Trends in Antimicrobial Resistance of Neisseria gonorrhoeae Isolated From Korean Patients From 2000 to 2006

• Published in: Sexually transmitted diseases 2011-11, Vol.38 (11), p.1082-1086
• Main Authors: Lee, Hyukmin, Hong, Seong Geun, Soe, Younghee, Yong, Dongeun, Jeong, Seok Hoon, Lee, Kyungwon, Chong, Yunsop
• Format: Article
• Language: English
• Subjects: Amino acids; Anti-Bacterial Agents - pharmacology; Antibiotics; Bacterial diseases; Bacterial diseases of the genital system; Biological and medical sciences; DNA Gyrase - genetics; DNA Topoisomerase IV - genetics; Drug resistance; Drug Resistance, Bacterial; Drug use; Epidemiology. Vaccinations; Female; General aspects; Gonorrhea; Gonorrhea - drug therapy; Gonorrhea - epidemiology; Gonorrhea - microbiology; Gonorrhoea; Human bacterial diseases; Human infectious diseases. Experimental studies and models; Humans; Infectious diseases; Korea; Male; Medical sciences; Medical treatment; Microbial Sensitivity Tests; Neisseria gonorrhoeae - drug effects; Neisseria gonorrhoeae - isolation & purification; Original Study; Penicillin; Republic of Korea - epidemiology; Sequence Analysis, DNA; Sex Work; Susceptibility; Tetracycline; Urethritis - drug therapy; Urethritis - epidemiology; Urethritis - microbiology
• ISSN: 0148-5717; 1537-4521
• DOI: 10.1097/OLQ.0b013e31822e60a4

Background: The recent emergence and spread of antimicrobial-resistant Neisseria gonorrhoeae has compromised treatment and control of gonorrhea. We determined recent trends in antimicrobial susceptibility of the isolates, analyzed recent use of antigonococcal agents, and investigated the relationship between fluoroquinolone nonsusceptibility and amino acid substitutions within the fluoroquinolone resistance-determining regions in Korea. Methods: The antimicrobial susceptibilities of 977 isolates of N. gonorrhoeae collected from 2000 to 2006 in Korea were determined with penicillin, ceftriaxone, spectinomycin, tetracycline, and cipro-floxacin disks. Some of the randomly selected isolates were tested by the Clinical and Laboratory Standards Institute agar dilution method, to determine subtle changes in susceptibility to the above antibiotics and cefixime. β-lactamase was detected using a cefinase disk. Results: All of the isolates exhibited plasmid- or chromosomally mediated resistance to penicillin; however, the proportions of penicillinase-producing N. gonorrhoeae decreased rapidly from 64% in 2000 to 21% in 2006. All isolates were susceptible to third-generation cephalosporins, except for 1 isolate that was not susceptible to cefixime. The proportion of ciprofloxacin-resistant isolates increased from 26% in 2000 to 83% in 2006. Of 7 substitution types, 5 (Ser-91-Phe in Gyrase A (GyrA), Ser-87-Arg in ParC subunit of topoisomerase IV (ParC); Ser-91-Phe and Asp-95-Ala in GyrA, and Ser-87-Asn in ParC; Ser-91-Phe and Asp-95-Gly in GyrA, and Asp-86-Asn in ParC; Ser-91 in GyrA; Ser-91-Phe in GyrA, and Asp-86-Asn in ParC) were new ones not identified in our 2004 study. All isolates were susceptible to spectinomycin. About half of the patients in our current study (52.6%-58.1%, depending on the year) received spectinomycin treatment. Majorities were resistant to tetracycline, and the rate of highly tetracycline-resistant N. gonorrhoeae increased from 3% in 2000 to 9% in 2006. Conclusions: The incidence of penicillinase-producing N. gonorrhoeae declined significantly, but none of the isolates were susceptible to penicillin G. All isolates were susceptible to spectinomycin, in contrast majority were resistant to tetracycline. Inappropriate use of fluoroquinolone was frequent. The minimum inhibitory concentrations of ceftriaxone were within the susceptible range for all isolates, but those of cefixime were slightly higher, and it was 0.5 μg/mL (nonsusceptible) for 1