1249. Neisseria gonorrhoeae strains with decreased susceptibility to cephalosporins in California
Session: Oral Abstract Session: Hot Topics in Public Health
Saturday, October 5, 2013: 11:45 AM
Room: The Moscone Center: 220-226
Background: There is growing concern about cephalosporin-resistant Neisseria gonorrhoeae (NG). Treatment failure to cephalosporins has been reported in Canada, Europe, and Asia where it has often been associated with NG strains such as sequence type 1407 (NG-Multi-antigen Sequence Typing, NG-MAST) in addition to altered penicillin binding proteins encoded by a mosaic penA gene.   The objective of this analysis was to determine the proportion of NG isolates with reduced cephalosporin susceptibility, their associated NG-MAST strain types and the presence of mosaic penA.

Methods: We conducted a cross-sectional analysis of all 2012 California NG isolates included in the Centers for Disease Control and Prevention (CDC) Gonococcal Isolate Surveillance Project (GISP), a national surveillance effort to monitor trends in NG antimicrobial susceptibility.   Specimens from the first 25 men with urethral gonorrhea attending sexually transmitted disease clinics each month in San Francisco, Los Angeles, Orange County, and San Diego were submitted to the San Francisco Department of Public Health Laboratory (SFDPHL) for testing with culture, NG-MAST and PCR for mosaic penA.  NG isolates were tested for minimum inhibitory concentrations (MIC) to ceftriaxone, cefixime and cefpodoxime with the ETest®(bioMeriux).  Reduced susceptibility was defined as ceftriaxone or cefixime MIC ≥0.125 µg/mL or cefpodoxime MIC ≥ 0.5 µg/mL. 

Results: Of 755 NG isolates, 34 (4.5 percent) had reduced cephalosporin susceptibility, with no significant differences by geographic location.  All 34 isolates possessed the mosaic penA gene, allele XXXIV; 28/34 (82 percent) were NG-MAST sequence type 1407, and 4 were closely related to ST1407 (>99 percent identical sequence in tbpB and penA genes).    There were no documented treatment failures among patients with these NG isolates. 

Conclusion: NG isolates with reduced cephalosporin susceptibility were highly likely to be NG-MAST sequence type 1407 and to possess mosaic penA.  Further surveillance and research are needed to examine trends in NG strain types over time and determine factors associated with NG treatment failure.

Juliet Stoltey, MD, MPH1, Duylinh Nguyen, MPH2, Michael Samuel, DrPH1, Mark Pandori, PhD2 and Ina Park, MD, MS1, (1)California Department of Public Health-STD Control Branch, Richmond, CA, (2)San Francisco Department of Public Health, San Francisco, CA


J. Stoltey, None

D. Nguyen, None

M. Samuel, None

M. Pandori, None

I. Park, None

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