Multidrug-resistant Neisseria gonorrhoeae infection with ceftriaxone resistance and intermediate resistance to azithromycin, Denmark, 2017

doi:10.2807/1560-7917.ES.2017.22.42.17-00659

Case Reports

. 2017 Oct;22(42):17-00659.

doi: 10.2807/1560-7917.ES.2017.22.42.17-00659.

Multidrug-resistant Neisseria gonorrhoeae infection with ceftriaxone resistance and intermediate resistance to azithromycin, Denmark, 2017

David Terkelsen^{1

2}, Jacob Tolstrup^{2

3}, Camilla Hundahl Johnsen⁴, Ole Lund⁴, Helle Kiellberg Larsen³, Peder Worning¹, Magnus Unemo^{5

6}, Henrik Westh^{1

7

6}

Affiliations

¹ Department of Clinical Microbiology, Hvidovre Hospital, Copenhagen, Denmark.
² These authors contributed equally to the work.
³ Department of Dermatovenerology, Bispebjerg Hospital, Copenhagen, Denmark.
⁴ Department of Bio and Health Informatics, Technical University of Denmark, Lyngby, Denmark.
⁵ WHO Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
⁶ These authors share last authorship.
⁷ Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.

PMID: 29067905
PMCID: PMC5710115
DOI: 10.2807/1560-7917.ES.2017.22.42.17-00659

Case Reports

Multidrug-resistant Neisseria gonorrhoeae infection with ceftriaxone resistance and intermediate resistance to azithromycin, Denmark, 2017

David Terkelsen et al. Euro Surveill. 2017 Oct.

. 2017 Oct;22(42):17-00659.

doi: 10.2807/1560-7917.ES.2017.22.42.17-00659.

Authors

David Terkelsen^{1

2}, Jacob Tolstrup^{2

3}, Camilla Hundahl Johnsen⁴, Ole Lund⁴, Helle Kiellberg Larsen³, Peder Worning¹, Magnus Unemo^{5

6}, Henrik Westh^{1

7

6}

Affiliations

¹ Department of Clinical Microbiology, Hvidovre Hospital, Copenhagen, Denmark.
² These authors contributed equally to the work.
³ Department of Dermatovenerology, Bispebjerg Hospital, Copenhagen, Denmark.
⁴ Department of Bio and Health Informatics, Technical University of Denmark, Lyngby, Denmark.
⁵ WHO Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
⁶ These authors share last authorship.
⁷ Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.

PMID: 29067905
PMCID: PMC5710115
DOI: 10.2807/1560-7917.ES.2017.22.42.17-00659

Abstract

We describe a multidrug-resistant Neisseria gonorrhoeae infection with ceftriaxone resistance and azithromycin intermediate resistance in a heterosexual man in Denmark, 2017. Whole genome sequencing of the strain GK124 identified MSLT ST1903, NG-MAST ST1614 and all relevant resistance determinants including similar penA resistance mutations previously described in ceftriaxone-resistant gonococcal strains. Although treatment with ceftriaxone 0.5 g plus azithromycin 2 g was successful, increased awareness of spread of gonococcal strains threatening the recommended dual therapy is crucial.

Keywords: Neisseria gonorrhoeae; Resfinder; STD; antibiotic; multidrug-resistant; treatment.

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Conflict of interest statement

Conflict of interest: None declared.

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References

1. Unemo M, Golparian D, Nicholas R, Ohnishi M, Gallay A, Sednaoui P. High-level cefixime- and ceftriaxone-resistant Neisseria gonorrhoeae in France: novel penA mosaic allele in a successful international clone causes treatment failure. Antimicrob Agents Chemother. 2012;56(3):1273-80. 10.1128/AAC.05760-11 - DOI - PMC - PubMed
1. Lahra MM, Ryder N, Whiley DM. A new multidrug-resistant strain of Neisseria gonorrhoeae in Australia. N Engl J Med. 2014;371(19):1850-1. 10.1056/NEJMc1408109 - DOI - PubMed
1. Cámara J, Serra J, Ayats J, Bastida T, Carnicer-Pont D, Andreu A, et al. Molecular characterization of two high-level ceftriaxone-resistant Neisseria gonorrhoeae isolates detected in Catalonia, Spain. J Antimicrob Chemother. 2012;67(8):1858-60. 10.1093/jac/dks162 - DOI - PubMed
1. Unemo M, Shafer WM. Antimicrobial resistance in Neisseria gonorrhoeae in the 21st century: past, evolution, and future. Clin Microbiol Rev. 2014;27(3):587-613. 10.1128/CMR.00010-14 - DOI - PMC - PubMed
1. Ohnishi M, Golparian D, Shimuta K, Saika T, Hoshina S, Iwasaku K, et al. Is Neisseria gonorrhoeae initiating a future era of untreatable gonorrhea?: detailed characterization of the first strain with high-level resistance to ceftriaxone. Antimicrob Agents Chemother. 2011;55(7):3538-45. 10.1128/AAC.00325-11 - DOI - PMC - PubMed

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[1] Unemo M, Golparian D, Nicholas R, Ohnishi M, Gallay A, Sednaoui P. High-level cefixime- and ceftriaxone-resistant Neisseria gonorrhoeae in France: novel penA mosaic allele in a successful international clone causes treatment failure. Antimicrob Agents Chemother. 2012;56(3):1273-80. 10.1128/AAC.05760-11 - DOI - PMC - PubMed

[2] Unemo M, Golparian D, Nicholas R, Ohnishi M, Gallay A, Sednaoui P. High-level cefixime- and ceftriaxone-resistant Neisseria gonorrhoeae in France: novel penA mosaic allele in a successful international clone causes treatment failure. Antimicrob Agents Chemother. 2012;56(3):1273-80. 10.1128/AAC.05760-11 - DOI - PMC - PubMed

[3] Lahra MM, Ryder N, Whiley DM. A new multidrug-resistant strain of Neisseria gonorrhoeae in Australia. N Engl J Med. 2014;371(19):1850-1. 10.1056/NEJMc1408109 - DOI - PubMed

[4] Lahra MM, Ryder N, Whiley DM. A new multidrug-resistant strain of Neisseria gonorrhoeae in Australia. N Engl J Med. 2014;371(19):1850-1. 10.1056/NEJMc1408109 - DOI - PubMed

[5] Cámara J, Serra J, Ayats J, Bastida T, Carnicer-Pont D, Andreu A, et al. Molecular characterization of two high-level ceftriaxone-resistant Neisseria gonorrhoeae isolates detected in Catalonia, Spain. J Antimicrob Chemother. 2012;67(8):1858-60. 10.1093/jac/dks162 - DOI - PubMed

[6] Cámara J, Serra J, Ayats J, Bastida T, Carnicer-Pont D, Andreu A, et al. Molecular characterization of two high-level ceftriaxone-resistant Neisseria gonorrhoeae isolates detected in Catalonia, Spain. J Antimicrob Chemother. 2012;67(8):1858-60. 10.1093/jac/dks162 - DOI - PubMed

[7] Unemo M, Shafer WM. Antimicrobial resistance in Neisseria gonorrhoeae in the 21st century: past, evolution, and future. Clin Microbiol Rev. 2014;27(3):587-613. 10.1128/CMR.00010-14 - DOI - PMC - PubMed

[8] Unemo M, Shafer WM. Antimicrobial resistance in Neisseria gonorrhoeae in the 21st century: past, evolution, and future. Clin Microbiol Rev. 2014;27(3):587-613. 10.1128/CMR.00010-14 - DOI - PMC - PubMed

[9] Ohnishi M, Golparian D, Shimuta K, Saika T, Hoshina S, Iwasaku K, et al. Is Neisseria gonorrhoeae initiating a future era of untreatable gonorrhea?: detailed characterization of the first strain with high-level resistance to ceftriaxone. Antimicrob Agents Chemother. 2011;55(7):3538-45. 10.1128/AAC.00325-11 - DOI - PMC - PubMed

[10] Ohnishi M, Golparian D, Shimuta K, Saika T, Hoshina S, Iwasaku K, et al. Is Neisseria gonorrhoeae initiating a future era of untreatable gonorrhea?: detailed characterization of the first strain with high-level resistance to ceftriaxone. Antimicrob Agents Chemother. 2011;55(7):3538-45. 10.1128/AAC.00325-11 - DOI - PMC - PubMed

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Multidrug-resistant Neisseria gonorrhoeae infection with ceftriaxone resistance and intermediate resistance to azithromycin, Denmark, 2017

Affiliations

Multidrug-resistant Neisseria gonorrhoeae infection with ceftriaxone resistance and intermediate resistance to azithromycin, Denmark, 2017

Authors

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Abstract

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