title: Genetic Resistance Determinants for Cefixime and Molecular Analysis of Gonococci Isolated in Italy.
abstract: A strictly defined subset of gonococci (n = 65) isolated in Italy from 2011 to 2014 was characterized by antimicrobial susceptibility for cefixime (CFM) and ceftriaxone (CRO) and by sequencing of resistance determinant genes (penA, mtrR, porB1b, ponA) for extended-spectrum cephalosporins and Neisseria gonorrhoeae multiantigen sequence typing (NG-MAST). The penA mosaic alleles XXXIV and XXXV were found in all resistant (R) and decreased susceptibility (DS) gonococci to CFM, except for one. They were associated with an adenine deletion in the mtrR promoter plus amino acid substitutions, H105Y or G45D, in the coding region and ponA L421P. The penA mosaic allele XXXIV, and one variant, was found exclusively among genogroup (G) 1407 and its closely related sequence types (STs), as in CFM-DS as well as in CFM-R isolates. Single or combined mutation patterns in penA, mtrR, porB1b, and ponA genes were associated with different CFM susceptibility patterns and NG-MAST STs. Genotyping and antimicrobial resistance (AMR) determinant analyses can be valuable to enhance the gonococcal AMR surveillance.
authors.affiliation: 1 Department of Infectious, Parasitic, and Immune-Mediated Diseases, Istituto Superiore di Sanità , Rome, Italy .
authors.forename: Anna
authors.initials: A
authors.lastname: Carannante
authors.affiliation: 1 Department of Infectious, Parasitic, and Immune-Mediated Diseases, Istituto Superiore di Sanità , Rome, Italy .
authors.forename: Paola
authors.initials: P
authors.lastname: Vacca
authors.affiliation: 2 Laboratory of Microbiology and Virology, Amedeo di Savoia Hospital , Turin, Italy .
authors.forename: Valeria
authors.initials: V
authors.lastname: Ghisetti
authors.affiliation: 3 Department of "Medicina di Laboratorio," P. O. Sant'Anna, Città della Salute e della Scienza di Torino , Turin, Italy .
authors.forename: Maria Agnese
authors.initials: MA
authors.lastname: Latino
authors.affiliation: 4 Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano , Milan, Italy .
authors.forename: Marco
authors.initials: M
authors.lastname: Cusini
authors.affiliation: 5 Clinic of Infectious and Tropical Diseases, University of Brescia , Brescia, Italy .
authors.forename: Alberto
authors.initials: A
authors.lastname: Matteelli
authors.affiliation: 6 Unit of Clinical Microbiology, CRREM Laboratory, St. Orsola-Malpighi, University Hospital , Bologna, Italy .
authors.forename: Caterina
authors.initials: C
authors.lastname: Vocale
authors.affiliation: 7 San Gallicano Dermatologic Institute , IRCSS, Rome, Italy .
authors.forename: Grazia
authors.initials: G
authors.lastname: Prignano
authors.affiliation: 8 Microbiology Section, Department of Experimental Medicine, University of Perugia , Perugia, Italy .
authors.forename: Christian
authors.initials: C
authors.lastname: Leli
authors.affiliation: 9 Microbiology and Virology Laboratory, "Santa Chiara Hospital , Trento," Trento, Italy .
authors.forename: Patrizia
authors.initials: P
authors.lastname: Ober
authors.affiliation: 10 Department of Clinical Pathology, "Azienda Ospedaliero-Universitaria OORR," Foggia, Italy .
authors.forename: Raffaele
authors.initials: R
authors.lastname: Antonetti
authors.affiliation: 11 Department of Infectious Diseases, "Ospedali Castelli ASL VCO," Verbania, Italy .
authors.forename: Federica
authors.initials: F
authors.lastname: Poletti
authors.affiliation: 1 Department of Infectious, Parasitic, and Immune-Mediated Diseases, Istituto Superiore di Sanità , Rome, Italy .
authors.forename: Paola
authors.initials: P
authors.lastname: Stefanelli
mesh_terms: D000483:Alleles; D019943:Amino Acid Substitution / Q000235:genetics; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001426:Bacterial Proteins / Q000235:genetics; D020682:Cefixime / Q000627:therapeutic use*; D002443:Ceftriaxone / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial / Q000235:genetics*; D005838:Genotype; D006069:Gonorrhea / Q000188:drug therapy* / Q000382:microbiology*; D006801:Humans; D007558:Italy; D008826:Microbial Sensitivity Tests / Q000379:methods; D009154:Mutation / Q000235:genetics; D009344:Neisseria gonorrhoeae / Q000187:drug effects* / Q000235:genetics* / Q000302:isolation & purification; D011401:Promoter Regions, Genetic / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D002511:Cephalosporins; D002443:Ceftriaxone; D020682:Cefixime