Dissemination and genome analysis of high-level ceftriaxone-resistant penA 60.001 Neisseria gonorrhoeae strains from the Guangdong Gonococcal antibiotics susceptibility Programme (GD-GASP), 2016-2019

• Published in: Emerging microbes & infections Vol. 11; no. 1; pp. 344 - 350
• Main Authors: Lin, Xiaomian, Chen, Wentao, Xie, Qinghui, Yu, Yuqi, Liao, Yiwen, Feng, Zhanjin, Qin, Xiaolin, Wu, Xingzhong, Tang, Sanmei, Zheng, Heping
• Format: Journal Article
• Language: English
• Published: United States Taylor & Francis 01.12.2022; Taylor & Francis Ltd; Taylor & Francis Group
• Subjects: Anti-Bacterial Agents - pharmacology; Antibiotics; Antimicrobial Agents; Azithromycin - pharmacology; Ceftriaxone - pharmacology; ceftriaxone-resistant; China - epidemiology; Ciprofloxacin - pharmacology; Drug resistance; Drug Resistance, Bacterial; epidemiological investigation; Genome, Bacterial; Genomes; Gonorrhea; Gonorrhea - drug therapy; Gonorrhea - microbiology; Humans; Microbial Sensitivity Tests; Molecular Epidemiology; Multilocus Sequence Typing; N. gonorrhoeae; Neisseria gonorrhoeae - classification; Neisseria gonorrhoeae - drug effects; Neisseria gonorrhoeae - genetics; Neisseria gonorrhoeae - isolation & purification; penA 60.001; Penicillin; Spectinomycin - pharmacology; China; N. gonorrhoeae; ceftriaxone-resistant; epidemiological investigation; penA 60.001
• DOI: 10.1080/22221751.2021.2011618
• ISSN: 2222-1751

Background: After Neisseria gonorrhoeae FC428 was first found in Japan, ceftriaxone-resistant strains disseminated globally, and the gonococcal resistance rate increased remarkably. Epidemiological investigations are greatly significant for the analysis of antimicrobial resistance (AMR) trends, molecular features and evolution. Objectives: To clarify the AMR trend from 2016-2019 and reveal the molecular characteristics and evolution of ceftriaxone-resistant penA 60.001 isolates. Methods: The minimum inhibitory concentrations (MICs) of antibiotics against 4113 isolates were detected by the agar dilution method. N. gonorrhoeae multiantigen sequence typing (NG-MAST), multilocus sequence typing (MLST) and N.gonorrhoeae sequence typing for antimicrobial resistance (NG-STAR) were used to identify the sequence types. Genome analysis was conducted to analyze resistance genes, virulence factors, and evolutionary sources. Results: Isolates with decreased ceftriaxone susceptibility have increased from 2.05% (2016) to 16.18% (2019). Six ceftriaxone-resistant isolates possessing penA 60.001 appeared in Guangdong Province, and were resistant to ceftriaxone, penicillin, tetracycline, ciprofloxacin and cefixime, but susceptible to azithromycin and spectinomycin. Single-nucleotide polymorphisms (SNPs) in the porB gene were the major cause of different NG-MAST types. ST1903 was the main NG-STAR genotype and only strain-ZH545 was ST7365, with molecular features consistent with the MICs. Furthermore, different MLSTs suggested diverse evolutionary sources. Genome analysis revealed a set of virulence factors along with the resistance genes "penA" and "blaTEM-1B". Half of penA 60.001 strains were fully mixed with global FC428-related strains. Conclusions: Global FC428-related clones have disseminated across Guangdong, possibly causing decreased ceftriaxone susceptibility. Enhanced gonococcal surveillance will help elucidate the trajectory of transmission and curb further dissemination.