title: Neisseria gonorrhoeae Sequence Typing for Antimicrobial Resistance, a Novel Antimicrobial Resistance Multilocus Typing Scheme for Tracking Global Dissemination of N. gonorrhoeae Strains.
abstract: A curated Web-based user-friendly sequence typing tool based on antimicrobial resistance determinants inNeisseria gonorrhoeaewas developed and is publicly accessible (https://ngstar.canada.ca). TheN. gonorrhoeaeSequence Typing for Antimicrobial Resistance (NG-STAR) molecular typing scheme uses the DNA sequences of 7 genes (penA,mtrR,porB,ponA,gyrA,parC, and 23S rRNA) associated with resistance to β-lactam antimicrobials, macrolides, or fluoroquinolones. NG-STAR uses the entirepenAsequence, combining the historical nomenclature forpenAtypes I to XXXVIII with novel nucleotide sequence designations; the fullmtrRsequence and a portion of its promoter region; portions ofponA,porB,gyrA, andparC; and 23S rRNA sequences. NG-STAR grouped 768 isolates into 139 sequence types (STs) (n= 660) consisting of 29 clonal complexes (CCs) having a maximum of a single-locus variation, and 76 NG-STAR STs (n= 109) were identified as unrelated singletons. NG-STAR had a high Simpson's diversity index value of 96.5% (95% confidence interval [CI] = 0.959 to 0.969). The most common STs were NG-STAR ST-90 (n= 100; 13.0%), ST-42 and ST-91 (n= 45; 5.9%), ST-64 (n= 44; 5.72%), and ST-139 (n= 42; 5.5%). Decreased susceptibility to azithromycin was associated with NG-STAR ST-58, ST-61, ST-64, ST-79, ST-91, and ST-139 (n= 156; 92.3%); decreased susceptibility to cephalosporins was associated with NG-STAR ST-90, ST-91, and ST-97 (n= 162; 94.2%); and ciprofloxacin resistance was associated with NG-STAR ST-26, ST-90, ST-91, ST-97, ST-150, and ST-158 (n= 196; 98.0%). All isolates of NG-STAR ST-42, ST-43, ST-63, ST-81, and ST-160 (n= 106) were susceptible to all four antimicrobials. The standardization of nomenclature associated with antimicrobial resistance determinants through an internationally available database will facilitate the monitoring of the global dissemination of antimicrobial-resistantN. gonorrhoeaestrains.
authors.affiliation: Public Health Agency of Canada, National Microbiology Laboratory, Winnipeg, MB, Canada.
authors.forename: W
authors.initials: W
authors.lastname: Demczuk
authors.affiliation: Public Health Agency of Canada, National Microbiology Laboratory, Winnipeg, MB, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Sidhu
authors.affiliation: WHO Collaborating Centre for Gonorrhoea and Other STIs, Örebro University Hospital, Örebro, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Unemo
authors.affiliation: The University of Queensland, Centre for Clinical Research, Brisbane, Australia.
authors.forename: D M
authors.initials: DM
authors.lastname: Whiley
authors.affiliation: Public Health Ontario Laboratories, Toronto, Ontario, Canada.
authors.forename: V G
authors.initials: VG
authors.lastname: Allen
authors.affiliation: Department of Microbiology and Immunology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
authors.forename: J R
authors.initials: JR
authors.lastname: Dillon
authors.affiliation: Public Health England, London, United Kingdom.
authors.forename: M
authors.initials: M
authors.lastname: Cole
authors.affiliation: Public Health Ontario Laboratories, Toronto, Ontario, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Seah
authors.affiliation: The University of Queensland, Centre for Clinical Research, Brisbane, Australia.
authors.forename: E
authors.initials: E
authors.lastname: Trembizki
authors.affiliation: Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: D L
authors.initials: DL
authors.lastname: Trees
authors.affiliation: Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: E N
authors.initials: EN
authors.lastname: Kersh
authors.affiliation: Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Abrams
authors.affiliation: STI Outpatient Clinic, Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands.|Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.|Center for Infection and Immunity Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: H J C
authors.initials: HJC
authors.lastname: de Vries
authors.affiliation: Public Health Laboratory, Public Health Service Amsterdam, Amsterdam, the Netherlands.|Department of Medical Microbiology, OLVG General Hospital, Amsterdam, the Netherlands.
authors.forename: A P
authors.initials: AP
authors.lastname: van Dam
authors.affiliation: Public Health Agency of Canada, National Microbiology Laboratory, Winnipeg, MB, Canada.
authors.forename: I
authors.initials: I
authors.lastname: Medina
authors.affiliation: Public Health Agency of Canada, National Microbiology Laboratory, Winnipeg, MB, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Bharat
authors.affiliation: Public Health Agency of Canada, National Microbiology Laboratory, Winnipeg, MB, Canada.
authors.forename: M R
authors.initials: MR
authors.lastname: Mulvey
authors.affiliation: Public Health Agency of Canada, National Microbiology Laboratory, Winnipeg, MB, Canada.
authors.forename: G
authors.initials: G
authors.lastname: Van Domselaar
authors.affiliation: Public Health Agency of Canada, National Microbiology Laboratory, Winnipeg, MB, Canada Irene.Martin@phac-aspc.gc.ca.
authors.forename: I
authors.initials: I
authors.lastname: Martin
mesh_terms: D000595:Amino Acid Sequence; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D017963:Azithromycin / Q000494:pharmacology; D002511:Cephalosporins / Q000494:pharmacology; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics*; D024841:Fluoroquinolones / Q000494:pharmacology; D006069:Gonorrhea / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D058885:Multilocus Sequence Typing / Q000379:methods*; D009344:Neisseria gonorrhoeae / Q000145:classification* / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D024841:Fluoroquinolones; D017963:Azithromycin
keywords: Neisseria gonorrhoeae; antimicrobial resistance; molecular epidemiology; sequence typing