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Fluoroquinolone-resistant Neisseria gonorrhoeae in Bali, Indonesia:
2004.
Sexually Transmitted Diseases 2006;33:625-629.
Donegan, EA, Wirawan DN, Muliawan P; Schachter J, Moncada J, Parekh
M, Knapp JS
Abstract
OBJECTIVES: In the mid-1990s, fluoroquinolones were introduced in Indonesia
for the management of gonorrhea and are now part of the national recommended
treatment guidelines. We recently documented introduction of ciprofloxacin-resistant
Neisseria gonorrhoeae strains in female sex workers (FSWs) in Timika, Indonesia,
5 years after treating gonococcal cervicitis with ciprofloxacin and periodically
monitoring antimicrobial susceptibility of isolates. To assess the importance
of this observation, we determined antimicrobial susceptibilities and strain
types of N. gonorrhoeae isolates from FSWs seen in a sexually transmitted
infection (STI) clinic in Denpasar, Bali, Indonesia. GOAL: The goal of this
study was to determine antimicrobial susceptibilities and strain types among
N. gonorrhoeae isolated from FSWs in Denpasar, Bali. STUDY DESIGN: FSWs in
Denpasar were screened for N. gonorrhoeae by standard culture. Endocervical
isolates were frozen in Microbank tubes and sent to the University of California
at San Francisco on dry ice. Antimicrobial susceptibility testing using a
Clinical Laboratory Standards Institute-recommended agar dilution method
was performed at the Centers for Disease Control and Prevention. Isolates
were characterized by beta-lactamase production, antimicrobial resistance
phenotypes, and auxotype/serovar class. RESULTS: One hundred forty-seven
N. gonorrhoeae isolates were characterized. All isolates were highly resistant
to tetracycline (minimum inhibitory concentration, >or=16.0 microg/mL):
117 (79.1%) were beta-lactamase-positive (PP-TR), 3 (2.0%) exhibited chromosomally
mediated resistance to penicillin (PenR-TRNG), and 27 (18.2%) were susceptible
to penicillin (TRNG). All isolates were susceptible to ceftriaxone, cefixime,
and spectinomycin; lack of interpretive criteria do not allow interpretation
of susceptibilities of cefoxitin, cefpodoxime, or azithromycin. Fifty-nine
(40.1%) isolates were ciprofloxacin-resistant; 35 (59.3%) of the ciprofloxacin-resistant
isolates exhibited high-level resistance to ciprofloxacin (Cip-HLR; minimum
inhibitory concentration, >or=4.0 microg/mL of ciprofloxacin). Three (2.0%)
isolates were intermediate to ciprofloxacin. Twenty-two strain types were
identified among these isolates; small clusters were identified with 3 strain
types. CONCLUSIONS: N. gonorrhoeae isolates from FSWs in Denpasar were resistant
to penicillin and tetracycline; 40.1% of the isolates were fluoroquinolone-resistant.
With gonorrhea prevalence of 35% at this clinic (by nucleic acid amplified
tests), ongoing surveillance for antimicrobial resistance will be needed
to appropriately choose treatment for infections caused by these resistant
organisms.