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Antimicrob Agents Chemother. 2019 Jun 24. pii: AAC.00773-19. doi: 10.1128/AAC.00773-19. [Epub ahead of print]

Emergence and Spread of Neisseria gonorrhoeae Strains with High-level Resistance to Azithromycin in Taiwan from 2001 to 2018.

Liu YH1,2, Wang YH3,4, Liao CH5,6, Hsueh PR7,8.

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Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
Department of Internal Medicine, Cardinal Tien Hospital, Taipei, Taiwan.
Medical Research Center, Cardinal Tien Hospital and School of Medicine, Taipei, Taiwan.
College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei County, Taiwan.
Department of Medicine, Yang-Ming University, Taipei, Taiwan.
Department of Laboratory Medicine, National Taiwan; University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.


A total of 598 Neisseria gonorrhoeae isolates obtained from patients in Taiwan from 2001 to 2018 were evaluated. The minimum inhibitory concentrations (MICs) of ceftriaxone (CRO) and azithromycin (AZM) against the isolates were determined by the agar dilution method. N. gonorrhoeae isolates with AZM MICs of ≥ 1 μg/ml were identified and characterized by the presence of AZM resistance determinants. For high-level AZM-resistant isolates (AZM-HLR, MIC ≥ 256 μg/ml), genotyping was performed using multilocus sequence typing (MLST) and N. gonorrhoeae multi-antigen sequence typing (NG-MAST). Among the N. gonorrhoeae isolates studied, 8.7% (52/598) exhibited AZM MICs of ≥ 1 μg/ml. Thirteen of the 52 isolates contained A2059G (23S rRNA NG-STAR type1) or C2611T (23S rRNA NG-STAR type 2) mutations. The prevalence of A2059G mutation was higher in AZM-HLR isolates (p < 0.001). The -35A deletion in the promoter region of the mtrR gene did not differ between AZM-HLR isolates (100 %, 10/10) and the isolates with AZM MICs of 1 μg/ml to 64 μg/ml (95.2%, 40/42) (p =1.000). The presence of mutations in the mtrR coding region was significantly different between these two groups, 90% (9/10) and 26.2% (11/42), respectively (p < 0.001). The AZM-HLR isolates, all carrying four mutated A2059G alleles, a -35A deletion, and G45D, were classified as MLST 12039/10899 and NG-MAST 1866/16497. In conclusion, Taiwan is among the countries reporting gonococci with high level resistance to AZM so that single dose of ceftriaxone 1g intramuscularly as the first choice for management of N. gonorrhoeae infection should be evaluated.


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