Antimicrobial susceptibility of Neisseria gonorrhoeae in Cuba (1995-1999): Implications for treatment of gonorrhea

Microbiology Branch, Tropical Medicine Institute Pedro Kourí, Havana, Cuba.
Sex Transm Dis (Impact Factor: 2.84). 02/2003; 30(1):10-4. DOI: 10.1097/00007435-200301000-00003
Source: PubMed


Antibiotic-resistant strains of Neisseria gonorrhoeae, especially those resistant to penicillin and tetracycline, have spread with remarkable rapidity in many Caribbean countries.
The goal of the study was to survey the antibiotic susceptibilities of N gonorrhoeae strains isolated from 1995 to 1999 in Cuba and to discuss the impact of antimicrobial resistance on the management of gonorrhea in the country.
Susceptibility of the strains to penicillin, tetracycline, cefuroxime, ceftriaxone, ciprofloxacin, spectinomycin, and azithromycin were determined by an agar dilution method.
Penicillin and tetracycline resistance was noted in 60.8% and 54.2%, respectively, of the N gonorrhoeae strains tested. A total of 63.35 (76/120) of the N gonorrhoeae strains exhibited plasmid-mediated resistance to penicillin, tetracycline, or both. Strains with chromosomally mediated resistance to these antibiotics accounted for 10% (12/120) of the strains. The strains were susceptible to ceftriaxone, cefuroxime, spectinomycin, and ciprofloxacin. One strain's ciprofloxacin MIC was 0.125 mircog/ml. Of the 52 strains tested, 23.1% displayed intermediate resistance to azithromycin.
N gonorrhoeae strains exhibited a high frequency of resistance and multiresistance to penicillin and tetracycline. Therefore, these antibiotics should no longer be used to treat gonococcal infections in Cuba and should be substituted with effective drugs such as third-generation cephalosporins, spectinomycin, and fluoroquinolones. The detection of intermediate resistance to azithromycin and ciprofloxacin underlines the importance of periodic surveillance for susceptibility of N gonorrhoeae strains to antimicrobials agents used as primary therapy for gonorrhea.

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    ABSTRACT: Introduction: along of antimicrobial era Neisseria gonorrhoeae have been developing resistance to several agents. It is estimated the occurrence of more than 1,5 million new cases for year in Brazil and the emergence of the vigilance and dissemination of resistant strains must be periodically monitorated. Objective: evaluate the resistance, phenotypic and molecular characterization of gonococcus isolated in the metropolitan area of Rio de Janeiro between February 2002 and June 2003, establishing basic information for further studies. Demographic profile of the patients with gonorrhea was determined. Method: samples of Neisseria gonorrhoeae isolated consecutively were tested for penicillin, tetracycline, azithromycin, ciprofloxacin, ceftriaxone and clo- ranfenicol using the E-test method to determine the Minimum Inhibitory Concentration (MIC). All the strains were tested for β-lactamase, plasmidial analysis, serotyping and Pulsed-Field Gel Electrophoresis (PFGE) to study the genetic variability. The demographic characteristics of the patients were obtained in medical file. Result: of the 115 tested samples, 10 (8.7%) were β-lactamase producing (PPNG), 88 (76.5%) had intermediary resistance to penicillin and 17 (14.8%) were sensitive. For tetracycline 39 (33.9%) were resistant, 37 (32.2%) had intermediary resistance and 39 (33,9%) were sensiti- ve. The resistance mediated by plasmid to tetracycline (TRNG, MIC ≥ 16 µg/mL) was detected in 20% of the isolate. To cloranfenicol, 4 (3.4%) were resistant, 14 (12.2%) had intermediary resistance and 97 (84.5%) were sensitive. Were found 23 (20%) isolates with reduced susceptibility to azithromycin (MIC 0.25 - 0.5 µg/mL) and 2 (1.7%) with reduced susceptibility to ciprofloxacin (MIC = 0.5 µg/mL). All the samples were sensitive to ceftriaxone. Among PPNG, we found three distinct type of plasmids, the Asia (4.4 Mda), Africa (3.2 Mda) and Toronto (3.05 Mda) types. The predominant serogroup was I-B/W II/III in about 90 % of the samples. Conclusion: the resistance surveillance to antimicrobial is important to monitorate the emergence and spread of resistant strains helping in therapeutic choice. In the area of Rio de Janeiro, penicillin and tetracycline are not recommended for the treatment of gonorrhea and the use of azithromycin demands attention. The phenotypic and genotypic analyses of the studied samples will give comparative instruments for future epidemiological studies. Our patients with gonorrhea are white men, young (average 22 years old), singles, heterosexuals, with multiple partners, with low level of education and familiar income, and continually exposed to risks of acquiring sexually transmitted diseases.
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