Recent dynamics in Neisseria gonorrhoeae genomic epidemiology in Brazil: antimicrobial resistance and genomic lineages in 2017-20 compared to 2015-16.

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  • Additional Information
    • Corporate Authors:
      Brazilian-GASP Network
    • Source:
      Publisher: Oxford University Press Country of Publication: England NLM ID: 7513617 Publication Model: Print Cited Medium: Internet ISSN: 1460-2091 (Electronic) Linking ISSN: 03057453 NLM ISO Abbreviation: J Antimicrob Chemother Subsets: MEDLINE
    • Publication Information:
      Publication: 1997- : London : Oxford University Press
      Original Publication: London, New York, Academic Press.
    • Subject Terms:
      Neisseria gonorrhoeae*/genetics ; Neisseria gonorrhoeae*/drug effects ; Neisseria gonorrhoeae*/classification ; Gonorrhea*/microbiology ; Gonorrhea*/epidemiology ; Anti-Bacterial Agents*/pharmacology ; Drug Resistance, Bacterial*/genetics ; Azithromycin*/pharmacology ; Microbial Sensitivity Tests* ; Whole Genome Sequencing*; Brazil/epidemiology ; Humans ; Male ; Genome, Bacterial ; Female ; Adult ; Molecular Epidemiology ; Young Adult ; Genomics ; RNA, Ribosomal, 23S/genetics ; Middle Aged ; Ceftriaxone/pharmacology ; Adolescent ; Multilocus Sequence Typing ; Cefixime/pharmacology
    • Abstract:
      Objectives: Regular quality-assured WGS with antimicrobial resistance (AMR) and epidemiological data of patients is imperative to elucidate the shifting gonorrhoea epidemiology, nationally and internationally. We describe the dynamics of the gonococcal population in 11 cities in Brazil between 2017 and 2020 and elucidate emerging and disappearing gonococcal lineages associated with AMR, compare to Brazilian WGS and AMR data from 2015 to 2016, and explain recent changes in gonococcal AMR and gonorrhoea epidemiology.
      Methods: WGS was performed using Illumina NextSeq 550 and genomes of 623 gonococcal isolates were used for downstream analysis. Molecular typing and AMR determinants were obtained and links between genomic lineages and AMR (determined by agar dilution/Etest) examined.
      Results: Azithromycin resistance (15.6%, 97/623) had substantially increased and was mainly explained by clonal expansions of strains with 23S rRNA C2611T (mostly NG-STAR CC124) and mtr mosaics (mostly NG-STAR CC63, MLST ST9363). Resistance to ceftriaxone and cefixime remained at the same levels as in 2015-16, i.e. at 0% and 0.2% (1/623), respectively. Regarding novel gonorrhoea treatments, no known zoliflodacin-resistance gyrB mutations or gepotidacin-resistance gyrA mutations were found. Genomic lineages and sublineages showed a phylogenomic shift from sublineage A5 to sublineages A1-A4, while isolates within lineage B remained diverse in Brazil.
      Conclusions: Azithromycin resistance, mainly caused by 23S rRNA C2611T and mtrD mosaics/semi-mosaics, had substantially increased in Brazil. This mostly low-level azithromycin resistance may threaten the recommended ceftriaxone-azithromycin therapy, but the lack of ceftriaxone resistance is encouraging. Enhanced gonococcal AMR surveillance, including WGS, is imperative in Brazil and other Latin American and Caribbean countries.
      (© The Author(s) 2024. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected].)
    • Grant Information:
      Örebro County Council Research Committe; Foundation for Medical Research at Örebro University Hospital, Örebro, Sweden; Brazilian Ministry of Health
    • Contributed Indexing:
      Investigator: SVF de Carvalho; MRR Costa; LG Dias; JDP Feitosa; MI Maciel; SC Neto; ER Porto; L da Fonseca Andrade; GR de Castro E Caldo Lima; VF Lozano; ML Bazzo; F de Rocco; FH Barazzetti; G Kerber; H de Melo Machado; JM Martins; K Buss; MC Scheffer; MA Schörner; R Zonta; MC Ramos; MRC Nicola; MC Cecconi; BSS de Noronha; CA Dos Santos; FM Lopes; J de Souza Gomes; JILP Júnior; PTC Saif; WA Ferreira; M Freire; AM Costa Ramos; FNM Carvalho; A Politano; RJC da Silva; S de Araújo; CC do Porto; RAL Bocalon; U de Oliveira Machado de Souza; R Mialski; K da Silva Nogueira; MB Bay; M do Monte Alves; EYL de Macedo; JC Campos; LFA Junior; L de Oliveira Camargo; LA de Souza Neves; APL Paes; F Barufaldi; HDO Reis; LS D'Oliveira Rocha; MIC Ribeiro; P da Silva; FR Amaral; FJ de Figueiroa; AMS Barbosa; AA Araujo; MG Varejão; FG de França Mendes; VO Cavalcanti; PGL Ribeiro; B Ishigami; L Caheté; CM Zoccoli
    • Accession Number:
      0 (Anti-Bacterial Agents)
      83905-01-5 (Azithromycin)
      0 (RNA, Ribosomal, 23S)
      75J73V1629 (Ceftriaxone)
      97I1C92E55 (Cefixime)
    • Publication Date:
      Date Created: 20240322 Date Completed: 20240501 Latest Revision: 20240501
    • Publication Date:
      20240502
    • Accession Number:
      10.1093/jac/dkae075
    • Accession Number:
      38517452