title: Emergence and spread of Neisseria gonorrhoeae clinical isolates harboring mosaic-like structure of penicillin-binding protein 2 in Central Japan.
abstract: Of 150 clinical isolates of Neisseria gonorrhoeae recovered in 2001, we examined 55 clinical isolates of N. gonorrhoeae for which cefixime MICs were > or=0.125 microg/ml and randomly selected 15 isolates for which cefixime MICs were < or =0.06 microg/ml for analysis of alterations in the penicillin-binding protein 2 (PBP 2) gene. We found insertion of an extra codon (Asp-345a) in the transpeptidase domain of PBP 2, and this insertion occurred alone or in conjunction with other amino acid substitutions. We also found a mosaic PBP 2 that was composed of fragments of the PBP 2 proteins from Neisseria cinera and Neisseria perflava. This mosaic PBP 2 was significantly associated with decreased susceptibilities to penicillin and cephalosporins, especially oral cephalosporins. For most of the isolates with a mosaic PBP 2, the cefixime MICs were > or =0.5 microg/ml and the cefdinir MICs were > or =1 microg/ml. Analysis of chromosomal DNA restriction patterns by pulsed-field gel electrophoresis revealed that most isolates with the mosaic PBP 2 were genetically similar. The recombination events that generated the mosaic PBP 2 would likely have contributed to the decreased sensitivities to cephalosporins. Isolates with the mosaic PBP 2 appear to threaten the efficacy of the currently recommended regimen with cefixime. The emergence of such strains may be the result of the in vivo generation of clones in which interspecies recombination occurred between the penA genes of N. gonorrhoeae and commensal Neisseria species.
authors.affiliation: Department of Urology, Gifu University School of Medicine, 1-1 Yanagido, Gifu City 501-1194, Japan.
authors.forename: Masayasu
authors.initials: M
authors.lastname: Ito
authors.forename: Takashi
authors.initials: T
authors.lastname: Deguchi
authors.forename: Koh-Suke
authors.initials: KS
authors.lastname: Mizutani
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Yasuda
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Yokoi
authors.forename: Shin-Ichi
authors.initials: S
authors.lastname: Ito
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ishihara
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kawamura
authors.forename: Takayuki
authors.initials: T
authors.lastname: Ezaki
mesh_terms: D000595:Amino Acid Sequence; D019943:Amino Acid Substitution; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D020682:Cefixime / Q000494:pharmacology; D024881:Drug Resistance, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D006069:Gonorrhea / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D008969:Molecular Sequence Data; D009343:Neisseria / Q000235:genetics / Q000378:metabolism; D009344:Neisseria gonorrhoeae / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification / Q000378:metabolism; D046915:Penicillin-Binding Proteins / Q000737:chemistry / Q000235:genetics*; D011995:Recombination, Genetic
chemical_list: D000900:Anti-Bacterial Agents; D046915:Penicillin-Binding Proteins; D020682:Cefixime