title: Rising trend of antimicrobial resistance among Neisseria gonorrhoeae isolates and the emergence of N. gonorrhoeae isolate with decreased susceptibility to ceftriaxone.
abstract: BACKGROUND
  Gonorrhoea is one of the most common sexually transmitted infections (STI) in developing countries and is a global health problem.
  
  
  OBJECTIVE
  To analyze the trend of antimicrobial susceptibility of Neisseria gonorrhoeae isolates over the years, in a tertiary care hospital of North India.
  
  
  METHODS
  The study population comprised males with urethritis and females with endocervicitis attending STI clinic of our hospital.
  
  
  METHODS
  In our STI laboratory, all gonococcal isolates are subjected to antimicrobial susceptibility testing by disc diffusion method as per CLSI guidelines. β-Lactamase production is determined by chromogenic cephalosporin test. Minimum Inhibitory Concentration (MIC) for ceftriaxone is determined by E-test.
  
  
  METHODS
  Data were expressed as percentages. The differences in percentages were tested for statistical significance by using χ2 test and P values were determined.
  
  
  RESULTS
  The percentage of penicillinase producing N. gonorrhoeae (PPNG) increased from 8% in 1995-96 to 20% in 2004-05 and 88% in 2011-2013. Quinolone-resistant N. gonorrhoeae (QRNG) showed a significant increase from 12% in 1995-96 to 98.3% in 2004-05, while 84% isolates were found to be QRNG by 2011-2013. In January 2013 we detected our first gonococcal isolate with decreased susceptibility to third-generation cephalosporins; Ceftriaxone, Cefixime and Cefpodoxime (MIC for ceftriaxone = 0.19 μg/ml).
  
  
  CONCLUSIONS
  The results of our study highlighted an alarming increase in the percentage of PPNG and QRNG strains over the years. Emergence of N. gonorrhoeae isolates with decreased susceptibility to third-generation cephalosporins is a cause of concern and thus emphasises the importance of antimicrobial susceptibility testing.
authors.forename: T
authors.initials: T
authors.lastname: Bharara
authors.affiliation: Department of Microbiology, Maulana Azad Medical College, New Delhi, India.
authors.forename: P
authors.initials: P
authors.lastname: Bhalla
authors.forename: D
authors.initials: D
authors.lastname: Rawat
authors.forename: V K
authors.initials: VK
authors.lastname: Garg
authors.forename: K
authors.initials: K
authors.lastname: Sardana
authors.forename: A
authors.initials: A
authors.lastname: Chakravarti
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002443:Ceftriaxone / Q000494:pharmacology*; D024881:Drug Resistance, Bacterial; D005260:Female; D006069:Gonorrhea / Q000453:epidemiology* / Q000382:microbiology*; D006801:Humans; D007194:India; D008297:Male; D008826:Microbial Sensitivity Tests; D009344:Neisseria gonorrhoeae / Q000187:drug effects* / Q000302:isolation & purification; D015995:Prevalence; D062606:Tertiary Care Centers; D001618:beta-Lactamases / Q000032:analysis
chemical_list: D000900:Anti-Bacterial Agents; D002443:Ceftriaxone; D001618:beta-Lactamases