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. 2023 Aug 17;11(4):e0097023.
doi: 10.1128/spectrum.00970-23. Epub 2023 Jun 20.

Sustained Transmission of Neisseria gonorrhoeae Strains with High-Level Azithromycin Resistance (MIC ≥ 256 μg/mL) in Argentina, 2018 to 2022

Ricardo Ariel Gianecini  1 , Tomas Poklepovich  2 , Daniel Golparian  3 , Noelia Cuenca  1 , Laura Scocozza  4 , Silvina Bergese  5 , Liliana Fernández Canigia  5 , Viviana Vilches  6 , María Julia Lazzarino Elgart  7 , Magnus Unemo  3   8 , Josefina Campos  2 , Patricia Galarza  1
Affiliations

Sustained Transmission of Neisseria gonorrhoeae Strains with High-Level Azithromycin Resistance (MIC ≥ 256 μg/mL) in Argentina, 2018 to 2022

Ricardo Ariel Gianecini et al. Microbiol Spectr. .

Abstract

Azithromycin combined with ceftriaxone is the recommended dual therapy for uncomplicated gonorrhea in many countries. Nevertheless, the increasing prevalence of azithromycin resistance compromises the effectiveness of this treatment strategy. From 2018 to 2022, we collected 13 gonococcal isolates with high-level azithromycin resistance (MIC ≥ 256 μg/mL) across Argentina. Whole-genome sequencing revealed that these isolates were mainly represented by the internationally spreading Neisseria gonorrhoeae multi-antigen sequence typing (NG-MAST) genogroup G12302, containing the 23S rRNA A2059G mutation (in all four alleles) together with mosaic mtrD and mtrR promoter 2 loci. This information is important to develop targeted public health policies to control the spread of azithromycin-resistant N. gonorrhoeae in Argentina and internationally. IMPORTANCE Azithromycin resistance in Neisseria gonorrhoeae has been increasing in numerous populations worldwide, which is of concern, as azithromycin is part of the recommended dual treatment in many countries. Here, we report 13 N. gonorrhoeae isolates with high-level azithromycin resistance (MIC ≥ 256 μg/mL). This study observed that high-level azithromycin-resistant gonococcal strains have shown sustained transmission in Argentina and are related to the successful international clone NG-MAST G12302. Genomic surveillance together with real-time tracing and data-sharing networks will be crucial in controlling the spread of azithromycin resistance in gonococcus.

Keywords: antimicrobial resistance; azithromycin; gonorrhea; treatment; whole-genome sequencing.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

FIG 1
FIG 1
Phylogenomic tree of Neisseria gonorrhoeae isolates with high-level resistance to azithromycin (MIC ≥ 256 μg/mL) collected across Argentina (2018 to 2022), compared with isolates from Norway (2016 to 2017) (16), Indianapolis, USA (2017 to 2018) (18), and Barcelona, Spain (2017 to 2018) (17). The first four columns next to the tree represent the country or city of origin/reporting. The following two columns describe azithromycin resistance determinants and the last three columns represent the MLST ST (all ST9363), NG-MAST genogroup (all except three were G12302), and NG-STAR clonal complexes (all except two were CC213).
See this image and copyright information in PMC

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