title: A community-based outbreak of infection with penicillin-resistant Neisseria gonorrhoeae not producing penicillinase (chromosomally mediated resistance).
abstract: From February through November of 1983, 199 cases of penicillin-resistant Neisseria gonorrhoeae infection were identified in a localized epidemic in Durham, North Carolina. The isolates did not produce beta-lactamase but were unusually resistant to penicillin (minimum inhibitory concentration, 2.0 to 4.0 micrograms per milliliter), and 15 of 16 patients treated with 4.8 million units of penicillin G procaine plus 1.0 g of probenecid did not respond to therapy. Recognition of the outbreak was impeded by a lack of routine surveillance for resistance other than that mediated by beta-lactamase. All epidemic isolates had a single serotype, auxotype, and antibiotic-susceptibility profile. The outbreak was halted by changing the treatment for all patients and their contacts to spectinomycin, and by intensive epidemiologic case-finding efforts. The emergence of such resistant strains poses potential major public health problems and indicates a need for reassessment of current surveillance procedures.
authors.forename: H
authors.initials: H
authors.lastname: Faruki
authors.forename: R N
authors.initials: RN
authors.lastname: Kohmescher
authors.forename: W P
authors.initials: WP
authors.lastname: McKinney
authors.forename: P F
authors.initials: PF
authors.lastname: Sparling
mesh_terms: D000328:Adult; D002876:Chromosomes, Bacterial; D004196:Disease Outbreaks / Q000453:epidemiology*; D004812:Epidemiologic Methods; D005260:Female; D006069:Gonorrhea / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009344:Neisseria gonorrhoeae / Q000187:drug effects* / Q000201:enzymology / Q000235:genetics; D009657:North Carolina; D010402:Penicillin G Procaine / Q000627:therapeutic use; D010403:Penicillin Resistance; D010405:Penicillinase / Q000096:biosynthesis; D011339:Probenecid / Q000627:therapeutic use; D000198:Spectinomycin / Q000627:therapeutic use; D001618:beta-Lactamases / Q000032:analysis
chemical_list: D010402:Penicillin G Procaine; D000198:Spectinomycin; D010405:Penicillinase; D001618:beta-Lactamases; D011339:Probenecid