title: [Resistance to ciprofloxacin of Neisseria gonorrhoeae strains isolated in Poland in 2012-2013].
abstract: BACKGROUND
  Ciprofloxacin is commonly used in Poland specially for the treatment of urinary tract infections including urethritis. Patients are often treated without pathogen identification and antimicrobial resistance tests. Neisseria gonorrhoeae infection is one of the most common causes of urethritis in Poland. The resistance of bacteria to a wide range of antibiotics including ciprofloxacine makes the therapy of gonorrhoea more difficult. The mechanism of ciprofloxacine action depends on inactivation of bacterial topoisomerase II (gyrase) and topoisomerase IV. A resistance to ciprofloxacine occurring in Neisseria gonorrhoeae is mainly due to mutations in bacterial gyrA (encoding topoisomerase II) and/or parC (encoding topoisomerase IV ) genes. High level resistance is an effect of combination of three or four mutations. Another, less important mechanism of ciprofloxacin resistance, that can coexist with mutations in gyrA and parC genes related to the overproduction of membrane pumps proteins.
  
  
  METHODS
  65 Neisseria gonorrhoeae strains isolated from patients of Department of Dermatology and Wenereology in Warsaw in the second half of 2012 and first of 2013 was investigated. The strains were cultured on chocolate agar plates in a 5% CO2 atmosphere at 37 degrees C and identified by colony morphology, Gram stain and oxidase reaction, followed by carbohydrate utilization test. Ciprofloxacin susceptibility was determined by E-Tests (bioMerieux). Bacteria were incubated at 35 degrees C in 5% CO2 for 24 h on chocolate agar plates. Tests were performed according to producers recommendations. The results (sensitive or resistant) were interpreted according to EUCAST recommendations.
  
  
  RESULTS
  The MIC (Minimal inhibitory concentration) of Ciprofloxacin in investigated strains ranged from 0,002 to > 32 mg/L, MIC50 = 8 mg/L, MIC90 = > 32 mg/L. It was shown that only 38.5% of the strains were sensitive to ciprofloxacin according to EUCAST criteria from 2013 year.
  
  
  CONCLUSIONS
  Due to the high percentage of ciprofloxacin resistant Neisseria gonorrhoeae strains (more than 61%) the antibiotic should not be used for the treatment of gonorrhoea in Poland.
authors.forename: Beata
authors.initials: B
authors.lastname: Młynarczyk-Bonikowska
authors.forename: Marlena
authors.initials: M
authors.lastname: Kujawa
authors.forename: Grażyna
authors.initials: G
authors.lastname: Młynarczyk
authors.forename: Magdalena
authors.initials: M
authors.lastname: Malejczyk
authors.forename: Sławomir
authors.initials: S
authors.lastname: Majewski
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002939:Ciprofloxacin / Q000494:pharmacology*; D000075202:Contraindications; D004352:Drug Resistance, Microbial; D006069:Gonorrhea / Q000188:drug therapy; D006801:Humans; D008826:Microbial Sensitivity Tests; D009344:Neisseria gonorrhoeae / Q000145:classification* / Q000187:drug effects* / Q000302:isolation & purification; D011044:Poland; D013045:Species Specificity
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin