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Kim, Seo, Kim, Lee, Lee, Lee, and Chong: Antimicrobial Resistance and Molecular Epidemiologic Characteristics of Neisseria gonorrhoeae Isolated from Korea in 2013
Original Article

Ann Clin Microbiol 2013;16(4):182-187.

Published online: 5 December 2013

DOI: https://doi.org/10.5145/ACM.2013.16.4.182

Antimicrobial Resistance and Molecular Epidemiologic Characteristics of Neisseria gonorrhoeae Isolated from Korea in 2013

Hyo Jin Kim1, Younghee Seo1, Wan Hee Kim1, Yangsoon Lee1, Hyukmin Lee2, Kyungwon Lee1, Yunsop Chong1

1Department of Laboratory Medicine, Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea

2Kwandong University College of Medicine, Incheon, Korea

Correspondence: Hyukmin Lee, Department of Laboratory Medicine, Kwandong University College of Medicine, 407-1, Jakjeon-dong, Gyeyang-gu, Incheon 407-816, Korea. (Tel) 82-32-553-3797, (Fax) 82-32-553-6988, (E-mail) hmlee.labmed@gmail.com

Received 8 November 201322 November 2013       Accepted 22 November 2013

Copyright © 2013 The Korean Society of Clinical Microbiology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Background

Antimicrobial resistance of Neisseria gonorrhoeae has become a serious problem world-wide, and ceftriaxone non-susceptible isolates have been recently reported from Japan and Europe. In this study, we evaluated the antimicrobial susceptibil-ities and molecular epidemiological characteristics of isolates from Korea in 2013.

Methods

Sixty strains of N. gonorrhoeae were collected from Korean patients and prostitutes. Antimicrobial susceptibility was tested by the agar dilution and disk diffusion methods. N. gonorrhoeae multiantigen sequence typing (NG-MAST) was performed in order to determine the molecular epidemiologic relatedness.

Results

All of isolates were non-susceptible to pen-icillin G and tetracycline, and the rate of ciprofloxacin- resistant isolates was 95% in 2013. The MICs of ceftriaxone were within the susceptible range for all isolates, but one isolate non-susceptible to cefixime (MIC=0.5 μ g/mL) was encountered. The isolates with decreased susceptibility (MIC≤0.12 μ g/mL) to cefixime or ceftriaxone accounted for 10% and 14% of the isolates tested, respectively. In NG-MAST analysis, 40 different STs were encountered among the 59 isolates. Isolates that belonged to tbpB110 showed higher cefixime and ceftriaxone MICs (0.12-0.5 μ g/ mL) as well as cefixime resistance.

Conclusion

Most of the N. gonorrhoeae isolates showed susceptibility to spectinomycin and cephalosporins. Due to the emergence of isolates that are non-sus-ceptible to cefixime and the prevalence of isolates with the tbpB110 allele belonging to ST1407, which cause cefixime and ceftriaxone treatment failure in successful global clones of N. gonorrhoeae, a continuous nationwide antimicrobial surveillance program is required to monitor the emergence of cephalospor-in resistance in N. gonorrhoeae.

Keywords: Microbial sensitivity tests, Neisseria gonorrhoeae, Neisseria gonorrhoeae multiantigen sequence typing

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Table 1.
Antimicrobial susceptibility of Neisseria gonorrhoeae isolates tested by diskdiffusion
Antimicrobial agents (Dosage) % of isolates with (N=60)
Susceptible Intermediate e NS† Resistant
Penicillin G (10 U) 0 42   58
Spectinomycin (100 μ g) 100 0   0
Ceftriaxone (0.5 μ g)∗ 50   50  
Ceftriaxone (30 μ g) 75   25  
Cefixime (5 μ g) 75   25  
Cefpodoxime (10 μ g) 82   18  
Cefotaxime (30 μ g) 70   30  
Tetracycline (30 μ g) 0 5   95
Ciprofloxacin (5 μ g) 5 2   93
Nalidixic acid (30 μ g)∗ 7   93  
Azithromycin (15 μ g)∗ 98   2  

∗ Australiancriteria (CDS) were applied. CLSI criteria were applied for the other antimicrobial agents;

† Not susceptible.

Table 2.
Antimicrobial susceptibility of Neisseria gonorrhoeae isolates tested by agar dilution
Antimicrobial agents MIC (μ g/mL) % of isolates with (N=59)
Range 50% 90% S I R
Penicillin G 0.12-128 1 4 0 75 25
Ceftriaxone ≤0.008-0.25 0.015 0.12 100 0† 0
Cefixime ≤0.008-0.5 0.015 0.12 98 2† 0
Cefpodoxime ≤0.008-4 0.06 0.5 92 8† 0
Spectinomycin ≤16-32 32 32 100 0 0
Gentamicin ≤2-8 8 8 NA NA NA
Tetracycline ≤0.12-64 2 16 5 44 51
Ciprofloxacin ≤0.008-32 4 16 3 2 95
Azithromycin∗ ≤0.06-2 0.12 0.5 85 13 2

∗ EUCAST breakpoints were applied;

† Not susceptible.

Abbreviations: S, susceptible; I, intermediate; R, resistant; NA, not applicable.

Table 3.
Number of isolates according to multiantigen sequence typing
Sequence type No. of isolates (N=59) s porB tbpB Region
ST6734 10 4,016 33 S, I, G, C, J
ST8043 5 206 455 I, G
ST9675∗ 3 4,801 33 S
ST228 2 23 27 G, J
ST2066 2 1,042 328 I, W
ST2958 2 1,785 110‡ S, G
ST3968 2 2,409 21 I
ST9673∗ 2 1,416 328 S, J
Other† 31     S, I, G, W, C, J

∗ New ST identified in this study;

† ST205 (porB164 tbpB4), ST278(porB4 tbpB27), ST807 (porB37 tbpB27), ST1670 (porB23 tbpB1674)*, ST3435 (porB1053 tbpB21), ST4502 (porB1785 tbpB21), ST4764(porB2874 tbpB21), ST5699 (porB580 tbpB328), ST7132 (porB4270 tbpB129), ST7548 (porB4530 tbpB21), ST7684 (porB4618 tbpB21), ST7686 (porB4620 tbpB21), ST7688 (porB23 tbpB21), ST8160(porB4892 tbpB563), ST8181 (porB4872 tbpB33), ST8561 (porB101 tbpB29), ST9667 (porB4 tbpB677)*, ST9668 (porB5700 tbpB33)*, ST9669 (porB5701 tbpB110

‡ )*, ST9671 (porB4016 tbpB862)*, ST 9672 (porB258 tbpB862)*, ST9674 (porB5702 tbpB455)*, ST9676(porB5703 tbpB186)*, ST9677 (porB5704 tbpB21)*, ST9678 (porB37 tbpB455)*, ST9679 (porB543 tbpB1692)*, ST9680 (porB5705 tbpB4)*, ST9681 (porB5706 tbpB4)*, ST9682 (porB5707 tbpB1336)*, ST9683(porB5708 tbpB21)*, ST9684 (porB5709 tbpB21)*;

‡ The same tbpB type of ST1407.

Abbreviations: S, Seoul; I, Incheon; G, Gyeonggi; W, Wonju; C, Chungbuk; J, Junbuk.

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