LITERATURE UPDATE
effects by enhancing gyrase-mediated DNA cleavage as opposed to inhibiting the DNA supercoiling activity of the enzyme.
In conclusion, this work links the
effects of ciprofloxacin on wild-type and resistant gyrase to results reported for cellular and clinical studies and provides a mechanistic explanation for the targeting and resistance of fluoroquinolones in N. gonorrhoeae.
Global trends of antimicrobial resistance rates in Neisseria gonorrhoeae: a systematic review and meta-analysis Hooshiar MH, Sholeh M, Beig M, Azizian K, Kouhsari E. Front Pharmacol. 2024 Jul 3; 15: 1284665. doi: 10.3389/ fphar.2024.1284665. eCollection 2024.
Antimicrobial resistance (AMR) of Neisseria gonorrhoeae (NG) is a significant public health concern. The objective of this study was to assess global AMR rates and test them both temporally and geographically.
The authors conducted a systematic
search of relevant reports from international databases up to 2021. The R statistical package was used for all statistical analyses.
A total of 225 articles were analysed, and 432,880 NG isolates were examined. The weighted pooled resistance (WPR) rate of different antibiotics was as follows: ciprofloxacin, 51.6%; tetracycline, 45.4%; trimethoprim/sulfamethoxazole, 42.4%; chloramphenicol, 4.1%; kanamycin, 2.1%; gentamicin, 0.6%; and spectinomycin, 0.3%. The resistance to spectinomycin, gentamicin and kanamycin decreased over time. Significant differences in antibiotic resistance rates were found between the countries.
The authors’ findings reveal a continuous increase in resistance to some antibiotics (tetracycline and ciprofloxacin) historically used for gonorrhoea, even after discontinuation. However, encouraging trends of decreasing resistance to spectinomycin, gentamicin and kanamycin were observed. Continued global monitoring of AMR profiles in NG isolates is essential for informing appropriate treatment strategies and mitigating the threat of untreatable gonorrhoea.
Maximizing the Neisseria gonorrhoeae confirmatory rate and the genotypic detection of ciprofloxacin resistance for samples screened with cobas CT/NG Pryce TM, Foti OR, Haygarth EJ, Whiley DM. J Clin Microbiol. 2024 Jan
54
17; 62 (1): e0103923. doi: 10.1128/ jcm.01039-23.
Supplementary nucleic acid amplification testing for Neisseria gonorrhoeae (NG) is widely used to circumvent specificity problems associated with extragenital sites. Here, the authors compared different supplementary approaches for confirming NG-positive samples from the cobas 4800 CT/NG (c4800) and cobas 6800 CT/NG (c6800) assays using the ResistancePlusGC (RP-GC) assay, which in addition to detecting NG, also predicts ciprofloxacin susceptibility via NG gyrA characterisation. Two different nucleic acid extraction techniques were investigated for RP- GC detection; extracts from c4800 (c4800-RP-GC) and MagNA Pure 96 (MP96-RP-GC). NG-positive (n=300) and -negative (n=150) samples in cobas PCR media from routine c4800 testing were retrospectively retested with c4800, c6800, c4800-RP-GC, and MP96-RP- GC. Selected samples were also tested with Xpert CT/NG (Xpert) for discrepant analysis. The gyrA status was compared to ETEST ciprofloxacin susceptibility or non-susceptibility for recovered isolates (n=63).
Extragenital confirmatory rates were higher for MP96-RP-GC (131/140; 93.6%) compared to c4800-RP-GC (126/146; 86.3%), albeit not significantly (P=0.6677). Of nine samples testing positive by c6800 and negative by MP96-RP-GC, seven (77.8%) were also negative by Xpert. By contrast, the number of samples returning a valid gyrA status was significantly (P=0.0003) higher for MP96-RP-GC (270/293; 92.2%) compared to c4800-RP-GC (245/298; 82.2%). The overall MP96- RP-GC gyrA status correlated 98.4% (61/62) with the reported ciprofloxacin sensitive (35/36; 97.2%) or non- susceptible (26/26; 100%) phenotype. Improved RP-GC confirmatory rates and reported gyrA status were observed using MP96 nucleic acids compared to c4800 extracts.
The data further highlight the ongoing need for NG supplemental testing for oropharyngeal samples.
Antimicrobial Resistance in Gonorrhea Vitiello A, Ferrara F, Boccellino M, Ponzo A, Sabbatucci M, Zovi A. Microb Drug Resist. 2024 Jul; 30 (7): 297–303. doi: 10.1089/mdr.2023.0259.
Antimicrobial resistance is a global public health emergency. The World Health Organization recently highlighted the growing number of new sexually transmitted infections such as
gonorrhoea, syphilis, and Chlamydia, which are resistant to common antibiotics.
The phenomenon is also on the rise due to increasing intercontinental travel. Emerging antibiotic-resistant strains of gonorrhoea are particularly associated with international spread from Southeast Asian travellers. Infection with Neisseria gonorrhoeae can cause a wide spectrum of associated diseases such as dermatitis, arthritis and septic arthritis, and pelvic inflammatory disease, and can even lead to serious health consequences for the individual. Natural infection confers no immunity, and vaccination is not available currently, although in several countries it has been reported that the antimeningococcal vaccine may protect against gonorrhoea.
Implementing all necessary
preventive measures is crucial, as well as appropriate and timely diagnostic methods and effective antimicrobial therapeutic treatments in the correct modalities to avoid the increase of forms of gonorrhoea that are resistant to common antibiotics and difficult to eradicate.
Antimicrobial treatment and resistance in sexually transmitted bacterial infections
Jensen JS, Unemo M. Nat Rev Microbiol. 2024 Jul; 22 (7): 435–50. doi: 10.1038/s41579-024-01023-3.
Sexually transmitted infections (STIs) have been part of human life since ancient times, and their symptoms affect quality of life, and sequelae are common. Socioeconomic and behavioural trends affect the prevalence of STIs, but the discovery of antimicrobials gave hope for treatment, control of the spread of infection and lower rates of sequelae. This has to some extent been achieved, but increasing antimicrobial resistance and increasing transmission in high-risk sexual networks threaten this progress. For Neisseria gonorrhoeae, the
only remaining first-line treatment (with ceftriaxone) is at risk of becoming ineffective, and for Mycoplasma genitalium, for which fewer alternative antimicrobial classes are available, incurable infections have already been reported. For Chlamydia trachomatis, in vitro
resistance to first-line tetracyclines and macrolides has never been confirmed despite decades of treatment of this highly prevalent STI. Similarly, Treponema pallidum, the cause of syphilis, has remained susceptible to first-line penicillin.
SEPTEMBER 2024
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