title: Phenotypic and molecular characterization of Neisseria gonorrhoeae isolates from Slovenia, 2006-12: rise and fall of the multidrug-resistant NG-MAST genogroup 1407 clone?
abstract: OBJECTIVE
  To determine the phenotypic and molecular characteristics of Neisseria gonorrhoeae isolates obtained between 2006 and 2012 in Slovenia.
  
  
  METHODS
  Gonococcal isolates obtained between 2006 and 2012 in Slovenia (n = 194) were investigated with Etest for susceptibility to cefixime, ceftriaxone, penicillin, ciprofloxacin, azithromycin, tetracycline, gentamicin and spectinomycin. All isolates were examined with N. gonorrhoeae multiantigen sequence typing for molecular epidemiology and sequencing of the major extended-spectrum cephalosporin (ESC) resistance determinants (penA, mtrR and penB) was performed.
  
  
  RESULTS
  The overall prevalence of decreased susceptibility or resistance to cefixime and ceftriaxone (MIC ≥0.125 mg/L) was 11% and 5%, respectively. The decreased susceptibility or resistance showed an epidemic peak in 2011 (33% for cefixime and 11% for ceftriaxone), decreasing to 6% and 4%, respectively, in 2012. ST1407 (9% of isolates), ST21 (6%) and ST225 (6%) were the most common sequence types (STs) during 2006-12. Genogroup G1407 (ST1407 most prevalent ST), an internationally spread clone with decreased susceptibility or resistance to ESCs, was most prevalent (48%) in 2009. However, the G1407 prevalence then declined: in 2010, 30%; in 2011, 28%; and in 2012, 8%. Instead, in 2012 the ESC- and ciprofloxacin-susceptible G21 was the predominant genogroup (26%).
  
  
  CONCLUSIONS
  The prevalence of gonococcal resistance to ESCs in Slovenia has been high, but fluctuating. Fortunately, in 2012 some ESC- and ciprofloxacin-susceptible clones, such as genogroups G21, G1195 and G2992, appeared to have mainly replaced the multidrug-resistant G1407 clone, a replacement also seen in several European countries.
authors.affiliation: Institute for Microbiology and Immunology, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
authors.forename: Samo
authors.initials: S
authors.lastname: Jeverica
authors.affiliation: WHO Collaborating Centre for Gonorrhoea and other STIs, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Microbiology, Örebro University Hospital, Örebro, Sweden.
authors.forename: Daniel
authors.initials: D
authors.lastname: Golparian
authors.affiliation: Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre Ljubljana, Ljubljana, Slovenia.
authors.forename: Mojca
authors.initials: M
authors.lastname: Matičič
authors.affiliation: Department of Dermatovenereology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
authors.forename: Marko
authors.initials: M
authors.lastname: Potočnik
authors.affiliation: Surgical Centre Zdrav Splet, Ljubljana, Slovenia.
authors.forename: Boštjan
authors.initials: B
authors.lastname: Mlakar
authors.affiliation: WHO Collaborating Centre for Gonorrhoea and other STIs, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Microbiology, Örebro University Hospital, Örebro, Sweden magnus.unemo@orebroll.se.
authors.forename: Magnus
authors.initials: M
authors.lastname: Unemo
mesh_terms: D000293:Adolescent; D000328:Adult; D000483:Alleles; D019943:Amino Acid Substitution; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D005798:Genes, Bacterial; D005838:Genotype; D006069:Gonorrhea / Q000453:epidemiology* / Q000266:history / Q000382:microbiology; D049674:History, 21st Century; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D058885:Multilocus Sequence Typing; D009154:Mutation; D009344:Neisseria gonorrhoeae / Q000187:drug effects* / Q000235:genetics* / Q000302:isolation & purification; D010641:Phenotype; D012621:Seasons; D017524:Slovenia / Q000453:epidemiology; D055815:Young Adult
keywords: ESCs; antimicrobial resistance; cefixime; ceftriaxone; extended-spectrum cephalosporins; gonorrhoea