title: Antimicrobial susceptibility and molecular determinants of quinolone resistance in Neisseria gonorrhoeae isolates from Shanghai.
abstract: OBJECTIVE
  To determine the antimicrobial susceptibility of Neisseria gonorrhoeae from Shanghai and to type the quinolone resistance-determining regions (QRDRs) of ciprofloxacin-resistant isolates.
  
  
  METHODS
  N. gonorrhoeae isolates (n = 159) were consecutively collected from male patients in Shanghai and examined for their antimicrobial susceptibilities to penicillin, tetracycline, ciprofloxacin, spectinomycin and ceftriaxone. The mutation profiles of the QRDRs of gyrA and parC were determined for 103 isolates including one susceptible isolate and one isolate with intermediate levels of susceptibility to ciprofloxacin.
  
  
  RESULTS
  High percentages of the 159 isolates were resistant to ciprofloxacin (98.7%), penicillin (93.1%) and tetracycline (56.5%). Penicillinase-producing N. gonorrhoeae (PPNG, 37.8%) or penicillinase-producing/tetracycline-resistant N. gonorrhoeae (PP/TRNG, 13.8%) accounted for 51.6% of the isolates. Chromosomal resistance to penicillin was observed in 41.5% of the isolates. Tetracycline resistance was noted in 56.5% of the isolates with 20.1% carrying plasmid-mediated resistance and 36.4% being chromosomally resistant. All isolates were susceptible to ceftriaxone and spectinomycin, although a trend to decreased susceptibility was noted. QRDR mutations were observed in the 101 ciprofloxacin-resistant isolates and the one ciprofloxacin-intermediate isolate, in contrast to the ciprofloxacin-susceptible isolate tested. Mutations in the QRDRs comprised four predominant (65.0% of the 103 isolates) patterns of a total of 19 patterns. Mutations in parC were significantly associated with higher MICs of ciprofloxacin.
  
  
  CONCLUSIONS
  Spectinomycin and ceftriaxone are currently recommended for the treatment of gonorrhoea in Shanghai. Although the present study indicates that these antimicrobials should remain effective, the identification of isolates with decreased susceptibility underscores the importance of ongoing antimicrobial susceptibility surveillance to monitor and respond to the emergence of resistant isolates.
authors.affiliation: Shanghai Skin Disease and STD Hospital, Shanghai China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Yang
authors.forename: Mingmin
authors.initials: M
authors.lastname: Liao
authors.forename: Wei-Ming
authors.initials: WM
authors.lastname: Gu
authors.forename: Kelli
authors.initials: K
authors.lastname: Bell
authors.forename: Lei
authors.initials: L
authors.lastname: Wu
authors.forename: Nelson F
authors.initials: NF
authors.lastname: Eng
authors.forename: Chu-Guang
authors.initials: CG
authors.lastname: Zhang
authors.forename: Yue
authors.initials: Y
authors.lastname: Chen
authors.forename: Ann M
authors.initials: AM
authors.lastname: Jolly
authors.forename: Jo-Anne R
authors.initials: JA
authors.lastname: Dillon
mesh_terms: D000890:Anti-Infective Agents / Q000494:pharmacology*; D002681:China; D002939:Ciprofloxacin / Q000494:pharmacology; D027081:DNA Gyrase / Q000235:genetics; D027101:DNA Topoisomerase IV / Q000235:genetics; D024881:Drug Resistance, Bacterial / Q000235:genetics*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D009154:Mutation; D009344:Neisseria gonorrhoeae / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D015363:Quinolones / Q000494:pharmacology*
chemical_list: D000890:Anti-Infective Agents; D015363:Quinolones; D002939:Ciprofloxacin; D027101:DNA Topoisomerase IV; D027081:DNA Gyrase