Neisseria gonorrhoeae and emerging resistance to extended spectrum cephalosporins

Current Opinion in Infectious Diseases

Volumn 22, Issue 1, 2009, Pages 87-91

  Tapsall, John W ^a  

^a PRINCE OF WALES HOSPITAL   (Australia)

Author keywords

Antibiotic resistance; Cephalosporins; Neisseria gonorrhoeae

Indexed keywords

CEFALEXIN; CEFIXIME; CEFTIBUTEN; CEFTRIAXONE; CEPHALOSPORIN DERIVATIVE; PENICILLIN BINDING PROTEIN; PENICILLIN BINDING PROTEIN 2; PENICILLIN DERIVATIVE; QUINOLONE DERIVATIVE; UNCLASSIFIED DRUG;

ANTIBIOTIC RESISTANCE; ANTIBIOTIC SENSITIVITY; BACTERIAL MUTATION; DNA POLYMORPHISM; DRUG EFFICACY; DRUG TREATMENT FAILURE; GENE MUTATION; GONORRHEA; HUMAN; INFECTION CONTROL; LABORATORY TEST; MINIMUM INHIBITORY CONCENTRATION; NEISSERIA GONORRHOEAE; PATIENT COMPLIANCE; REVIEW; TREATMENT FAILURE;

ANTI-BACTERIAL AGENTS; BETA-LACTAM RESISTANCE; CEPHALOSPORINS; GONORRHEA; HUMANS; NEISSERIA GONORRHOEAE; TREATMENT FAILURE;

EID: 58849107648     PISSN: 09517375     EISSN: None     Source Type: Journal    
DOI: 10.1097/QCO.0b013e328320a836     Document Type: Review

References (33)

1. Tapsall JW. Antimicrobial resistance in Neisseria gonorrhoeae. WHO/CDS/CSR/DRS/2001.3. Geneva: World Health Organization; 2001.
2. Tapsall JW. Antibiotic resistance in Neisseria gonorrhoeae. Clin Infect Dis 2005; 41:S263-S268.
3. Tapsall J. Antibiotic resistance in Neisseria gonorrhoeae is diminishing available treatment options for gonorrhea: some possible remedies. Exp Rev Antiinfect Ther 2006; 4:619-628.
4. The WHO Western Pacific Gonococcal Antimicrobial Surveillance Programme. Surveillance of antibiotic resistance in Neisseria gonorrhoeae in the WHO Western Pacific Region, 2006. Commun Dis Intell 2008; 32:48-51. Available from http://www.health.gov.au/internet/main/publish-ing.nsf/Content/ cda-pubs-annlrpt-gonoanrep.htm (accessed 6th August 2008). Important recent data on resistance patterns (including data on cephems) in a region with high levels of antibiotic resistance in N. gonorrhoeae.
5. Centers for Disease Control and prevention (CDC). Update to CDC's sexually transmitted diseases treatment guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR Morb Mortal Wkly Rep 2007; 56:332-336.
6. Wang SA, Harvey AB, Conner SM, et al. Antimicrobial resistance for Neisseria gonorrhoeae in the United States, 1988-2003; the spread of fluoroquinolone resistance. Ann Intern Med 2007; 147:81 -88. Documents the US experience with spread for fluoroquinolone-resistant N. gonorrhoeae.
7. Tapsall JW, Limnios EA, Murphy DM, on behalf of the Australian Gonococcal Surveillance Programme. An analysis of trends in antimicrobial resistance in Neisseria gonorrhoeae isolated in Australia, 1997-2006. J Antimicrob Chemother 2008; 61:150-155. Longitudinal data on antimicrobial resistance in gonococci in Australia is linked to disease patterns and antibiotic use practices to explain the reasons for the spread of multiresistant gonococci in some communities but not others.
8. Newman LM, Moran JS, Workowski KA. Update on the management of gonorrhea in adults in the United States. Clin Infect Dis 2007; 44 (Suppl 3): S84-S101. Timely review of drugs available for use for gonorrhoea and their limitations.
9. Akasaka S, Muratani T, Yamada Y, et al. Emergence of cephem- and aztreonam-high-resistant Neisseria gonorhoeae that does not produce beta-lactamase. J Infect Chemother 2001; 7:49-50.
10. Muratani T, Akasaka S, Kobayashi T, et al. Outbreak of cefozopran (penicillin, oral cephems, and aztreonam)-resistant Neisseria gonorrhoeae in Japan. Antimicrob Agent Chemother 2002; 45:3603-3606.
11. Deguchi T, Yasuda M, Yokoi S, et al. Treatment of uncomplicated gonococcal urethritis by double-dosing of 200 mg cefixime at 6-h interval. J Infect Chemother 2003; 9:35-39.
12. Yokoi S, Deguchi T, Ozawa T, et al. Threat to cefixime treatment for gonorrhea. Emerg Infect Dis 2007; 13:1275-1277. Recent reminder of the continuing problems with cephem-resistant gonococci in Japan.
13. Lo JYC, Ho KM, Leung AOC, et al. Ceftibuten resistance and treatment failure of Neisseria gonorrhoeae infection. Antimicrob Agent Chemother 2008; 52:3564-3567. doi: 10.1128/AAC.00198-08. This study significantly extends the basis of knowledge relating to treatment failures with oral cephems outside Japan. It points to significant areas of concern and the need for continuing surveillance and studies on gonococci from treatment failures.
14. Japanese Society for Sexually Transmitted Disease. Guidelines for diagnosis and treatment of sexually transmitted disease, 2006. Jpn J Sex Transm Dis 2006; 17 (1 Suppl):35-39 [cited in [29••]].
15. Tapsall JW. What management is there for gonorrhea in the postquinolone era? Sex Transm Dis 2006; 33:8-10.
16. Tapsall JW, Shultz TR, Limnios EA, et al. Failure of azithromycin therapy in gonorrhea and discorrelation with laboratory test parameters. Sex Transm Dis 1998; 25:505-508.
17. Martin IMC, Hoffman S, Ison CA. European surveillance of sexually transmitted infections (ESSTI): the first combined antimicrobial susceptibility data for Neisseria gonorrhoeae in Western Europe. J Antimicrob Chemother 2006; 58:587-593.
18. Workowski KA, Berman SM, Douglas JM Jr. Emerging antimicrobial resis-tance in Neisseria gonorrhoeae: urgent need to strengthen prevention strategies. Ann Intern Med 2008; 148:606-613. This study shows the seriousness with which the US CDC regards the situation of emerging resistance in N. gonorrhoeae and provides details of improved control and treatment strategies.
19. Wang SA, Lee MV, O'Connor N, et al. Multidrug-resistant Neisseria gonorrhoeae with decreased susceptibility to cefixime: Hawaii, 2001. Clin Infect Dis 2003; 37:849-852.
20. Ameyama S, Onodera S, Takahata M, et al. Mosaic-like structure of penicillin-binding protein 2 gene (penA) in clinical isolates of Neisseria gonorrhoeae with reduced susceptibility to cefixime. Antimicrob Agents Chemother 2002; 46:3744-3749.
21. Lindberg R, Fredlund R, Nicholas R, Unemo M. Neisseria gonorrhoeae isolates with reduced susceptibility to cefixime and ceftriaxone: association with genetic polymorphisms in penA, mtrR, porBIb and ponA. Antimicrob Agents Chemother 2007; 51:2117-2122. Important observations on the genetic elements involved in gonococci with decreased cephem susceptibility and the interactions between these genetic changes.
22. Ochiai S, Sekiguchi S, Hayashi A, et al. Decreased affinity of mosaic-structure recombinant penicillin-binding protein 2 for oral cephalosporins in Neisseria gonorrhoeae. J Antimicrobial Chemother 2007; 60:54-60. Provides an explanation by which cephem susceptibility is reduced in the presence of mosaic PBP2 changes.
23. Takahata S, Senju N, Osaki Y, et al. Amino acid substitutions in mosaic penicillin-binding protein 2 associated with reduced susceptibility to cefixime in clinical isolates of Neisseria gonorrhoeae. Antimicrob Agents Chemother 2006; 50:3638-3645.
24. Ito M, Deguchi T, Mizutani K, et al. Emergence and spread of Neisseria gonorrhoeae clinical isolates harboring mosaic-like structure of penicillin-binding protein 2 in central Japan. Antimicrob Agents Chemother 2005; 49:137-143.
25. Shafer WM, Folster JP. Towards an understanding of chromosomally mediated penicillin resistance in Neisseria gonorrhoeae: evidence for a porin-efflux pump collaboration. J Bacteriol 2006; 188:2297-2299.
26. Ropp PA, Hu M, Olesky M, Nicholas RA. Mutations in ponA, the gene encoding penicillin-binding protein 1, and a novel locus, penC, are required for high-level chromosomally mediated penicillin resistance in Neisseria gonorrhoeae. Antimicrob Agents Chemother 2002; 46:769-777.
27. Whiley DM, Limnios EA, Ray S, et al. Further questions regarding the role of mosaic penA sequences in conferring reduced susceptibility to ceftriaxone in Neisseria gonorrhoeae. Antimicrob Agent Chemother 2007; 51:802-803. Short study that described additional mosaic PBP2 alterations and revised some earlier interpretations of genetic changes.
28. Whiley DM, Limnios EA, Ray S, et al. Diversity of penA alterations and subtypes of Neisseria gonorrhoeae less susceptible to ceftriaxone from Sydney, Australia. Antimicrob Agents Chemother 2007; 51:3111 -3116. A study that examined gonococci originating from diverse sources and with a much wider range of lesions in penA than formerly suspected. The study also illustrates that gonococci with altered PBP2 are nonclonal.
29. Osaka K, Takakura T, Narukawa K, et al. Analysis of amino acid sequences of penicillin-binding protein 2 in clinical isolates of Neisseria gonorrhoeae with reduced susceptibility to cefixime and ceftriaxone. J Infect Chemother 2008; 14:195-203. Important and very recent study that examines other nonmosaic gene mechanisms in penA that result in reduced cephem susceptibility and possible reasons for this effect.
30. Ito M, Yasuda M, Yokoi S, et al. Remarkable increase in central Japan in 2002-2002 of Neisseria gonorrhoeae isolates with decreased susceptibility to penicillin, tetracycline, oral cephalosporins and fluoroquinolones. Antimicrob Agents Chemother 2004; 48:3185-3187.
31. Limnios EA, Nguyen N-L, Ray S, et al. Dynamics of appearance and expansion of a prolyliminopeptidase-negative subtype among Neisseria gonorrhoeae isolates collected in Sydney, Australia, from 2002 to 2005. J Clin Microbiol 2006; 44:1400-1404.
32. Whiley D, Bates J, Limnios A, et al. Use of a novel screening PCR indicates presence of Neisseria gonorrhoeae isolates with a mosaic penA gene sequence in Australia. Pathology 2007; 39:445-446. First description of a molecular tool for rapid detection of gonococci harbouring mosaic PBP2.
33. Ochiai S, Ishiko H, Yasuda M, Deguchi T. Rapid detection of the mosaic structure of the Neisseria gonorrhoeae penA gene, which is associated with decreased susceptibilities to oral cephalosporins. J Clin Microbiol 2008; 46:1804-1810.