Resistência de Neisseria gonorrhoeae a antimicrobianos na prática clínica: como está o Brasil? / Antimicrobials resistance of Neisseria gonorrhoeae in clinical practice: where Brazil stands?

Estima-se que um milhão de infecções sexualmente transmissíveis (IST) sejam adquiridas por dia no mundo, segundo a Organização Mundial da Saúde. Elas podem ser causadas por diversos micro-organismos pelo contato sexual. Embora tratáveis, as infecções, como a clamidiana, sífilis, tricomoníase e gonorreia, são responsáveis por 350 milhões de novos casos de IST anualmente no mundo. A gonorreia é a segunda IST bacteriana mais prevalente no planeta e tem chamado atenção nos últimos anos em decorrência da baixa eficácia em seu tratamento. O agente etiológico é a Neisseria gonorrhoeae. Na maioria das mulheres, a infecção por esse micro-organismo é assintomática, dificultando ainda mais seu diagnóstico e tratamento e, portanto, aumentando o risco de desenvolvimento de suas complicações associadas. Mesmo quando diagnosticada, essa infecção está sujeita a um alto índice de insucesso terapêutico que se deve, principalmente, à grande plasticidade genética da N. gonorrhoeae para aquisição de genes cromossômicos ou plasmidiais de resistência. O aumento da resistência desse micro-organismo a antimicrobianos comumente utilizados no tratamento, como penicilina, tetraciclina e ciprofloxacina, tem sido relatado em diversos países. No Brasil, poucos estudos estão disponíveis, mas em alguns estados já foram relatadas linhagens resistentes à ciprofloxacina. Dessa forma, deve-se ressaltar a importância de novos estudos que visem descrever o perfil da resistência da N. gonorrhoeae a antimicrobianos. Tais achados certamente nortearão a implementação de sistemas de vigilância epidemiológica no país visto que, até o momento, as infecções por N. gonorrhoeae sequer estão incluídas na lista nacional de doenças e agravos de notificação compulsória.(AU)

According to the World Health Organization, approximately one million sexually transmitted infections (STI) are acquired daily in the world. These infections can be caused by several microorganisms via contact. The treatable STI, such as chlamydia, syphilis, trichomoniasis and gonorrhea, account for 350 million new cases of STI each year worldwide. Gonorrhoea is caused by Neisseria gonorrhoeae and is the second most common bacterial STI in the world. It has drawn more attention in the last years due to the low efficacy in its treatment. Most women with this infection are asymptomatic, which makes its diagnosis and treatment troublesome increasing the risk for its associated complications. Even when diagnosed, this infection is subject to a high rate of therapeutic failure mainly due to the great genetic plasticity of N. gonorrhoeae for the acquisition of chromosomal or resistance plasmid enes. Increased resistance of this microorganism to antimicrobials commonly used in treatment such as penicillin, tetracycline and ciprofloxacin has been reported in several countries. In Brazil, few studies are available, but in some states strains resistant to ciprofloxacin were alreadyreported. The refore, it is important to highlight the importance of new studies aimed at describing the resistance profile of N. gonorrhoeae to antimicrobials in Brazil context. These findings will certainly guide the implementation of epidemiological surveillance systems in the country, since until now N. gonorrhoeae infections do not figure into the national list of compulsorily notifiable diseases.(AU)

Isolation and identification of Moraxella cuniculi from a rabbit with keratoconjunctivitis

A Gram-negative, catalase- and oxidase-positive, coccus-shaped bacterium was isolated from a rabbit with keratoconjunctivitis. Colonies of the isolate were round, smooth, and exhibited hemolytic activity on 5% sheep blood agar. Scanning electron microscopy revealed 0.4 to 0.5 µm diameter oval cocci. Partial 16S rRNA gene (1446 bp) sequence analysis demonstrated the isolate had significant homology with the Moraxella cuniculi CCUG2154 strain isolated from a rabbit in Germany in 1973. Our isolate was designated as APQAB1701. Antibiotic susceptibility tests demonstrated that APQAB1701 was sensitive to 24 antibiotics; 3 of the antibiotics (nalidixic acid, spectinomycin, and colistin) had minimal inhibitory concentrations ≥ 32 µg/mL against the isolate.

The current epidemiological status of infectious coryza and efficacy of PoulShot Coryza in specific pathogen-free chickens

Infectious coryza (IC) is an infectious disease caused by Avibacterium (Av.) paragallinarum. IC is known to cause economic losses in the poultry industry via decreased egg production in layers. Between 2012 and 2013, Av. paragallinarum was isolated from seven chicken farms by Chungbuk National University. We identified Av. paragallinarum, the causative pathogen of IC by polymerase chain reaction (PCR) and serovar serotype A, by multiplex PCR. Antibiotic sensitivity tests indicated that a few field-isolated strains showed susceptibility to erythromycin, gentamicin, lincomycin, neomycin, oxytetracycline, spectinomycin, and tylosin. A serological survey was conducted to evaluate the number of flocks that were positive for Av. paragallinarum by utilizing a HI test to determine the existence of serovar A. Serological surveys revealed high positivity rates of 86.4% in 2009, 78.9% in 2010, 70.0% in 2011, and 69.6% in 2012. We also challenged specific pathogen-free chickens with isolated domestic strains, ADL121286 and ADL121500, according to the measured efficacy of the commercial IC vaccine, PoulShot Coryza. We confirmed the effectiveness of the vaccine based on relief of clinical signs and a decreased re-isolation rate of ADL121500 strain. Our results indicate IC is currently prevalent in Korea, and that the commercial vaccine is effective at protecting against field strains.

Emergence of decreased susceptibility to extended-spectrum cephalosporins in Neisseria gonorrhoeae in India.

Background. In the past, Neisseria gonorrhoeae has developed resistance to antimicrobial agents used for its treatment. Consequently, extended-spectrum cephalosporins form the mainstay of treatment for gonorrhoea. Methods. Samples from 88 patients attending the sexually transmitted diseases clinics from December 2009 to January 2011 in two referral hospitals in New Delhi were studied. Antimicrobial susceptibility testing was done using the disc diffusion method as per the calibrated dichotomous sensitivity technique against the following antibiotics: penicillin (0.5 i.u.), tetracycline (10 μg), nalidixic acid (30 μg), ciprofloxacin (1 μg), spectinomycin (100 μg), ceftriaxone (0.5 μg) and cefpodoxime (10 μg) (Oxoid UK). Azithromycin (15 μg) (Oxoid, UK) was tested as per the guidelines of the Clinical and Laboratory Standards Institute. Minimum inhibitory concentrations were determined using the Etest for penicillin, tetracycline, ciprofloxacin, ceftriaxone, spectinomycin and azithromycin as per the manufacturer’s instruction (Biomerieux, France). Results. Eighteen isolates of Neisseria gonorrhoeae were obtained. Three of these had decreased susceptibility to ceftriaxone and cefpodoxime by the disc diffusion method. The minimum inhibitory concentrations of ceftriaxone for two isolates were 0.064 μg/ml and for one isolate it was 0.125 μg/ml. Conclusion. Higher minimum inhibitory concentrations to extended-spectrum cephalosporins is of concern as it has been shown to precede treatment failure. This may warrant its use in increased/multiple dosages alone or possibly in combination (dual therapy), thereby complicating effective disease control. Our report is in accordance with earlier reports from different parts of the world. Therefore, a continuous surveillance of antimicrobial resistance is crucial to tailor treatment schedules for Neisseria gonorrhoeae in a particular geographical region.

Detection and the antibiotic susceptibility analysis of mycoplasma and chlamydia in urogenital tract infections of 327 cases patients with tubal infertility / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To explore the effects of mycoplasma and chlamydia infections on tubal infertilityand to assess the antibiotic susceptibility and resistance of female urogenital, and consequently to guide clinical rational drug use.</p><p><b>METHODS</b>327 tubal infertility women as infertility group and 286 healthy pregnant women as control group were randomly selected, detected chlamydia trachomatis (CT), ureaplasma urealyticum (UU) and mycoplasma hominis (MH) in cervical secretions and drug resistance of UU and MH.</p><p><b>RESULTS</b>CT infection rates (14.99%), UU infection rates (23.24%), UU + MH infection rates (29.05%),CT + UU + MH infection rates (9.17%) and total infection rates (88.99%) in infertility group is higher than those (order: 2.80%, 6.99%, 8.39%, 4.55%, 29.02%) in the control group, comparisons of two groups are statistically significant differences (P < 0.05), the susceptibility of UU to roxithromycin (sensitivity is 96.05%), josamycin (sensitivity is 96.05%), tetracycline (sensitivity is 82.89%), vibramycin( sensitivity is 92.11%) and clarithromycin (sensitivity is 96.05%) were relatively high and low to ciprofloxacin and acetyl spiramycin. The susceptibility of MH to josamycin (sensitivity is 95.83%), vibramycin (sensitivity is 91.67%), minocin (sensitivity is 83.33%) and actinospectacin (sensitivity is 75.00%) were relatively high and low to erythromycin, azithromycin, roxithromycin and clarithromycin. UU + MH was only sensitive to josamycin (sensitivity is 90.52%), high resistance (77.89% -91.58%) to erythromycin, azithromycin, acetyl spiramycin, ciprofloxacin, ofloxacin, azithromycin and clarithromycin.</p><p><b>CONCLUSION</b>Infection of CT, UU, MH and tubal infertility have certain relevance,the rates of CT, UU and MH infection in tubal infertility patients higher than fertile people. For many commonantibacterial drugs, UU, MH and UU + MH has strong resistance, the etiology detection and using adapted antibios should be taken seriously in clinical treatment.</p>

Genetic and physical map of broad host range cosmid pRG930cm

We hereby present the complete sequence and annotation of pRG930cm, a spectinomycin/streptomycin/chloramphenicol-resistant cosmid vector. pRG930cm (17,256 bp; GenBank Accession No.: FM174471) has a broad host range, and is stably maintained by a number of Gram-negative bacteria including Pseudomonas spp, Escherichia coli, Agrobacterium tumefaciens and Azorhizobium caulinodans ORS571. pRG930cm is already widely used and its sequence will aid efficient construction and analysis of cosmid libraries.

Antimicrobial Resistance of Neisseria gonorrhoeae Isolated in Korea / 감염

BACKGROUND: The aim of this study was to monitor trends in antimicrobial susceptibilities of Neisseria gonorrhoeae isolates, in particular, to examine the possibility of increasing prevalence of fluoroquinolone resistance in Korea and the relationship between patterns of mutations involving gyrA and parC genes and the ciprofloxacin resistance level. METHODS: The antimicrobial susceptibilities of 489 gonoccocal isolates which were nationwide collected from patients visiting Health Centers were determined by NCCLS disk diffusion and agar plate dilution methods. PCR and direct DNA sequencing of the amplicons were performed to identify mutations within the quinolone resistance-determining regions of gyrA and parC genes. RESULTS: The proportion of resistance to penicillin, tetracycline, or both remained as high as 94%. The isolates with ciprofloxacin resistance remarkably increased from 1% in 1999 to 5% in 2000 and also resistance to cefoxitine and ceftriaxone were shown to be increased. The strains resistant to spectinomycin was little reported. Four isolates with 16 microgram/mL of MIC for ciprofloxacin all showed the same alternations of Ser-91 to Phe, Asp-95 to Gly in GyrA and Ser-87 to Arg in ParC, but ciprofloxacin-susceptible strains have little amino acid substitution. CONCLUSION: Considering the increasing prevalence of isolates with resistance to ciprofloxacin and ofloxacin, it is likely that the antibiotics such as spectinomycin, or ceftriaxone are recommended as the first-line treatment for gonoccocal infections in Korea. The results from this study suggest that mutation analysis for quinolone resistance-determining regions of gyrA and parC genes are important in epidemiological studies for the spread of ciprofloxacin resistant strains.

Antibacterianos de acción sistémica, parte II: otros grupos de antibióticos / Systemic antibacterial drugs, part II: other groups of antibiotics

Se presenta la segunda parte de una revisión bibliográfica sobre los antibacterianos de acción sistémica, la cual incluye grupos de antibióticos tan importantes como aminociclitoles, aminoglucósidos, diaminopirimidinas, estreptograminas, fosfomicinas, fusidanos, glicopéptidos, lincosamidas, macrólidos, nitrofuranos, nitroimidazoles, polipéptios, quinolonas y rifamicinas

Farmacología clínica de los aminoglicósidos y los aminociclitoles en medicina veterinaria / Clinical pharmacology of aminoglycoside and aminocyclitol antibacterials in veterinary medicine

Dada la importancia de los aminoglicósidos y aminocilitoles en la clínica veterinaria, y en virtud de la enorme cantidad de información que se genera en torno a estos antimicrobianos, se consideró de importancia llevar a cabo un análisisi farmacológico y clínico de la literatura especializada. La intención primordial de realizar estudios documentales de esta naturaleza es estrechar las actividades del clínico con las del investigador para procurar un mejor manejo de estos medicamentos en el campo, aunque también se hace énfacis en las áreas que aún requieren atención de los investigadores. Este ensayo no pretende ser enciclopédico y solamente se incluye un porcentaje del enorme caudal de información que se genera con estos dos grupos de antimicrobianos. Se hace énfasis en los aspectos farmacológicos que pueden ser de importancia para el clínico, incluyendo rasgos generales de los grupos, datos farmacocinéticos, de espectro, residuos, toxicidad y usos. Cuando resulta neceario, se presenta la opinión de los autores

The sensitivity of N. gonorrhoeae to several antibodies / 대한피부과학회지

Decreased sensitivity of N. gonorrhoeae to many existing antibiotics and the emergence and increase of penicillinase producing and of spectinomycin resistant N. gonorrhoeae necessitate intensive efforts to study on resistance. Male patients with uncomplicated gonococcal urethritis treated during the year 1990 at the VD clinic of Choong-ku Public Health Center in Seoul were included in this study. A total of 85 strains, 44 strains of non-PPNG and 41 strains of PPNG isolated from the patients were studied to evaluate their sensitivities to ampicillin, penicillin, cefoxitin, kanamycin, tetracycline, erythromycin, spectinomycin and cotrimazole. The results are summerized as follw: In non-PPNG strains, the range of MICs. MIC50 and MIC90 for both ampicillin and penicillin were 0.125-32, 2 and 16 mcg/ml respectively. For cefoxitin, they were 0.125-8, s and 16 mcg/ml respectively, and for kanamycin, 8--64 mcg/ml respectively. For tetracycline, the values were 2-64, 16 and 32 mcg/ml, and for erythromycin, they were 0.5-16, 4 and 8 mcg/ml respectively. for spectinomycin, they were 8--<64, 32, and 64 mcg/ml and finally for cotrimazole, 5--<160, 80 and 160 mcg/ml respectively. From these results, it is concluded that the MICs of both PPNG and non-PPNG were about 2 folds higher than the results of sensitivity tests at the same instituition in 1985. 2) The prevalence of PPNG among 35 gonorrhoeae patients who received treatment before the visit was 60% (21/35), while that among the patients without previous treatment was 40% (20/50). 3) In the cases of ampicillin, penicillin and cotrimazole, their MIC values were found to be significantly higher for the strains isolated from the patients with previous treatment history than those without previous treatment (p<0.05). 4) In non-PPNG strains, a significant positive correlation is found between the sensitivities to most pairs of ampicillin, penicillin, cefoxitin, kanamycin, tetracycline, erythromycin and spectinomycin. However this excludes some pairs such as : tetracycline-cefoxitin, erythromycin-penicillin, erythromycin-cefoxitin, spectinomycin-penicillin, and spectinomycincefoxitin (p<0.05). 5) In PPNG strains, a significant positive correlation is also found between the sensitivities to most pairs of ampicillin, penicillin, cefoxitin, tetracycline, erythromycin and spectinomycin. However, the exceptional cases include tetracycline-cefoxitin, erythromyoinpenicillin, erythromycin-cefoxitin, spectinomycin-penicillin, and spectinomycin-cefoxitin pairs. In addition, the sensitivity to kanamycin was found to be strongly correlated with that to tetracycline, erytheromycin and spectinomycin (p<0.05). Therefore it is essential for the management fo gonorrhoeae, together with a correct diagnosis, to use currently most effective treatment regimens which would also prevent the emergence of resistant strains. It is also suggested that when a treatment is failed, to use the durg which do not show correlation in sensitivities on re-treatment.

Co-existence of N. gonorrhoeae and U. urealyticum in male urethra.

Eight hundred and forty male patients attending sexually transmitted disease (STD) clinic for urethritis were investigated. Out of them, 31.6% had gonococcal urethritis, 16.1% suffered from nongonococcal urethritis due to Ureaplasma urealyticum and in 12.6%, both the organisms were present. Though 14.62% strains of N. Gonorrhoeae were resistant to penicillin, all the strains were sensitive to spectinomycin; while all Ureaplasma strains were sensitive to tetracyclines. As the treatment differs for these two organisms, it is necessary to identify the correct etiological agent.

Treatment of Gonorrhoea

Because of increasing resistance of circulating N. gonorrhoeae and frequent failures in the treatment of gonorrhoea, intensive work on gonorrhoea has become of paramount importance. During January 1980-April 1984, at the Choong-Ku VD Clinic in Seoul, 3,340 male patients with uncomplicated gonococcal urethritis were treated with various treatment regimens. Diagnosis of gonorrhoea and declaration of a treatment failure were made on the basis of positive urethral culture. In 1984, the prevalence of Penicillinase Producing N. gonorrhoeae (PPNG) was about 30%, The pretreatment minimun inhibitory concentration of various antibiotics were quite high. Even for non-PPNG urethritis standard penicillin regimens gave unsatisfactory results. For PPNG urethritis, only spectinomycin, cefoperazone and cefotaxim-probenecid regimens gave satisfactory results. No spectmomycin resistant strain of N. gonorrhoeae has been found since 1982 at the Choong-Ku VD Clinic. As an agent of single drug therapy, spectinomycin seems to be one of the most cost effective drugs in the treatment of uncomplicated gonorrhoea in men.

Pathological and haematological studies due to prolonged administration of Robenidine, spectinomycin and the interaction between them in chickens

Experiments were carried out in this work to study the effect of Robenidine and Spectinomycin, each alone and in combination on blood picture and histopathological findings of liver and kidneys. The hematological values of chickens, due to prolonged administration of Robenidine and Spectinomycin individually or in combination, showed a significant drop in red cell count, hemoglobin concentration, packed cell volume and lymphocytes. On the other h and, Robenidine causes increase in neutrophils and monocytes. The changes observed in chickens reared on Robenidine alone or in combination with Spectinomycin were confined to the liver and kidney and characterized by congestion, hemorrhages with mononuclear cell infiltration as well as degeneration and necrosis in focal areas. Meanwhile, the changes observed in chickens reared on Spectinomycin were confined only to the liver

Antibiotic Susceptibility Test of Neisseria gonorrhoeae by Disc Diffusion Method and Its Correlaction with Agar Plate Dilution Method / 대한피부과학회지

In this study, we compared the MIC by agar plate dilution method with the inhibition zone diameters by ordinary disc diffusion method and 24 hr-prediffusion disc method on five antibiotics, respectively. The results were summarized as follows; 1. The agar plate dilution method and the ordinary disc diffusion method gave a satisfactory degree of correlation by linear regression. The correlation coeffecients were highly significant for penicillin (r= -0.88) and ampicillin(r = -0.91) but less significant for tetracyclin(r= -0.34), kanamycin(r= -0.55) and spectinomycin (r = -0.46). 2. Between the agar plate dilution method and the 24 hour-prediffusion disc method the correlation coeffecients were highly significant for penicillin(r= -0.9) and ampicillin (r= -0.91) but less so for tetracyclin(r= -0.4), kanamycin (r=-0.57) and spectinomycin(r=-0.5), 3. In relation to the MIC values by agar pate dilution method, the correlation coefficients were slightly higher and the slopes of linear regression were steeper for the 24 hour-prediffusion disc method than the ordinary disc diffusion method, but the differences were statistically not significant.

Prevalencia de Neisseria gonorrhoeae productora de penicilinasa en una clínica de alto riesgo, en la región metropolitana / Prevalence of Neisseria gonorrhoeae productor of penicillinase in a clinic of high risk, in the Metropolitan region

Se estudió la prevalencia de Neisseria gonorrhoeae (NG) productora de penicilinasa (NGPP) en cada uno de los Centros de Salud de la Región Metropolitana, debido al aumento de los casos con NGPP observados de octubre a diciembre de 1983. Ese estudio demostró que de 3388 mujeres examinadas, en 404 (11.9%) cultivos de igual número de pacientes se encontró NG en el material obtenido de la cérvix y que en 91 cultivos (22.5%) la cepa era de tipo NGPP. Además, que el aislamiento de NG fue de 7% en los cultivos de pacientes del Centro de Salud de Chorrillo; y de 17,5%, en los pacientes del Centro de Salud Emiliano Ponce. También se comprobó que solamente el 5.2% de los cultivos positivos del Centro de Salud de Santa Ana eran de NGPP mientras que el 56% de los cultivos del Centro de Salud de Pueblo Nuevo eran de NGPP

A Study on Postgonococcal Urethritis / 대한피부과학회지

The subject were 653 male patients with uncomplicated gonorrhea at the VD Clinic of Choong Ku Public Health Center in Seoul from January to November 1985. 653 male patients with uncomplicated gonococcal infection were treated one of the following regimens. Five treatment regimens used were 2, 0 gm spectinomycin single 1M, 4 0 mega unit fortified procain penicillin G+2. 0 gm kanamycin sulfate IM preceded by 1 pgm probenecid PO, 6.0 mega unit fortified procain penicillin G+2 pgm kanamycin sulfate IM preceded by 1. 0 gm probenecid PO, 5, 0 rnega unit aqueous crystaline penicillin+2. 0 gm kanamycin sulfate irn preceded by 1, 0 gm probenecid PO and 9 tablets of cotrimoxazole+ 2. 0 gm kanamycin sulfate IM. There were no significant differences in the incidence of PGU among the five treatment groups. The overall PGU rate was 67.3% 59.2% and 53.6% at 3~5, 7~10 and 14 days after treatment respectively. The incidence of PGU at 7-10 days was not significantly higher than that of at 14 days after treatment. It is suggested that it is best to test PGU at 7 days after treatment. Because the longer one waits, the harder to follow the patients, and in earlier period, post-inflammatory irritation might be too frequent. It is also suggested that at 3 5 days after treatment examination of urethritis might serve to compare the effect of treatment regimens on the incidence of PGU.