title: Changing figures of antimicrobial susceptibility and serovar distribution in Neisseria gonorrhoeae isolated in Greece.
abstract: OBJECTIVE
  To update surveillance data on antimicrobial susceptibility of Neisseria gonorrhoeae isolated in Greece with information for the years 2005 to 2008, and analyze changes occurred from the previous 4-year period.
  
  
  METHODS
  Annual antimicrobial susceptibility rates, susceptibility patterns, and serovars of 635 gonococci isolated in 2005 to 2008 were determined and compared to respective data concerning the gonococcal sample of 2001 to 2004. Genetic similarity of the isolates in phenotypic clusters was investigated by pulsed field gel electrophoresis. Epidemiologic information was also considered.
  
  
  RESULTS
  Despite a reduction in the isolation frequency of penicillinase-producing strains (3.9% vs. 11.6% in the previous period), the rates of resistance and intermediate susceptibility increased for penicillin, as well as for tetracycline, erythromycin, and chloramphenicol, leaving very small proportions of isolates sensitive to these agents (4.3%, 12.8%, 10.2%, and 3.6%, respectively). Resistance to fluoroquinolones increased from 11.3% in 2004 up to 63% in 2008, and strongly correlated with multidrug-resistant isolates of Bropyst serovar, accounting for 72.6% of the quinolone-resistant strains isolated during the last 4 years. All isolates were susceptible to spectinomycin and only 2 exceeded susceptibility breakpoints set for cefotaxime, exhibiting MICs 0.75 to 1 microg/mL. These latter isolates, however, belonged to a cluster of strains with decreased susceptibility to cephalosporins (CDS, cefotaxime MICs >or=0.25 microg/mL) that emerged in late 2006 and increased in frequency up to 20.7% through 2008. Notably, CDS isolates were also quinolone-resistant and multiresistant, further contributing to the increasing rates of quinolone and multidrug resistance in the Greek gonococcal sample.
  
  
  CONCLUSIONS
  Antimicrobial susceptibility figures of Neisseria gonorrhoeae in Greece are worsening due to changes in the synthesis of gonococcal population, resulting from high endemicity rates of multidrug-resistant strains.
authors.affiliation: National Reference Center for Neisseria gonorrhoeae, Laboratory of Bacteriology, Hellenic Pasteur Institute, Athens, Greece. tzelepi@pasteur.gr
authors.forename: Eva
authors.initials: E
authors.lastname: Tzelepi
authors.forename: Helen
authors.initials: H
authors.lastname: Avgerinou
authors.forename: Alexandros
authors.initials: A
authors.lastname: Flemetakis
authors.forename: Eirini
authors.initials: E
authors.lastname: Siatravani
authors.forename: Maria
authors.initials: M
authors.lastname: Stathi
authors.forename: Maria
authors.initials: M
authors.lastname: Daniilidou
authors.forename: Vivi
authors.initials: V
authors.lastname: Miriagou
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics; D006069:Gonorrhea / Q000453:epidemiology* / Q000382:microbiology*; D006115:Greece / Q000453:epidemiology; D006801:Humans; D008826:Microbial Sensitivity Tests; D009344:Neisseria gonorrhoeae / Q000145:classification* / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D010641:Phenotype; D012703:Serotyping
chemical_list: D000900:Anti-Bacterial Agents