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Antimicrobial resistance and molecular epidemiology using whole-genome sequencing of Neisseria gonorrhoeae in Ireland, 2014–2016: focus on extended-spectrum cephalosporins and azithromycin

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Abstract

High-level resistance and treatment failures with ceftriaxone and azithromycin, the first-line agents for gonorrhoea treatment are reported and antimicrobial-resistant Neisseria gonorrhoeae is an urgent public health threat. Our aims were to determine antimicrobial resistance rates, resistance determinants and phylogeny of N. gonorrhoeae in Ireland, 2014–2016. Overall, 609 isolates from four University Hospitals were tested for susceptibility to extended-spectrum cephalosporins (ESCs) and azithromycin by the MIC Test Strips. Forty-three isolates were whole-genome sequenced based on elevated MICs. The resistance rate to ceftriaxone, cefixime, cefotaxime and azithromycin was 0, 1, 2.1 and 19%, respectively. Seven high-level azithromycin-resistant (HLAzi-R) isolates were identified, all susceptible to ceftriaxone. Mosaic penA alleles XXXIV, X and non-mosaic XIII, and G120K plus A121N/D/G (PorB1b), H105Y (MtrR) and A deletion (mtrR promoter) mutations, were associated with elevated ESC MICs. A2059G and C2611T mutations in 23S rRNA were associated with HLAzi-R and azithromycin MICs of 4–32 mg/L, respectively. The 43 whole-genome sequenced isolates belonged to 31 NG-MAST STs. All HLAzi-R isolates belonged to MLST ST1580 and some clonal clustering was observed; however, the isolates differed significantly from the published HLAzi-R isolates from the ongoing UK outbreak. There is good correlation between previously described genetic antimicrobial resistance determinants and phenotypic susceptibility categories for ESCs and azithromycin in N. gonorrhoeae. This work highlights the advantages and potential of whole-genome sequencing to be applied at scale in the surveillance of antibiotic resistant strains of N. gonorrhoeae, both locally and internationally.

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Acknowledgements

We are grateful to all of the medical laboratory scientists in St. James’s Hospital, as well as to Elaine Phelan (University Hospital Waterford) and Belinda Hanahoe (University Hospital Galway) for help in retrieval of isolates.

Funding

This study was supported by internal funding from the Department of Microbiology. St James’s Hospital, Dublin. M.M.A. was the recipient of an Irish Research Council fellowship (EPSPD/2015/32).

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Authors and Affiliations

  1. Department of Clinical Microbiology, St James’s Hospital, Dublin, Ireland

    L. Ryan, N. Fennelly, L. Rose & B. Crowley

  2. WHO Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections, Department of Laboratory Medicine, Clinical Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden

    D. Golparian & M. Unemo

  3. Department of Computing, Cork Institute of Technology, Cork, Ireland

    P. Walsh & B. Lawlor

  4. Department of Clinical Microbiology, Trinity Translational Medicine Institute, School of Medicine, Trinity College Dublin, Dublin, Ireland

    M. Mac Aogáin

  5. Department of Virology, St James’s Hospital, Dublin, Ireland

    B. Crowley

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Ryan, L., Golparian, D., Fennelly, N. et al. Antimicrobial resistance and molecular epidemiology using whole-genome sequencing of Neisseria gonorrhoeae in Ireland, 2014–2016: focus on extended-spectrum cephalosporins and azithromycin. Eur J Clin Microbiol Infect Dis 37, 1661–1672 (2018). https://doi.org/10.1007/s10096-018-3296-5

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