title: Emergence of a Neisseria gonorrhoeae clone showing decreased susceptibility to cefixime in England and Wales.
abstract: OBJECTIVE
  The third-generation cephalosporins recommended in national guidelines are amongst the last remaining effective agents for treatment of gonorrhoea. This study characterizes gonococcal isolates with decreased cefixime susceptibility from England and Wales.
  
  
  METHODS
  A total of 96 isolates of Neisseria gonorrhoeae exhibiting cefixime MICs of ≥0.125 mg/L, either collected as part of the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) between 2005 and 2008 (54 from a total of 4649 isolates) or referred to the national reference laboratory in 2008 and 2009 (42 isolates), were tested for susceptibility to a range of antimicrobial agents and were typed using N. gonorrhoeae multiantigen sequence typing (NG-MAST).
  
  
  RESULTS
  All 96 isolates were also resistant to tetracycline (MIC ≥2 mg/L) and ciprofloxacin (MIC ≥16 mg/L) and 56% showed low-level chromosomal resistance to penicillin. Where data were available, the mean patient age was 31 years, and 88% (83/94) of patients were men. Isolates referred through GRASP were predominantly from men who have sex with men (MSM; 29/44, 66%) and from patients of white British ethnicity (25/43, 58%). The majority of isolates belonged either to sequence type (ST) 1407 (71/96, 74%) or to a highly related ST that shares the tpbB allele (allele 110), but with a different por allele (20/96, 21%). ST1407 was found in both MSM (22/29, 76%) and heterosexual patients (12/15, 80%) and among all eight isolates from patients reporting sex abroad.
  
  
  CONCLUSIONS
  The emergence of a clonal group of gonococci showing decreased susceptibility to cefixime in England and Wales highlights the need for continued surveillance.
authors.affiliation: Sexually Transmitted Bacteria Reference Laboratory, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, UK.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Chisholm
authors.forename: Sarah
authors.initials: S
authors.lastname: Alexander
authors.forename: Leah
authors.initials: L
authors.lastname: Desouza-Thomas
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Maclure-Webster
authors.forename: John
authors.initials: J
authors.lastname: Anderson
authors.forename: Tom
authors.initials: T
authors.lastname: Nichols
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Lowndes
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Ison
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D020682:Cefixime / Q000494:pharmacology*; D002939:Ciprofloxacin / Q000494:pharmacology; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics*; D004739:England / Q000453:epidemiology; D005260:Female; D006069:Gonorrhea / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D017720:Molecular Epidemiology; D058889:Molecular Typing; D009344:Neisseria gonorrhoeae / Q000187:drug effects* / Q000235:genetics* / Q000302:isolation & purification; D010406:Penicillins / Q000494:pharmacology; D012725:Sexual Behavior; D013752:Tetracycline / Q000494:pharmacology; D014852:Wales
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins; D002939:Ciprofloxacin; D020682:Cefixime; D013752:Tetracycline