microbiology and Immunology, University of Ljubljana, Ljubljana, Slovenia.
12
Vivantes Klinikum Neukölln, Berlin, Germany.
13
Medical University of Warsaw, Warsaw, Poland.
14
Infectology Centre of Latvia, Riga, Latvia.
15
Outpatients' Centre for Infectious Venereodermatological Diseases, Vienna, Austria.
16
Istituto Superiore di Sanitá, Rome, Italy.
17
HPL Laboratory Ltd, Bratislava, Slovakia.
18
Hellenic Pasteur Institute, Athens, Greece.
19
Institute of Health Carlos III, Madrid, Spain.
20
Pathogen Genomics, The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Cambridgeshire, UK.
21
Örebro University, Örebro, Sweden magnus.unemo@regionorebrolan.se.

Abstract

OBJECTIVES:

To elucidate the genome-based epidemiology and phylogenomics of azithromycin-resistant (MIC >2 mg/L) Neisseria gonorrhoeae strains collected in 2009-14 in Europe and clarify the azithromycin resistance mechanisms.

METHODS:

Seventy-five azithromycin-resistant (MIC 4 to >256 mg/L) N. gonorrhoeae isolates collected in 17 European countries during 2009-14 were examined using antimicrobial susceptibility testing and WGS.

RESULTS:

Thirty-six N. gonorrhoeae multi-antigen sequence typing STs and five phylogenomic clades, including 4-22 isolates from several countries per clade, were identified. The azithromycin target mutation A2059G (Escherichia coli numbering) was found in all four alleles of the 23S rRNA gene in all isolates with high-level azithromycin resistance (n = 4; MIC ≥256 mg/L). The C2611T mutation was identified in two to four alleles of the 23S rRNA gene in the remaining 71 isolates. Mutations in mtrR and its promoter were identified in 43 isolates, comprising isolates within the whole azithromycin MIC range. No mutations associated with azithromycin resistance were found in the rplD gene or the rplV gene and none of the macrolide resistance-associated genes [mef(A/E), ere(A), ere(B), erm(A), erm(B), erm(C) and erm(F)] were identified in any isolate.

CONCLUSIONS:

Clonal spread of relatively few N. gonorrhoeae strains accounts for the majority of the azithromycin resistance (MIC >2 mg/L) in Europe. The four isolates with high-level resistance to azithromycin (MIC ≥256 mg/L) were widely separated in the phylogenomic tree and did not belong to any of the main clades. The main azithromycin resistance mechanisms were the A2059G mutation (high-level resistance) and the C2611T mutation (low- and moderate-level resistance) in the 23S rRNA gene.

PMID:
27432597
DOI:
10.1093/jac/dkw279
[Indexed for MEDLINE]

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