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Journal of Clinical Microbiology, September 2009, p. 2944-2949, Vol. 47, No. 9
0095-1137/09/$08.00+0     doi:10.1128/JCM.01001-09
Copyright © 2009, American Society for Microbiology. All Rights Reserved.

Strain Typing and Antimicrobial Resistance of Fluoroquinolone-Resistant Neisseria gonorrhoeae Causing a California Infection Outbreak{triangledown}

Sheldon R. Morris,1* Douglas F. Moore,2 Paul B. Hannah,2 Susan A. Wang,3 Julia Wolfe,2 David L. Trees,3 Gail Bolan,1 and Heidi M. Bauer1

California Department of Health Services, Sexually Transmitted Diseases Control Branch, Richmond, California,1 Orange County Public Health Laboratory, Santa Ana, California,2 Centers for Disease Control and Prevention, Atlanta, Georgia3

Received 20 May 2009/ Returned for modification 2 July 2009/ Accepted 13 July 2009

Antimicrobial-resistant Neisseria gonorrhoeae is an emerging public health problem as a result of the alarming limitation in treatment options. We examined an outbreak in California of fluoroquinolone-resistant Neisseria gonorrhoeae (QRNG) by evaluation of a combination of routine isolates from the Gonococcal Isolate Surveillance Project and isolates collected by expanded surveillance performed between April 2000 and June 2002. QRNG isolates were characterized by two methods: (i) determination of a combination of antibiogram, auxotype, serovar, Lip type, and patterns of amino acid alteration in the quinolone resistance-determining region of GyrA and ParC (ASLGP) and (ii) pulsed-field gel electrophoresis (PFGE). Strain typing was used to describe the QRNG outbreak strains and the associated antimicrobial resistance profiles. Among 79 isolates that were completely characterized, we identified 20 different ASLGP strain types, and 2 of the types were considered to belong to outbreak strains that comprised 65% (51/79) of the isolates. By PFGE typing, there were 24 different strain types, and 4 of these were considered outbreak types and comprised 66% (52/79) of the isolates. The overall agreement between the typing methods in distinguishing outbreak strains and non-outbreak strains was 84% (66/79). The most common QRNG ASLGP strain type had chromosomally mediated resistance to penicillin and tetracycline and an azithromycin MIC of 0.5 µg/ml. The occurrence of an outbreak caused by QRNG strains that could fail to be eradicated by most antibiotic classes reinforces the serious problem with antimicrobial resistance in Neisseria gonorrhoeae that the public health system faces. Adherence to a regimen with the recommended antibiotics at the appropriate dose is critical, and monitoring for antimicrobial susceptibility needs to be actively maintained to adapt treatment guidelines appropriately.

* Corresponding author. Present address: University of California, San Diego, Antiviral Research Center, 150 West Washington St., San Diego, CA 92103. Phone: (619) 543-8080. Fax: (619) 298-0177. E-mail: shmorris{at}ucsd.edu

{triangledown} Published ahead of print on 22 July 2009.

Journal of Clinical Microbiology, September 2009, p. 2944-2949, Vol. 47, No. 9
0095-1137/09/$08.00+0     doi:10.1128/JCM.01001-09
Copyright © 2009, American Society for Microbiology. All Rights Reserved.





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