High-Level Cefixime- and Ceftriaxone-Resistant Neisseria gonorrhoeae in France: Novel penA Mosaic Allele in a Successful International Clone Causes Treatment Failure

ABSTRACT Recently, the first Neisseria gonorrhoeae strain (H041) highly resistant to the expanded-spectrum cephalosporins (ESCs) ceftriaxone and cefixime, which are the last remaining options for first-line gonorrhea treatment, was isolated in Japan. Here, we confirm and characterize a second strain (F89) with high-level cefixime and ceftriaxone resistance which was isolated in France and most likely caused a treatment failure with cefixime. F89 was examined using six species-confirmatory tests, antibiograms (33 antimicrobials), porB sequencing, N. gonorrhoeae multiantigen sequence typing (NG-MAST), multilocus sequence typing (MLST), and sequencing of known gonococcal resistance determinants ( penA , mtrR , penB , ponA , and pilQ ). F89 was assigned to MLST sequence type 1901 (ST1901) and NG-MAST ST1407, which is a successful gonococcal clone that has spread globally. F89 has high-level resistance to cefixime (MIC = 4 μg/ml) and ceftriaxone (MIC = 1 to 2 μg/ml) and resistance to most other antimicrobials examined. A novel penA mosaic allele ( penA-CI ), which was penA-XXXIV with an additional A501P alteration in penicillin-binding protein 2, was the primary determinant for high-level ESC resistance, as determined by transformation into a set of recipient strains. N. gonorrhoeae appears to be emerging as a superbug, and in certain circumstances and settings, gonorrhea may become untreatable. Investigations of the biological fitness and enhanced understanding and monitoring of the ESC-resistant clones and their international transmission are required. Enhanced disease control activities, antimicrobial resistance control and surveillance worldwide, and public health response plans for global (and national) perspectives are also crucial. Nevertheless, new treatment strategies and/or drugs and, ideally, a vaccine are essential to develop for efficacious gonorrhea management

A survey of primary care physician practices in antibiotic prescribing for the treatment of uncomplicated male gonoccocal urethritis

<p>Abstract</p> <p>Background</p> <p>The development of resistance to antimicrobial therapy by <it>Neisseria gonorrhoeae </it>causes on-going problems for individual case management of gonorrhoea. Surveillance data about <it>N. gonorrhoeae </it>have indicated an increase in the incidence of gonorrhoea in France in 2006. As a consequence of the development of antibiotic resistance in <it>N. gonorrhoeae</it>, French guidelines excluded fluoroquinolones as a standard treatment for <it>N. gonorrhoeae</it>. Ceftriaxone became the recommended treatment, associated with azithromycin for <it>Clamydia trachomatis </it>infection. Our aim was to describe the practice patterns of general practitioners (GPs) in managing the antibiotic treatment of patients with symptoms suggestive of uncomplicated male urethritis.</p> <p>Methods</p> <p>We developed a clinical vignette describing a man with typical gonococcal urethritis symptoms to elicit questions about antibiotic treatment. We mailed the electronic questionnaire to a random sample of 1000 French GPs belonging to the <it>Sentinelles </it>Network.</p> <p>Results</p> <p>By the end of the survey period, 350 vignettes were received, yielding a response rate of 35%. Sixty-six GPs (20.2%) prescribed the recommended antibiotics for the simultaneous treatment of <it>N</it>. <it>gonorrhoeae </it>and <it>C. trachomatis </it>infections, while 132 GPs (40.4%) prescribed only non-recommended antibiotics, including ciprofloxacin in 69 cases (21.1%). General practitioners with less than 10 years in practice showed better compliance to guidelines than those with more years in practice (p < 0.05).</p> <p>Conclusions</p> <p>The results suggest a mismatch between the guidelines and the antibiotic treatment of male uncomplicated urethritis by French GPs, mostly among the subgroup of physicians who have been in practice longer. Educational approaches based on practice feedback need to be developed to improve these deficits in the quality of care.</p

Etat de la sensibilité aux antibiotiques des bactéries anaérobies isolées lors d'infections odontogènes. Intérêt de l'association spiramycine-metronidazole

Le but de cette étude a été de tester l’activité in vitro des antibiotiques suivants : l’amoxicilline seule ou associée à l'acide clavulanique, l’érythromycine, l’azithromycine, la spiramycine, la clindamycine, la pristinamycine, le métronidazole et l’association spiramycine + métronidazole vis-à-vis de 104 souches isolées en 2002 à partir de cellulites d’origine dentaire et dans deux tiers des cas de poches parodontales. Les concentrations minimales inhibitrices (CMI) ont été mesurées par la méthode de dilution en milieu gélosé de Brucella + 5 % de sang. La lecture des CMI a été réalisée après 48 heures d’incubation en chambre anaérobie. La production de ß-lactamase a été recherchée à l’aide de disques de nitrocéfine. La production de ß-lactamase chez Prevotella et Porphyromonas est peu fréquente (10 %). Les taux de résistance les plus élevés sont observés avec l'érythromycine (53,8 %) dont 20 souches de Fusobacterium et 13souches de Veillonella, la spiramycine (41,3 %) dont 9 souches de Fusobacterium et 13 souches de Veillonella. 29 % des souches sont résistantes à la pristinamycine dont 12 souches de Veillonella. 11,5 % des souches à l'azithromycine, 14,4 % au métronidazole dont 12 souches de Propionibacterium acnes et 6,7 % à la clindamycine. La sensibilité des anaérobies stricts aux macrolides et aux streptogramines est techniquement difficile à établir du fait du CO2, ce qui rend aléatoire toute comparaison entre ces antibiotiques. L'association spiramycine + métronidazole est active sur les 47 souches résistantes à la spiramycine, les 15 souches résistantes au métronidazole et sur les 3 souches résistantes à ces deux antibiotiques. Au total 100 % des souches sont sensibles aux associations spiramycine + métronidazole et amoxicilline + acide clavulanique. La grande activité de l'association spiramycine + métronidazole est due à la complémentarité de leurs spectres respectifs et à la synergie totale (FIC index < 0,5) ou partielle (FIC < 0,75) observée pour respectivement 30 et 43 souches. Cette étude permet d'affirmer le maintien de l'activité des composants de l’association spiramycine + métronidazole sur les anaérobies stricts impliqués dans les infections odontogènes. (Med Buccale Chir Buccale 2003 ; 9 : 167-75

First Neisseria gonorrhoeae Genotyping Analysis in France: Identification of a Strain Cluster with Reduced Susceptibility to Ceftriaxone ▿

Sexually transmitted infections are a major public health problem in France and other European countries. Particularly, surveillance data about Neisseria gonorrhoeae infections have clearly indicated an increase in the incidence of gonorrhoea in France in 2006. The French laboratories participated on voluntary basis in the RENAGO (Réseau National du Gonocoque) network and sent all of their collected strains to the National Reference Center for Neisseria gonorrhoeae. In this first French molecular epidemiological study, 93 isolates collected in 2006 and representative of the French gonorrhoea epidemiology were selected. Antibiotic susceptibility to six antibiotics was determined, and serotyping and N. gonorrhoeae multiantigen sequence typing (NG-MAST) were performed. NG-MAST identified 53 sequence types (STs), of which 13 STs contained 2 to 16 isolates. The major STs identified in France were previously described elsewhere. However, two newly described STs, ST1479 and ST1987, had only been found in France until now. ST1479 was characterized by a multiple-resistance phenotype, whereas ST1987 presented a susceptibility phenotype. Moreover, among the predominant French STs, ST225, which had already been described in many countries, comprised isolates (14/16) resistant to ciprofloxacin and with reduced susceptibility to ceftriaxone. Thus, the surveillance of resistance to antibiotics is a priority in order to adapt treatment and decrease the transmission of resistant strains. Of note, no predominant ST was identified among rectal isolates from men who have sex with men

Chronic prostatitis does not influence urinary PCA3 score

International audienceBACKGROUND The influence of chronic prostatitis on serum PSA level is well known. Whether it also influences potential new biomarkers of prostate cancer (PCa) has to be determined. We conducted a prospective study to evaluate the effect of chronic prostatitis on the PCa urinary marker PCA3. METHODS. Included were 38 patients, mean-aged of 37.5 years, with clinical suspicion of chronic prostatitis. A simplified version of the Meares-Stamey four-glass localization test was performed and urine specimens were collected for cytological analysis and culture. A postprostatic massage urine sample was used for the urinary PCA3 test. RESULTS. Four patients had an eventual diagnosis of urethritis and all had a PCA3 score less than 5. Among the remaining 34 patients, 7 had bacterial chronic prostatitis (NIH II prostatitis), 11 had abacterial chronic prostatitis (NIH IIIa), and 16 had non inflammatory prostatodynia (NIH IIIb). All these patients had a PCA3 score less than 28, that is, under the cutoff of 35, which is commonly used for prostate cancer diagnosis. Patients with NIH category IIIa prostatitis had significantly higher number of leukocytes and red cells as well as prostate cells in urine samples but their PCA3 scores did not differ from those of other prostatitis patients. CONCLUSION. In this study, NIH II and III chronic prostatitis did not influence the PCA3 score. Our results suggest that increased PCA3 score is unlikely to be explained by the sole chronic prostatitis and warrants prostate biopsies to eliminate prostate cancer. Prostate 72: 549-554, 2012. (C) 2011 Wiley Periodicals, Inc