ArticleAntimicrobial agents and chemotherapy2014
Azithromycin resistance is coevolving with reduced susceptibility to cephalosporins in Neisseria gonorrhoeae in Ontario, Canada.
Article in Antimicrobial agents and chemotherapy, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers.
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Who cites it
32 citing papers in PubMed, 53 citations in OpenAlex.
- Antibacterial potential of danthron, embelin, sanguinarine and shikonin against multidrug-resistant Neisseria gonorrhoeae in vitro.International microbiology : the official journal of the Spanish Society for Microbiology · 2026Article
- Whole-Genome Sequencing to Predict Antimicrobial Susceptibility Profiles in Neisseria gonorrhoeae.The Journal of infectious diseases · 2023Article
- Safety Aspects and Rational Use of Single Intramuscular Dose Ceftriaxone: Clinical Insights on the Management of Uncomplicated Gonococcal Infections.Drug, healthcare and patient safety · 2023Review
- Markedly Increasing Antibiotic Resistance and Dual Treatment of Neisseria gonorrhoeae Isolates in Guangdong, China, from 2013 to 2020.Antimicrobial agents and chemotherapy · 2022Article
- The Accuracy of Molecular Detection Targeting the Mutation C2611T for Detecting Moderate-Level Azithromycin Resistance inAntibiotics (Basel, Switzerland) · 2021Review
- Phylogenomic analysis reveals persistence of gonococcal strains with reduced-susceptibility to extended-spectrum cephalosporins and mosaic penA-34.Nature communications · 2021Article
- Evaluating the generalizability of a multiplex real-time PCR assay for predicting decreased susceptibility to ceftriaxone in a global set of Neisseria gonorrhoeae sequences.The Journal of antimicrobial chemotherapy · 2021Article
- Atypical Mutation in Neisseria gonorrhoeae 23S rRNA Associated with High-Level Azithromycin Resistance.Antimicrobial agents and chemotherapy · 2021Article
- Persistence Dynamics of Antimicrobial-ResistantAntimicrobial agents and chemotherapy · 2020Article
- Emergence of Neisseria gonorrhoeae Strains Harboring a Novel Combination of Azithromycin-Attenuating Mutations.Antimicrobial agents and chemotherapy · 2019Article
- Applications of genomics to slow the spread of multidrug-resistant Neisseria gonorrhoeae.Annals of the New York Academy of Sciences · 2019Review
- Evaluation of the accuracy of molecular assays targeting the mutation A2059G for detecting high-level azithromycin resistance inInfection and drug resistance · 2019Review
- Antimicrobial Resistance And Molecular Characteristics AmongInfection and drug resistance · 2019Article
- Antimicrobial resistance and molecular epidemiology using whole-genome sequencing of Neisseria gonorrhoeae in Ireland, 2014-2016: focus on extended-spectrum cephalosporins and azithromycin.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2018Article
- Genomic epidemiology and antimicrobial resistance of Neisseria gonorrhoeae in New Zealand.The Journal of antimicrobial chemotherapy · 2018Article
- Mechanistic Pathways for Peptidoglycan O-Acetylation and De-O-Acetylation.Frontiers in microbiology · 2018Review
- Overall Low Extended-Spectrum Cephalosporin Resistance but high Azithromycin Resistance in Neisseria gonorrhoeae in 24 European Countries, 2015.BMC infectious diseases · 2017Article
- A Case-Control Study of Molecular Epidemiology in Relation to Azithromycin Resistance in Neisseria gonorrhoeae Isolates Collected in Amsterdam, the Netherlands, between 2008 and 2015.Antimicrobial agents and chemotherapy · 2017Article
- Neisseria gonorrhoeae Sequence Typing for Antimicrobial Resistance, a Novel Antimicrobial Resistance Multilocus Typing Scheme for Tracking Global Dissemination of N. gonorrhoeae Strains.Journal of clinical microbiology · 2017Article
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Authors and funding
4 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Azithromycin (AZM) is routinely recommended as a component of dual therapy for gonorrhea in combination with third-generation cephalosporins (3GC). In this study, we examined the prevalence of AZM-resistant (AZM(r)) Neisseria gonorrhoeae from July 2010 to February 2013, assessed the rate of concurrent cephalosporin resistance under the current treatment recommendations, and analyzed the clonal distribution of AZM(r) isolates in Ontario, Canada. Nineteen AZM(r) clinical isolates (one per patient; MIC, ≥2 μg/ml) were included in the study. Susceptibility profiles of these isolates to 11 antibiotics, molecular typing, characterization of macrolide resistance mechanisms, and penicillin-binding protein 2 (PBP2) patterns were determined for all the isolates. Two groups were defined based on AZM(r) level; group A isolates displayed high-level resistance (MIC, ≥2,048 μg/ml) due to mutations (A2143G) in the four copies of the 23S rRNA rrl gene, and group B isolates had moderate resistance to AZM (MICs, 2 to 8 μg/ml, C2599T mutation in the rrl gene), with a subgroup belonging to sequence type 3158 (ST3158) (n = 8), which also showed reduced susceptibility to 3GC (MICs, 0.12 to 0.25 μg/ml, PBP2 pattern XXXIV). This AZM(r) phenotype was not observed in previous provincial surveillance in 2008 (the ST3158 clone was found, with AZM MICs of 0.25 to 0.5 μg/ml associated with mtrR mutations). We hypothesized that the AZM mutant prevention concentration (MPC) in the ST3158 subpopulation we found in 2008 was higher than the MPC in wild-type isolates (AZM MIC, ≤0.031 μg/ml), increasing the chances of additional selection of AZM(r) mutations. Full AZM resistance is now emerging in this clone together with reduced susceptibility to 3GC, threatening the future efficacy of these antibiotics as therapeutic options for treatment of gonorrhea.
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