title: Reduced susceptibility to azithromycin and high percentages of penicillin and tetracycline resistance in Neisseria gonorrhoeae isolates from Manaus, Brazil, 1998.
abstract: BACKGROUND
  The identification of Neisseria gonorrhoeae isolates resistant to antimicrobial agents currently recommended for the treatment of gonococcal infections continues to escalate globally. Thus, in some areas, resistance to fluoroquinolone drugs is commonplace; several reports document resistance to third-generation cephalosporins, and the sporadic isolation of spectinomycin-resistant isolates continues unabated. Gonococcal resistance to azithromycin, an antibiotic used for the primary treatment of gonococcal infections in some Latin American countries, also has been described. Because the prevalence of resistant isolates is insufficiently documented in many areas of Latin America, the efficacy of locally recommended therapies for gonococcal infections is often unknown.
  
  
  OBJECTIVE
  To determine the antimicrobial susceptibility and strain types of N gonorrhoeae isolates collected in Manaus, Brazil. These data will establish antimicrobial susceptibility baseline data for the region as a reference point for future surveillance.
  
  
  METHODS
  Consecutive N gonorrhoeae isolates from urethral and endocervical specimens were collected and examined for identity, antimicrobial susceptibility, and strain type (plasmid content, tetM type, auxotype, and serovar).
  
  
  RESULTS
  Most of the isolates (65/81; 85.2%) were resistant to tetracycline, penicillin, or both, with the majority (n = 62) carrying plasmid-mediated resistance to tetracycline (tetracycline-resistant N gonorrhoeae [TRNG]). All of the TRNG contained the Dutch-type tetM plasmid, and 18 were A/S class NR/IA-02. Penicillinase-producing N gonorrhoeae comprised 8.2% (7/81) of the isolates. Of these seven isolates, four also were TRNG, and two carried chromosomal resistance to tetracycline. The isolates were susceptible to ciprofloxacin, spectinomycin, and ceftriaxone. However, 23 isolates were characterized by reduced susceptibility to azithromycin (MIC, 0.25-0.5 microg/ml), and one isolate had reduced susceptibility to ciprofloxacin (MIC, 0.25 microg/ml).
  
  
  CONCLUSIONS
  This study supports the continued use of third-generation cephalosporins, spectinomycin, and fluoroquinolone drugs for the primary treatment of gonococcal infections in Manaus. The occurrence of isolates with reduced susceptibility to azithromycin and ciprofloxacin underscores the importance of ongoing antimicrobial susceptibility monitoring to support decisions regarding appropriate drugs for the treatment of gonococcal infections.
authors.affiliation: Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, Canada. jdillon@uottawa.ca
authors.forename: J A
authors.initials: JA
authors.lastname: Dillon
authors.forename: J P
authors.initials: JP
authors.lastname: Rubabaza
authors.forename: A S
authors.initials: AS
authors.lastname: Benzaken
authors.forename: J C
authors.initials: JC
authors.lastname: Sardinha
authors.forename: H
authors.initials: H
authors.lastname: Li
authors.forename: M G
authors.initials: MG
authors.lastname: Bandeira
authors.forename: E
authors.initials: E
authors.lastname: dos Santos Fernando Filho
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D017963:Azithromycin / Q000627:therapeutic use; D001938:Brazil / Q000453:epidemiology; D024841:Fluoroquinolones; D006069:Gonorrhea / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D066298:In Vitro Techniques; D008826:Microbial Sensitivity Tests / Q000379:methods; D009344:Neisseria gonorrhoeae / Q000187:drug effects* / Q000302:isolation & purification; D010403:Penicillin Resistance; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D013753:Tetracycline Resistance
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D024841:Fluoroquinolones; D017963:Azithromycin