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Multiclonal increase in ciprofloxacin-resistant Neisseria gonorrhoeae,
Thailand, 1998-1999.
Sexually Transmitted Diseases 2002;29(11):668-673.
Trees DL, Sirivongrangson P, Schultz AJ, Buatiang A, Neal SW, Knapp
JS, Kilmarx PH.
Abstract
BACKGROUND: isolates exhibiting clinically significant resistance to fluoroquinolones
have been isolated most frequently in Asian and western Pacific countries,
including Thailand. In Bangkok, Thailand, ciprofloxacin has been used to
treat gonorrhea since 1987. GOAL: Our goal was to determine the prevalence
of isolates of that exhibit resistance to ciprofloxacin in Bangkok and to
characterize these strains with regard to ciprofloxacin MICs, auxotype/serovar
(A/S) classification, A and C mutations responsible for ciprofloxacin resistance,
and outer membrane lipoprotein (Lip) subtype analysis. STUDY DESIGN: MICs
of gonococcal isolates from consecutive patients attending the Bangrak Hospital
STD Clinic in Bangkok were determined by agar dilution. A/S class was determined
by established procedures. Mutations within A and C were determined by DNA
sequencing. Lip subtypes were determined by PCR and DNA sequencing. RESULTS:
In 1998 and 1999, 115 of 168 isolated strains of exhibited decreased susceptibility
or resistance to ciprofloxacin, and three cases of possible ciprofloxacin
treatment failure were identified. Ciprofloxacin-resistant (CipR) strains
increased from 13.8% (8/58) in 1998 to 25.4% (28/110) in 1999 ( = 0.08).
Ciprofloxacin MICs of CipR isolates ranged from 1.0 microg/ml to 32.0 microg/ml.
CipR strains belonged to a number of A/S classes and Lip subtypes. Different
CipR strains contained alterations at both amino acid 91 and amino acid 95
of A and also contained an amino acid alteration in C. These alterations
are known to be involved in gonococcal resistance to ciprofloxacin. CONCLUSIONS:
The prevalence of CipR strains of isolated in Bangkok increased substantially
in the 1990s. Characterization of the CipR isolates revealed a number of
different strain subtypes, indicating that CipR isolates in Bangkok are not
from a single clonal source and therefore result from multiple cases of importation
or local emergence. Because of the high level of CipR isolates at Bangrak
Hospital, in 2000 the Thai Ministry of Public Health issued recommendations
against the use of fluoroquinolones for the treatment of gonococcal infection
in Thailand.