Alarming Increase in Ciprofloxacin- and Penicillin-Resistant Neisseria gonorrhoeae Isolates in New Delhi, India

Safdarjang Hospital, New Dilli, NCT, India
Sex Transm Dis (Impact Factor: 2.84). 07/2003; 30(6):523-5. DOI: 10.1097/00007435-200306000-00010
Source: PubMed


Resistance of ciprofloxacin has been reported in several regions of the world, including India. In India, ciprofloxacin is still being used as single-dose treatment for gonorrhea.
The aim of the study was to determine the antimicrobial susceptibility of Neisseria gonorrhoeae isolates from patients with acute gonococcal urethritis in New Delhi.
By means of disc diffusion, we determined the susceptibility profiles of N gonorrhoeae isolates, determined the MICs of ciprofloxacin, penicillin, and ceftriaxone, and compared our data with previous findings.
On the basis of MIC values, 35.3% and 52.9% of strains were found to be resistant and less sensitive, respectively, to penicillin; 67.3% and 28.2% strains were observed to be resistant and less sensitive, respectively, to ciprofloxacin. Only one isolate (5.9%) was found to be less sensitive to ceftriaxone.
The significant increase in ciprofloxacin resistance in the current study indicates that resistance has developed under selective antibiotic pressure.

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    • "In the face of widespread penicillin resistance, fluoroquinolones have been used as an effective antimicrobial agent for treatment of N. gonorrhoeae infection. However, presently fluoroquinolone-resistance in N. gonorrhoeae (QRNG) has emerged and increased rapidly in the United States, Western Europe, and Asia (Fiorito et al., 2001; Bala et al., 2003; Vereshchagin et al., 2004; Yong et al., 2004;, 2004; Xie et al., 2006; Allen et al., 2011; Angeliki et al., 2011;). "
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    ABSTRACT: In the study, the ciprofloxacin resistance rate was 100%. High-level ciprofloxacin resistance rate was 63.55%. Sixteen different mutation patterns involved in the formation of ciprofloxacin resistance were identified. The most prevalent were patterns P7 (25.2%), P8 (15.0%), P9 (11.2%), P1 (10.3%), and P5 (10.3%). All of the 107 NG isolates analyzed for mutations in the study have demonstrated a change of Ser-91 → Phe in the gyrA gene, and all except one have demonstrated a change in position 95 of the amino acid sequence. All of the 68 high-level QRNG isolates had double mutations in gyrA gene combined with a single or two mutations in parC gene. It is most important that a new mutation site of Ile-97 → Met in gyrA and a new mutation of Leu-106 → Ile in parC were found in the study, both leading to high-level ciprofloxacin resistance (MIC values, 8 μg/mL, 32 μg/mL, respectively). Therefore, we confim that gyrA mutations are necessary for the fluoroquinolone resistance phenotype and parC mutations are correlated intimately with high-level fluoroquinolone resistance. In China fluoroquinolone resistance in Neisseria gonorrhoeae strains is very serious and the new mutation sites in the fluoroquinolone resistance-determining regions emerge more and more quickly. Hence, in China fluoroquinolones, which are used to treat gonorrhoea presently, should be substituted by a new antibiotics.
    Brazilian Journal of Microbiology 05/2013; 44(1):273-6. DOI:10.1590/S1517-83822013005000020 · 0.59 Impact Factor
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    • "Further, exceedingly rare resistance (mainly single isolates) to spectinomycin and azithromycin has been observed in India and Bangladesh [32,36,37]. Finally, decreased susceptibility to ESCs has been noted in India and Bangladesh, whereas resistance to ESCs has not yet been reported from this region [31-37]. However, few isolates from this region have been examined and, in most cases, disc diffusion methods that do not reflect the exact MIC have been used for antimicrobial susceptibility testing rather than quality assured, internationally validated methods to determine the exact MIC. "
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    ABSTRACT: Background Knowledge on antimicrobial drug resistance and genetic characteristics of Neisseria gonorrhoeae isolates circulating in India, Pakistan, and Bhutan is sorely lacking. In this paper, we describe the prevalence of antimicrobial resistance and molecular characteristics of N. gonorrhoeae isolates from India, Pakistan, and Bhutan in 2007–2011. Methods Antimicrobial susceptibility and β-lactamase production were tested for 65 N. gonorrhoeae isolates from India (n=40), Pakistan (n=18) and Bhutan (n=7) using Etest methodology (eight antimicrobials) and nitrocefin solution, respectively. Resistance determinants, i.e. penA, mtrR, porB1b, gyrA, and parC, were sequenced. N. gonorrhoeae multiantigen sequence typing (NG-MAST) was performed for molecular epidemiology. Results The highest resistance level was observed for ciprofloxacin (94%), followed by penicillin G (68%), erythromycin (62%), tetracycline (55%), and azithromycin (7.7%). All the isolates were susceptible to ceftriaxone, cefixime, and spectinomycin. Thirty-four (52%) of the isolates were producing β-lactamase. No penA mosaic alleles or A501-altered alleles of penicillin-binding protein 2 were identified. Forty-nine NG-MAST STs were identified, of which 42 STs have not been previously described worldwide. Conclusions Based on this study, ceftriaxone, cefixime, and spectinomycin can be used as an empirical first-line therapy for gonorrhoea in India, Pakistan, and Bhutan, whereas ciprofloxacin, penicillin G, tetracycline, erythromycin, and azithromycin should not be. It is imperative to strengthen the laboratory infrastructure in this region, as well as to expand the phenotypic and genetic surveillance of antimicrobial resistance, emergence of new resistance, particularly, to extended-spectrum cephalosporins, and molecular epidemiology.
    BMC Infectious Diseases 01/2013; 13(1):35. DOI:10.1186/1471-2334-13-35 · 2.61 Impact Factor
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    ABSTRACT: Introduction: it's essential to monitor the susceptibility of N. gonorrhoeae to antibiotics as a means of assuring the efficiency of the therapeutic protocols. This study was designed to test the behavior of strains of N. gonorrhoeae betalactamase producer against threes of the most frequently pre- scripts antibiotic for the management of gonoccocal urethral and cervical discharge in our region. Objective: to determine, using ephysolometric method, the in vitro susceptibility of N. gonorrhoeae betalactamase producers strains against azithromycin, ceftriaxone and ciprofloxacin. Method: the ephisolometric test (e-test) was used to determine the susceptibility of 41 strains of N. gonorrhoeae betalactamase producer against azithromycin, ceftriaxone and ciprofloxacin in samples of urethral and cervical discharge colleted from patients seen at the Sexual Transmitted Disease Center of Fundação Alfredo da Matta (FUAM) from July to December, 2002. Results: the results showed that 21,9% (9/41) of the strains were resistant to azithromycin and 29,6% (12/41) showed reduced sensibility. Nine point seven percent (9,7% - 4/41) of the isolates showed reduced sensibility against ciprofloxacin, whereas towards ceftriaxone the sensibility was 95,1% (39/41). The MIC four two of the strains tested against ceftriaxone were above 0,25µg/ml which is the highest value for sensibility to this antibiotic. Conclusion: this study is the first report of N. gonorrhoeae resistant to azithromycin among the patients seen at FUAM. Also, it's important to underline the demonstration of reduced sensibility to ciprofloxacin and MIC values above the standard for sensibility to ceftriaxone. These results raise the possibility of therapeutic failure in the near future when these antibi- otics are used in the treatment. It is important to maintain programs of periodic evaluation of the drugs used in the syndromic treatment of urethral and cervical discharge.
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