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. 2017 May;23(5):830-832.
doi: 10.3201/eid2305.170088.

Azithromycin Resistance and Decreased Ceftriaxone Susceptibility in Neisseria gonorrhoeae, Hawaii, USA

John R Papp, A Jeanine Abrams, Evelyn Nash, Alan R Katz, Robert D Kirkcaldy, Norman P O'Connor, Pamela S O'Brien, Derek H Harauchi, Eloisa V Maningas, Olusegun O Soge, Ellen N Kersh, Alan Komeya, Juval E Tomas, Glenn M Wasserman, Gail Y Kunimoto, David L Trees, A Christian Whelen

Azithromycin Resistance and Decreased Ceftriaxone Susceptibility in Neisseria gonorrhoeae, Hawaii, USA

John R Papp et al. Emerg Infect Dis. 2017 May.

Abstract

During 2016, eight Neisseria gonorrhoeae isolates from 7 patients in Hawaii were resistant to azithromycin; 5 had decreased in vitro susceptibility to ceftriaxone. Genomic analysis demonstrated a distinct phylogenetic clade when compared with local contemporary strains. Continued evolution and widespread transmission of these strains might challenge the effectiveness of current therapeutic options.

Keywords: Hawaii; Neisseria gonorrhoeae; STD; STI; United States; antimicrobial resistance; azithromycin; bacteria; bacterial infection; ceftriaxone; genomic analysis; gonorrhea; in vitro susceptibility; phylogenic cluster; sexual transmitted infections; sexually transmitted disease.

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Figures

Figure
Figure
Maximum-likelihood phylogeny of Neisseria gonorrhoeae samples (N = 62) collected in Hawaii during February–May 2016, 1 isolate collected in Hawaii in 2011, and 1 isolate collected in the United Kingdom in 2015. The clade denoted with the black vertical bar contains 8 samples that exhibited resistance to azithromycin (MIC >256 µg/mL by Etest) and reduced susceptibility to ceftriaxone (MIC range 0.094–0.125 µg/mL). The 2011 isolate from Hawaii (H11S8, bold) also exhibited resistance to azithromycin. The United Kingdom isolate (underlined) was associated with failed dual antimicrobial therapy of ceftriaxone and azithromycin. The phylogeny is based on the core genome single nucleotide polymorphism alignment of the 62 genomes and the FA19 reference genome. Values on the nodes of the phylogeny (based on 1,000 bootstrap replicates) represent the support for each node and the corresponding clade. Scale bar indicates substitutions per site.
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