Search

Background Neisseria gonorrhoeae (NG) has an extraordinary ability to develop resistance to all antimicrobials used for its treatment. This study analysed molecular determinants of antimicrobial resistance and NG-MAST of 153 NG isolates collected at Florianopolis metropolitan area during 2008–2016. Methods Minimal Inhibitory Concentration (MIC) was determined by agar dilution and the molecular epidemiology was evaluated by NG-MAST. Results Resistance was observed to penicillin (PEN) (26.1%), tetracycline (TET) (41.2%), ciprofloxacin (CIP) (52.3%) and azithromycin (AZT) (5.2%). All isolates were susceptible to cefixime (CFX) and ceftriaxone (CRO). However, 8.5% of isolates had MIC=0.125 mg/L for CFX, one log below the resistance cut-off point (EUCAST). β-lactamase production was detected in 12.4% of isolates and one of them carried the blaTEM-135 allele. The American or Dutch tetM gene were carried by 5.2% of the isolates. Mutations in the QRDR were observed in 87.5% of isolates resistant to CIP. NG-MAST showed 64 different sequence types (STs), including 19 novel STs. ST225, ST2992, ST1582, ST338, ST1407, ST2202 and ST6827 were most prevalent. G225 genogroup was associated with resistance to CIP (p Conclusion This study showed high rates of resistance to PEN, TET and CIP associated with persistence and dissemination of gonococcal strains resistant to CIP and plasmid resistance to PEN and TET. Despite the high resistance profile to CIP, the treatment recommended to the south region of Brazil was the association of CIP-AZT until 2017, when the national recommendation changed it to CRO-AZT. Disclosure No significant relationships.

Introduction: Neisseria gonorrhoeae (NG), initially highly susceptible to many antimicrobials, was recently assigned as a superbug due to its ability to develop resistance to all antimicrobials introduced for treatment during the last years. This study aimed to determine the prevalence and trends of NG antimicrobial resistance (AMR) during 2008–2016 in Grande Florianopolis, Santa Catarina, Brazil. Methods A total of 152 gonococcal isolates from urogenital specimens were submitted to Santa Luzia Medical Laboratory, Florianopolis, Brazil. All isolates were identified to the species level using MALDI-TOF. The minimum inhibitory concentration (MIC) was determined using agar dilution method to penicillin, tetracycline, ciprofloxacin, ceftriaxone, cefixime and azithromycin. Quality control was performed using NG WHO reference strains and ATCC 49226. Results All isolates were sensitive to ceftriaxone (MIC 0.001–0.06 µg/ml) and cefixime (MIC: 0.0005–0.125 µg/ml). Resistance to penicilin, tetracycline, ciprofloxacin and azithromycin were 26.3%, 40.8%, 52.0% and 5.2% respectively. Conclusion The study showed increased resistance to penicillin, tetracycline, ciprofloxacin and azithromycin. No resistance to ceftriaxone and cefixime was detected. Due to the high level ciprofloxacin resistance, the dual therapy currently recommended in Brazil for gonococcal infections (ciprofloxacin plus azithromycin) is no more an effective treatment option in Grande Florianopolis. Thus, ceftriaxone constitute the treatment option for gonococcal infections, as well as in the states of Rio de Janeiro, Sao Paulo and Minas Gerais, where regional studies have already detected high level ciprofloxacin resistance. AMR testing needs to be frequently performed to ensure the treatment effectiveness.