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P3.270 Antimicrobial Susceptibility and Molecular Characterization of Neisseria Gonorrhoeae Strains from Slovenia 2008–2012
  1. S Jeverica1,
  2. D Golparian2,
  3. M Matičič3,
  4. M Potočnik4,
  5. B Mlakar5,
  6. M Unemo2
  1. 1Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
  2. 2WHO Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections, Department of Laboratory Medicine, Microbiology, Örebro University Hospital, Örebro, Sweden
  3. 3Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre Ljubljana, Ljubljana, Slovenia., Ljubljana, Slovenia
  4. 4Clinic for Dermatovenereology, University Medical Centre Ljubljana, Ljubljana, Slovenia
  5. 5Surgical Centre Zdrav Splet, Ljubljana, Slovenia

Abstract

Objectives Antimicrobial resistance in Neisseria gonorrhoeae is a major public health problem worldwide. Slovenia is among the countries with highest prevalence of decreased susceptibility and resistance to extended-spectrum cephalosporins (ESCs) in Europe. Herein, the phenotypic and molecular characterization of Slovenian N. gonorrhoeae strains from 2008–2012 is presented.

Methods N. gonorrhoeae isolates cultured 2008–2012 in Slovenia (n = 138) were examined for antimicrobial susceptibility with Etest methodology for 8 antimicrobials (cefixime, ceftriaxone, penicillin, ciprofloxacin, azithromycin, tetracycline, gentamicin and spectinomycin). Furthermore, all isolates were investigated with Neisseria gonorrhoeae multi-antigen sequence typing (NG-MAST) for molecular epidemiology, and sequencing of major ESC resistance determinants; penA, mtrR and penB.

Results The overall prevalence of resistance and decreased susceptibility to cefixime and ceftriaxone (MIC≥ 0.125 mg/L) was 16% and 7%, respectively. The resistance and decreased susceptibility showed an epidemic peak during 2009–2011 when it reached 28% for cefixime and 12% for ceftriaxone, however, the prevalence subsequently decreased to 6% and 4%, respectively, in the year 2012. NG-MAST sequence types 1407 (13% of all isolates), 21 (8%) and 225 (6%) were the most common STs during 2008–2012. ST1407, previously stated as an internationally spread successful clone with resistance or decreased susceptibility to ESCs, was most prevalent in 2009 (43%). However, the ST1407 prevalence declined in 2010 (15%) and 2011 (11%) and the clone was rare in 2012 (4%). Instead, in 2012 the ESC susceptible ST21 was the predominant ST (21%). During 2008–2012, a penA mosaic allele (mainly penA XXXIV, associated with ST1407) was detected in 25% of isolates.

Conclusion The prevalence of gonococcal resistance to ESC in Slovenia has fluctuated, which is mainly due to the longitudinal prevalence of a few gonococcal clones. Fortunately, some ESC susceptible clones, such as ST21, now appear to replace the main ESC resistant clone ST1407, a replacement that is indicated in several European countries.

  • Antimicrobial Resistance
  • Molecular epidemiology
  • Neisseria gonorrhoeae

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