Multiresistant Neisseria gonorrhoeae : a new threat in second decade of the XXI century
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REVIEW
Multiresistant Neisseria gonorrhoeae: a new threat in second decade of the XXI century Beata Młynarczyk‑Bonikowska1 · Anna Majewska2 · Magdalena Malejczyk1 · Grażyna Młynarczyk2 · Sławomir Majewski3 Received: 25 November 2018 / Accepted: 26 November 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract Neisseria gonorrhoeae is an etiologic agent of gonorrhoea, one of the most common sexually transmitted diseases caused by bacteria. For many years, infections caused by N. gonorrhoeae were considered to be relatively easy to treat; however, resistance has emerged successively to all therapeutic agents used in treatment of the disease, e.g., penicillin, ciprofloxacin or azithromycin. Currently, the global problem is the emergence and a threat of spread of N. gonorrhoeae strains resistant to extended-spectrum cephalosporins (ESC), such as injectable ceftriaxone and oral-used cefixime. Especially, dangerous are multi-resistant strains resistant simultaneously to ESC and azithromycin. Three strains with high-level resistance to azithromycin and resistant to ESC were first time isolated in 2018. Moreover, in 2018, the first ESBL was described in N. gonorrhoeae and that makes the threat of appearing the ESBL mechanism of resistance in N. gonorrhoeae more real, even though the strain was sensitive to ceftriaxone. Molecular typing revealed that variants resistant to ESC occurred also among strains belonging to epidemic clonal complex CC1 (genogroup G1407) distinguished in NG-MAST typing system. The G1407 genogroup, in particular the ST1407 sequence type, is currently dominant in most European countries. The presence of different mechanisms of drug resistance significantly affects clinical practice and force changes in treatment regimens and introduction of new drugs. Keywords Epidemic clones NG-MAST · Gonorrhoea · Mechanisms of antibiotic resistance · Multiresistant Neisseria gonorrhoeae
Introduction Gonorrhoea is one of the most common sexually transmitted bacterial diseases in the world [1]. Several bacterial or viral diseases can be transmitted simultaneously that may need the adequate diagnostics and therapy [2, 3]. Gonorrhoea Edited by Volkhard A. J. Kempf. * Anna Majewska [email protected] 1
Department of Diagnostics of Sexually Transmitted Diseases, Medical University of Warsaw, 82a Koszykowa Str, 02‑008 Warsaw, Poland
2
Department of Medical Microbiology, Medical University of Warsaw, 5 Chalubinskiego Str, 02‑004 Warsaw, Poland
3
Department of Dermatology and Venereology, Medical University of Warsaw, 82a Koszykowa Str, 02‑008 Warsaw, Poland
diagnostics can be carried out using both culture and molecular methods, but bacterial culture is necessary to determine drug susceptibility [4, 5]. According to the WHO data, the number of gonorrhoea patients amounted to over 78 million people per year [6], and this value may be greatly underestimated considering a relative ease of treatment and incomplete registration of infections in many countries. Single doses of third-
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