Genotypic and Phenotypic Characterization of Antimicrobial Resistance in <named-content content-type="genus-species">Neisseria gonorrhoeae</named-content>: a Cross-Sectional Study of Isolates Recovered from Routine Urine Cultures in a High-Incidence Setting

ABSTRACT The objectives of this study were to perform genomic and phenotypic characterization of antimicrobial resistance in Neisseria gonorrhoeae isolates recovered from urine samples from patients in St. Louis, MO, USA. Sixty-four clinical isolates were banked over a 2-year period and subjected to...

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Autores principales:	Adam L. Bailey, Robert F. Potter, Meghan A. Wallace, Caitlin Johnson, Gautam Dantas, Carey-Ann D. Burnham
Formato:	article
Lenguaje:	EN
Publicado:	American Society for Microbiology 2019
Materias:	Neisseria gonorrhoeae gonorrhea urine culture Microbiology QR1-502
Acceso en línea:	https://doaj.org/article/282067f752994ab984f6951bd30b75c1
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spelling	oai:doaj.org-article:282067f752994ab984f6951bd30b75c12021-11-15T15:22:27ZGenotypic and Phenotypic Characterization of Antimicrobial Resistance in <named-content content-type="genus-species">Neisseria gonorrhoeae</named-content>: a Cross-Sectional Study of Isolates Recovered from Routine Urine Cultures in a High-Incidence Setting10.1128/mSphere.00373-192379-5042https://doaj.org/article/282067f752994ab984f6951bd30b75c12019-08-01T00:00:00Zhttps://journals.asm.org/doi/10.1128/mSphere.00373-19https://doaj.org/toc/2379-5042ABSTRACT The objectives of this study were to perform genomic and phenotypic characterization of antimicrobial resistance in Neisseria gonorrhoeae isolates recovered from urine samples from patients in St. Louis, MO, USA. Sixty-four clinical isolates were banked over a 2-year period and subjected to antimicrobial susceptibility testing (AST) by Kirby-Bauer disk diffusion (penicillin, tetracycline, cefuroxime, and ciprofloxacin) and gradient diffusion (tetracycline, doxycycline, azithromycin, ceftriaxone, cefixime, ciprofloxacin, gemifloxacin, and delafloxacin). The medical records for the patients were evaluated to determine the demographics, location, and prescribed treatment regimen. Isolate draft genomes were assembled from Illumina shotgun sequencing data, and resistance determinants were identified by ResFinder and PointFinder. Of the 64 isolates, 97% were nonsusceptible to penicillin, with resistant isolates all containing the blaTEM-1b gene; 78 and 81% of isolates were nonsusceptible to tetracycline and doxycycline, respectively, with resistant isolates all containing the tet(M) gene. One isolate was classified as non-wild-type to azithromycin, and all isolates were susceptible to ceftriaxone; 89% of patients received this combination of drugs as first-line therapy. Six percent of isolates were resistant to ciprofloxacin, with most resistant isolates containing multiple gyrA and parC mutations. Correlation between disk and gradient diffusion AST devices was high for tetracycline and ciprofloxacin (R2 > 99% for both). The rates of N. gonorrhoeae antibiotic resistance in St. Louis are comparable to current rates reported nationally, except ciprofloxacin resistance was less common in our cohort. Strong associations between specific genetic markers and phenotypic susceptibility testing hold promise for the utility of genotype-based diagnostic assays to guide directed antibiotic therapy. IMPORTANCE Neisseria gonorrhoeae causes the sexually transmitted infection gonorrhea, which is most commonly diagnosed using a DNA-based detection method that does not require growth and isolation of N. gonorrhoeae in the laboratory. This is problematic because the rates of antibiotic resistance in N. gonorrhoeae are increasing, but without isolating the organism in the clinical laboratory, antibiotic susceptibility testing cannot be performed on strains recovered from clinical specimens. We observed an increase in the frequency of urine cultures growing N. gonorrhoeae after we implemented a total laboratory automation system for culture in our clinical laboratory. Here, we report on the rates of resistance to multiple historically used, first-line, and potential future-use antibiotics for 64 N. gonorrhoeae isolates. We found that the rates of antibiotic resistance in our isolates were comparable to national rates. Additionally, resistance to specific antibiotics correlated closely with the presence of genetic resistance genes, suggesting that DNA-based tests could also be designed to guide antibiotic therapy for treating gonorrhea.Adam L. BaileyRobert F. PotterMeghan A. WallaceCaitlin JohnsonGautam DantasCarey-Ann D. BurnhamAmerican Society for MicrobiologyarticleNeisseria gonorrhoeaegonorrheaurine cultureMicrobiologyQR1-502ENmSphere, Vol 4, Iss 4 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	Neisseria gonorrhoeae gonorrhea urine culture Microbiology QR1-502
spellingShingle	Neisseria gonorrhoeae gonorrhea urine culture Microbiology QR1-502 Adam L. Bailey Robert F. Potter Meghan A. Wallace Caitlin Johnson Gautam Dantas Carey-Ann D. Burnham Genotypic and Phenotypic Characterization of Antimicrobial Resistance in <named-content content-type="genus-species">Neisseria gonorrhoeae</named-content>: a Cross-Sectional Study of Isolates Recovered from Routine Urine Cultures in a High-Incidence Setting
description	ABSTRACT The objectives of this study were to perform genomic and phenotypic characterization of antimicrobial resistance in Neisseria gonorrhoeae isolates recovered from urine samples from patients in St. Louis, MO, USA. Sixty-four clinical isolates were banked over a 2-year period and subjected to antimicrobial susceptibility testing (AST) by Kirby-Bauer disk diffusion (penicillin, tetracycline, cefuroxime, and ciprofloxacin) and gradient diffusion (tetracycline, doxycycline, azithromycin, ceftriaxone, cefixime, ciprofloxacin, gemifloxacin, and delafloxacin). The medical records for the patients were evaluated to determine the demographics, location, and prescribed treatment regimen. Isolate draft genomes were assembled from Illumina shotgun sequencing data, and resistance determinants were identified by ResFinder and PointFinder. Of the 64 isolates, 97% were nonsusceptible to penicillin, with resistant isolates all containing the blaTEM-1b gene; 78 and 81% of isolates were nonsusceptible to tetracycline and doxycycline, respectively, with resistant isolates all containing the tet(M) gene. One isolate was classified as non-wild-type to azithromycin, and all isolates were susceptible to ceftriaxone; 89% of patients received this combination of drugs as first-line therapy. Six percent of isolates were resistant to ciprofloxacin, with most resistant isolates containing multiple gyrA and parC mutations. Correlation between disk and gradient diffusion AST devices was high for tetracycline and ciprofloxacin (R2 > 99% for both). The rates of N. gonorrhoeae antibiotic resistance in St. Louis are comparable to current rates reported nationally, except ciprofloxacin resistance was less common in our cohort. Strong associations between specific genetic markers and phenotypic susceptibility testing hold promise for the utility of genotype-based diagnostic assays to guide directed antibiotic therapy. IMPORTANCE Neisseria gonorrhoeae causes the sexually transmitted infection gonorrhea, which is most commonly diagnosed using a DNA-based detection method that does not require growth and isolation of N. gonorrhoeae in the laboratory. This is problematic because the rates of antibiotic resistance in N. gonorrhoeae are increasing, but without isolating the organism in the clinical laboratory, antibiotic susceptibility testing cannot be performed on strains recovered from clinical specimens. We observed an increase in the frequency of urine cultures growing N. gonorrhoeae after we implemented a total laboratory automation system for culture in our clinical laboratory. Here, we report on the rates of resistance to multiple historically used, first-line, and potential future-use antibiotics for 64 N. gonorrhoeae isolates. We found that the rates of antibiotic resistance in our isolates were comparable to national rates. Additionally, resistance to specific antibiotics correlated closely with the presence of genetic resistance genes, suggesting that DNA-based tests could also be designed to guide antibiotic therapy for treating gonorrhea.
format	article
author	Adam L. Bailey Robert F. Potter Meghan A. Wallace Caitlin Johnson Gautam Dantas Carey-Ann D. Burnham
author_facet	Adam L. Bailey Robert F. Potter Meghan A. Wallace Caitlin Johnson Gautam Dantas Carey-Ann D. Burnham
author_sort	Adam L. Bailey
title	Genotypic and Phenotypic Characterization of Antimicrobial Resistance in <named-content content-type="genus-species">Neisseria gonorrhoeae</named-content>: a Cross-Sectional Study of Isolates Recovered from Routine Urine Cultures in a High-Incidence Setting
title_short	Genotypic and Phenotypic Characterization of Antimicrobial Resistance in <named-content content-type="genus-species">Neisseria gonorrhoeae</named-content>: a Cross-Sectional Study of Isolates Recovered from Routine Urine Cultures in a High-Incidence Setting
title_full	Genotypic and Phenotypic Characterization of Antimicrobial Resistance in <named-content content-type="genus-species">Neisseria gonorrhoeae</named-content>: a Cross-Sectional Study of Isolates Recovered from Routine Urine Cultures in a High-Incidence Setting
title_fullStr	Genotypic and Phenotypic Characterization of Antimicrobial Resistance in <named-content content-type="genus-species">Neisseria gonorrhoeae</named-content>: a Cross-Sectional Study of Isolates Recovered from Routine Urine Cultures in a High-Incidence Setting
title_full_unstemmed	Genotypic and Phenotypic Characterization of Antimicrobial Resistance in <named-content content-type="genus-species">Neisseria gonorrhoeae</named-content>: a Cross-Sectional Study of Isolates Recovered from Routine Urine Cultures in a High-Incidence Setting
title_sort	genotypic and phenotypic characterization of antimicrobial resistance in <named-content content-type="genus-species">neisseria gonorrhoeae</named-content>: a cross-sectional study of isolates recovered from routine urine cultures in a high-incidence setting
publisher	American Society for Microbiology
publishDate	2019
url	https://doaj.org/article/282067f752994ab984f6951bd30b75c1
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Genotypic and Phenotypic Characterization of Antimicrobial Resistance in <named-content content-type="genus-species">Neisseria gonorrhoeae</named-content>: a Cross-Sectional Study of Isolates Recovered from Routine Urine Cultures in a High-Incidence Setting

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