scholarly journals Decreased Cephalosporin Susceptibility of Oropharyngeal Neisseria Species in Antibiotic-using Men Who Have Sex With Men in Hanoi, Vietnam

2019 ◽  
Vol 70 (6) ◽  
pp. 1169-1175 ◽  
Author(s):  
Huan V Dong ◽  
Loc Q Pham ◽  
Hoa T Nguyen ◽  
Minh X B Nguyen ◽  
Trung V Nguyen ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Neisseria Gonorrhoeae ◽  
Genetic Material ◽  
Antibiotic Use ◽  
Neisseria Species ◽  
The Past ◽  
User Groups ◽  
Sex With Men ◽  
Imminent Threat ◽  
Commensal Neisseria

Abstract Background Neisseria gonorrhoeae (NG) infections are a global health burden. NG resistance to cephalosporins, which is increasingly reported, is an imminent threat to public health. Many hypothesize that commensal Neisseria species are an important reservoir for genetic material conferring antimicrobial resistance in NG; however, clinical data are lacking. Methods Men who have sex with men (MSM) in Hanoi, Vietnam, completed a questionnaire regarding antibiotic use. We collected pharyngeal specimens, cultured Neisseria species, and measured minimum inhibitory concentrations (MICs) to ciprofloxacin, cefixime, ceftriaxone, and cefpodoxime. Using MIC criteria for antimicrobial susceptibility in NG, we categorized the Neisseria species and compared mean MIC levels between different antibiotic user groups. Results Of 207 participants, 38% used at least 1 antibiotic in the past 6 months; 52% without a prescription. A median of 1 Neisseria species was cultured from each participant (range, 1–4) with 10 different Neisseria species identified overall. The proportion of Neisseria with reduced susceptibility to ciprofloxacin was 93%, cefpodoxime 84%, cefixime 31%, and ceftriaxone 28%. Antibiotic use within the past month was strongly associated with Neisseria species having increased MICs to cefixime, ceftriaxone, and cefpodoxime (mean MIC ratios of 6.27, 4.11, and 7.70, respectively), compared with those who used antibiotics between 1 and 6 months prior (P < .05, all comparisons). Conclusions MSM in our study often used antibiotics without a prescription. At least 1 commensal Neisseria species colonized all men. Recent use of any antibiotics may select for oropharyngeal Neisseria species with antimicrobial resistance. The normal flora of the oropharynx may be an important source of antimicrobial resistance in Neisseria gonorrhoeae.

scholarly journals The Impact of Recent Antibiotic Usage on Oropharyngeal Neisseria spp. in MSM of Hanoi, Vietnam

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S105-S105
Author(s):  
Huan Dong ◽  
Hoa Thi Nguyen ◽  
Minh Binh Xuan Nguyen ◽  
Trung Vu Nguyen ◽  
Folasade May ◽  
...  
Keyword(s):  
Antimicrobial Susceptibility ◽  
Antibiotic Use ◽  
Antibiotic Usage ◽  
The Past ◽  
History Of ◽  
Neisseria Gonorrhea ◽  
Sex With Men ◽  
The Impact ◽  
Susceptibility Status ◽  
Commensal Neisseria

Abstract Background Neisseria gonorrhea (NG) has a long history of gaining resistance to nearly all antimicrobials used for treatment since the 1930s, which makes susceptibility to last-line cephalosporins of dire importance. Horizontal gene transmission is highly prevalent among the Neisseria genus, with genetic fragments from common commensal Neisseria having been found in resistant NG strains. Globally, NG disproportionately affects men-who-have-sex-with-men (MSM) and nearly all ceftriaxone-resistant cases have been reported from pharyngeal samples. Our study aims to assess the impact of antibiotic usage on the antimicrobial susceptibility of oropharyngeal Neisseria spp. Methods MSM from Hanoi, Vietnam, were surveyed regarding antibiotic usage. Pharyngeal swabs were collected and cultured on chocolate and modified-Thayer–Martin agar. Neisseria spp. were subcultured, identified using MALDI-TOF, and antimicrobial susceptibility determined by E-test using NG CLSI MIC breakpoints to ciprofloxacin (CIP), cefixime (CFM), ceftriaxone (CRO), and cefpodoxime (CPD). Results The 225 MSM surveyed were young (mean age 23.9 years, std 4.4). In the past 6 months: 41.6% participants used any antibiotics, among whom 62.4% did not have a prescription; 6.6% used CFM (16.4% more were unsure), among whom 55.6% did not have a prescription; and 4.5% received CRO. From 72 swabs, 102 Neisseria isolates were obtained; N. flavescens (n = 59), N. perflava (n = 14), N. macacae (n = 8), N. sublfava (n = 7), N. gonorrhoeae (n = 5), N. mucosa (n = 3), N. meningitides (n = 3), N. cinerea (n = 2), and N. lactamica (n = 1). 
“Reduced susceptibility” status for any Neisseria spp. was 35.3, 10, 8, and 30% to CIP, CFM, CRO, and CPD, respectively; 61.8% were “resistant” to CIP. MSM who took any antibiotics in the past 6 months were almost twice as likely to have Neisseria spp. with reduced susceptibility to cephalosporins (CFM, CRO, or CPD), RR 1.8 (95% CI 1.1–3.2; P = 0.026) compared with non-antibiotic users. Conclusion Many MSM in Hanoi used antibiotics recently, often without a prescription. Antibiotic use was associated with antimicrobial “reduced susceptibility” of commensal Neisseria spp. to cephalosporins, possibly potentiating resistance acquisition by NG. Disclosures All authors: No reported disclosures.

scholarly journals Antimicrobial susceptibility of commensal Neisseria in a general population and men who have sex with men in Belgium

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Jolein Gyonne Elise Laumen ◽  
Christophe Van Dijck ◽  
Saïd Abdellati ◽  
Irith De Baetselier ◽  
Gabriela Serrano ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
General Population ◽  
Neisseria Gonorrhoeae ◽  
Resistance Genes ◽  
Antimicrobial Susceptibility ◽  
Resistance Determinants ◽  
Antimicrobial Resistance Genes ◽  
Sex With Men ◽  
Commensal Neisseria ◽  
Tof Ms

AbstractNon-pathogenic Neisseria are a reservoir of antimicrobial resistance genes for pathogenic Neisseria meningitidis and Neisseria gonorrhoeae. Men who have sex with men (MSM) are at risk of co-colonization with resistant non-pathogenic and pathogenic Neisseria. We assessed if the antimicrobial susceptibility of non-pathogenic Neisseria among MSM differs from a general population and if antimicrobial exposure impacts susceptibility. We recruited 96 participants at our center in Belgium: 32 employees, 32 MSM who did not use antibiotics in the previous 6 months, and 32 MSM who did. Oropharyngeal Neisseria were cultured and identified with MALDI-TOF–MS. Minimum inhibitory concentrations for azithromycin, ceftriaxone and ciprofloxacin were determined using E-tests® and compared between groups with non-parametric tests. Non-pathogenic Neisseria from employees as well as MSM were remarkably resistant. Those from MSM were significantly less susceptible than employees to azithromycin and ciprofloxacin (p < 0.0001, p < 0.001), but not ceftriaxone (p = 0.3). Susceptibility did not differ significantly according to recent antimicrobial exposure in MSM. Surveilling antimicrobial susceptibility of non-pathogenic Neisseria may be a sensitive way to assess impact of antimicrobial exposure in a population. The high levels of antimicrobial resistance in this survey indicate that novel resistance determinants may be readily available for future transfer from non-pathogenic to pathogenic Neisseria.

scholarly journals Emergence of ceftriaxone-resistant Neisseria gonorrhoeae strains harbouring a novel mosaic penA gene in China

2020 ◽  
Vol 75 (4) ◽  
pp. 907-910 ◽  
Author(s):  
Leshan Xiu ◽  
Qianqin Yuan ◽  
Yamei Li ◽  
Chi Zhang ◽  
Lingli Tang ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Antimicrobial Resistance ◽  
Neisseria Gonorrhoeae ◽  
Current Treatment ◽  
Neisseria Species ◽  
Treatment Regimens ◽  
Gonorrhoeae Strain ◽  
Neisseria Perflava ◽  
Interspecies Recombination ◽  
Commensal Neisseria

Abstract Objectives The continuous emergence of ceftriaxone-resistant Neisseria gonorrhoeae strains threatens the effectiveness of current treatment regimens for gonorrhoea. The objective of the present study was to characterize three ceftriaxone-resistant N. gonorrhoeae strains with a novel mosaic penA allele isolated in China. Methods Three ceftriaxone-resistant Neisseria gonorrhoeae strains (GC150, GC161 and GC208) isolated in 2017 were characterized by N. gonorrhoeae multiantigen sequence typing (NG-MAST), MLST and N. gonorrhoeae sequence typing for antimicrobial resistance (NG-STAR). Recombination analyses were performed using the SimPlot software. Results Three strains had the same antibiotic resistance profiles, with resistance to ceftriaxone (MIC 0.5 mg/L), ciprofloxacin (MIC 8.0 mg/L), penicillin (MIC 2.0 mg/L) and tetracycline (MIC 2.0–8.0 mg/L). STs were assigned as MLST7360, NG-MAST14292 and NG-STAR1611/NG-STAR1612. The penA gene of these three strains differed from previous ceftriaxone-resistant gonococcal strains and harboured a novel mosaic allele (penA-121.001). Like N. gonorrhoeae FC428, a widely disseminated ceftriaxone-resistant strain that was initially described in Japan in 2015, all strains also possessed substitutions A311V and T483S in PBP2, which are associated with resistance to ceftriaxone. Potential recombination events were detected in penA between N. gonorrhoeae strain FC428 and commensal Neisseria species. Our results provide further evidence that the commensal Neisseria species (Neisseria cinerea and Neisseria perflava) can serve as a reservoir of ceftriaxone resistance-mediating penA sequences in clinical gonococcal strains. Conclusions The emergence of such strains may be the result of the interspecies recombination of penA genes between N. gonorrhoeae strain FC428 and commensal Neisseria species.

scholarly journals Choosing New Therapies for Gonorrhoea: We Need to Consider the Impact on the Pan-Neisseria Genome. A Viewpoint

Antibiotics ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 515
Author(s):  
Chris Kenyon ◽  
Jolein Laumen ◽  
Sheeba Manoharan-Basil
Keyword(s):  
Antimicrobial Resistance ◽  
Neisseria Gonorrhoeae ◽  
Treatment Guidelines ◽  
Treatment Options ◽  
Neisseria Species ◽  
New Therapies ◽  
The Impact ◽  
Commensal Neisseria

The development of new gonorrhoea treatment guidelines typically considers the resistance-inducing effect of the treatment only on Neisseria gonorrhoeae. Antimicrobial resistance in N. gonorrhoeae has, however, frequently first emerged in commensal Neisseria species and then been passed on to N. gonorrhoeae via transformation. This creates the rationale for considering the effect of gonococcal therapies on resistance in commensal Neisseria. We illustrate the benefits of this pan-Neisseria strategy by evaluating three contemporary treatment options for N. gonorrhoeae—ceftriaxone plus azithromycin, monotherapy with ceftriaxone and zoliflodacin.

scholarly journals Differences in Neisseria gonorrhoeae population structure and antimicrobial resistance pattern between men who have sex with men and heterosexuals

2016 ◽  
Vol 145 (2) ◽  
pp. 379-385 ◽  
Author(s):  
J. SERRA-PLADEVALL ◽  
M. J. BARBERÁ ◽  
A. E. CALLARISA ◽  
R. BARTOLOMÉ-COMAS ◽  
A. ANDREU
Keyword(s):  
Population Structure ◽  
Antimicrobial Resistance ◽  
Neisseria Gonorrhoeae ◽  
Antimicrobial Susceptibility ◽  
Sexual Practices ◽  
Resistance Pattern ◽  
High Prevalence ◽  
Sex With Men ◽  
Resistance Rates ◽  
Sequence Types

SUMMARYThis study compared the antimicrobial susceptibility and genotypes of strains of Neisseria gonorrhoeae isolated from men who have sex with men (MSM) and from heterosexuals. One hundred and eleven strains were characterized from 107 patients, comprising 57 strains from 54 heterosexuals and 54 strains from 53 MSM. Antimicrobial resistance rates were higher in strains from heterosexual patients, with resistance to cefixime (P = 0·0159) and ciprofloxacin (P = 0·002) being significantly higher. Typing by N. gonorrhoeae multi-antigen sequence typing (NG-MAST) showed that the most prevalent sequence types (ST) and genogroups (G) respectively were ST2400, ST2992, and ST5793, and G1407, G2992, and G2400. A statistically significant association was observed for MSM and genogroups G2400 (P = 0·0005) and G2992 (P = 0·0488), and G1407 with heterosexuals (P = 0·0002). We conclude that in our region distinct populations of gonococci are circulating among subjects with different sexual practices, with their corresponding transmission patterns. Furthermore, the high prevalence of genotype G2400 in MSM, has not to our knowledge been previously described.

scholarly journals Mosaic structure of the penA gene in the oropharynx of men who have sex with men negative for gonorrhoea

2020 ◽  
Vol 31 (3) ◽  
pp. 230-235 ◽  
Author(s):  
Antonella Marangoni ◽  
Giacomo Marziali ◽  
Melissa Salvo ◽  
Antonietta D’Antuono ◽  
Valeria Gaspari ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Dna Recombination ◽  
Genetic Material ◽  
Mosaic Structure ◽  
Multi Drug Resistance ◽  
Transmitted Infection ◽  
Neisseria Species ◽  
Sexually Transmitted ◽  
Pcr Products ◽  
Sex With Men

The oropharynx represents a crucial site for the emergence of multi-drug resistance in Neisseria gonorrhoeae. The mosaic penA alleles, associated with decreased susceptibility to cephalosporins, have emerged by DNA recombination with partial penA genes, particularly those from commensal pharyngeal Neisseria species. Here, we investigated the prevalence of the mosaic structure of the penA gene in the oropharynx of men who have sex with men testing negative for pharyngeal gonorrhoea. From January 2016 to June 2018, 351 gonorrhoea-negative men who have sex with men attending a sexually transmitted infection clinic in Italy were enrolled. Pharyngeal swabs underwent a real-time polymerase chain reaction (PCR) for the detection of the mosaic penA gene. In case of positivity, PCR products were sequenced and searched against several sequences of Neisseria strains. Overall, 31 patients (8.8%) were found positive for the presence of the mosaic penA gene. The positivity was significantly associated with previous cases of pharyngeal gonorrhoea (relative risk [RR]: 3.56, 95% confidence interval 1.44–8.80) and with recent exposure to beta-lactams (RR: 4.29, 95% confidence interval 2.20–8.38). All penA-positive samples showed a high relatedness (90–99%) with mosaic-positive Neisseria strains. Our data underline that commensal Neisseria species of the oropharynx may be a significant reservoir for genetic material conferring antimicrobial resistance in N. gonorrhoeae.

scholarly journals Commensal Neisseria Are Shared between Sexual Partners: Implications for Gonococcal and Meningococcal Antimicrobial Resistance

Pathogens ◽  
2020 ◽  
Vol 9 (3) ◽  
pp. 228 ◽  
Author(s):  
Christophe Van Dijck ◽  
Jolein G. E. Laumen ◽  
Sheeba S. Manoharan-Basil ◽  
Chris Kenyon
Keyword(s):  
Antimicrobial Resistance ◽  
16S Rrna Gene Sequencing ◽  
Sexual Partners ◽  
Rrna Gene ◽  
Intimate Partners ◽  
Dissimilarity Index ◽  
Individual Level ◽  
Sex With Men ◽  
The Individual ◽  
Commensal Neisseria

Antimicrobial resistance in pathogenic Neisseria parallels reduced antimicrobial susceptibility in commensal Neisseria in certain populations, like men who have sex with men (MSM). Although this reduced susceptibility can be a consequence of frequent antimicrobial exposure at the individual level, we hypothesized that commensal Neisseria are transmitted between sexual partners. We used data from a 2014 microbiome study in which saliva and tongue swabs were taken from 21 couples (42 individuals). Samples were analyzed using 16S rRNA gene sequencing. We compared intimate partners with unrelated individuals and found that the oral Neisseria communities of intimate partners were more similar than those of unrelated individuals (average Morisita–Horn dissimilarity index for saliva samples: 0.54 versus 0.71, respectively (p = 0.005); and for tongue swabs: 0.42 versus 0.63, respectively (p = 0.006)). This similarity presumably results from transmission of oral Neisseria through intimate kissing. This finding suggests that intensive gonorrhea screening in MSM may, via increased antimicrobial exposure, promote, rather than prevent, the emergence and spread of antimicrobial resistance in Neisseria. Non-antibiotic strategies such as vaccines and oral antiseptics could prove more sustainable options to reduce gonococcal prevalence.

scholarly journals Emergence and evolution of antimicrobial resistance genes and mutations in Neisseria gonorrhoeae

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Koji Yahara ◽  
Kevin C. Ma ◽  
Tatum D. Mortimer ◽  
Ken Shimuta ◽  
Shu-ichi Nakayama ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Neisseria Gonorrhoeae ◽  
Acquired Resistance ◽  
Antibiotic Use ◽  
Health Concern ◽  
Fluoroquinolone Resistance ◽  
Resistance Mutations ◽  
Treatment Regimens ◽  
Antimicrobial Resistance Genes ◽  
Sequence Types

Abstract Background Antimicrobial resistance in Neisseria gonorrhoeae is a global health concern. Strains from two internationally circulating sequence types, ST-7363 and ST-1901, have acquired resistance to third-generation cephalosporins, mainly due to mosaic penA alleles. These two STs were first detected in Japan; however, the timeline, mechanism, and process of emergence and spread of these mosaic penA alleles to other countries remain unknown. Methods We studied the evolution of penA alleles by obtaining the complete genomes from three Japanese ST-1901 clinical isolates harboring mosaic penA allele 34 (penA-34) dating from 2005 and generating a phylogenetic representation of 1075 strains sampled from 35 countries. We also sequenced the genomes of 103 Japanese ST-7363 N. gonorrhoeae isolates from 1996 to 2005 and reconstructed a phylogeny including 88 previously sequenced genomes. Results Based on an estimate of the time-of-emergence of ST-1901 (harboring mosaic penA-34) and ST-7363 (harboring mosaic penA-10), and > 300 additional genome sequences of Japanese strains representing multiple STs isolated in 1996–2015, we suggest that penA-34 in ST-1901 was generated from penA-10 via recombination with another Neisseria species, followed by recombination with a gonococcal strain harboring wildtype penA-1. Following the acquisition of penA-10 in ST-7363, a dominant sub-lineage rapidly acquired fluoroquinolone resistance mutations at GyrA 95 and ParC 87-88, by independent mutations rather than horizontal gene transfer. Data in the literature suggest that the emergence of these resistance determinants may reflect selection from the standard treatment regimens in Japan at that time. Conclusions Our findings highlight how antibiotic use and recombination across and within Neisseria species intersect in driving the emergence and spread of drug-resistant gonorrhea.

scholarly journals Does gonorrhoea screening intensity play a role in the early selection of antimicrobial resistance in men who have sex with men (MSM)? A comparative study of Belgium and the United Kingdom

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 569 ◽  
Author(s):  
Chris R. Kenyon ◽  
Irith De Baetselier ◽  
Tania Crucitti
Keyword(s):  
United Kingdom ◽  
Antimicrobial Resistance ◽  
The United States ◽  
National Surveillance ◽  
Surveillance Programme ◽  
The Past ◽  
The United Kingdom ◽  
Sex With Men ◽  
The Uk ◽  
Selection Of

Background: It is unclear why antimicrobial resistance in Neisseria gonorrhoeae in the United Kingdom (UK) and the United States has tended to first appear in men who have sex with men (MSM). We hypothesize that increased exposure to antimicrobials from intensive STI screening programmes plays a role. Methods: We assess if there is a difference in the distribution of azithromycin, cefixime and ceftriaxone minimum inhibitory concentrations (MICs) between MSM and women in the United Kingdom (UK) where 70% of MSM report STI screening in the past year vs. Belgium where 9% report STI screening in the past year. Our hypothesis is that MICs of the MSM should be higher than those of the women in the UK but not Belgium. Data for the MICs were taken from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) in the UK in 2010/2011 and 2014 and a similar national surveillance programme in Belgium in 2013/2014 (the first most complete available data). We used the Mann–Whitney test to compare the MIC distributions between MSM and women within each country Results: In the UK the MICs for all three antimicrobials were significantly higher in MSM than women at both time points (P all <0.0005). In Belgium only the MIC distribution for azithromycin was higher in MSM (P<0.0005). Conclusion: The findings for cefixime and ceftriaxone, but not azithromycin are compatible with our hypothesis that screening-intensity could contribute to the emergence of AMR. Numerous other interpretations of our results are discussed.

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