The emergence of multiresistant strains of gonococci with reduced susceptibility to cefixime

Gonococcal infection is one of the most common sexually transmitted diseases (STDs), causing a number of serious complications (inflammatory diseases of the pelvic organs, ectopic pregnancy, infertility). In addition, gonococcal infection increases the risk of HIV transmission by a factor of 3 to 5.

In recent years, strains of gonococci (Neisseria gonorrhoeae) with multi-resistance to antibacterial drugs of different classes (penicillins, tetracyclines and fluoroquinolones) have become more common, making it difficult to treat this infection. Currently, as the drug of choice, especially in populations with a high level of resistance of N.gonorrhoeae to fluoroquinolones, it is recommended to use generation III cephalosporins (ceftriaxone and cefixime by orally), to which no resistance was noted.

However, in 2001, the first cases of decrease in the sensitivity of multiresistant strains of gonococci to cefixime were noted in Hawaii, accompanied by the clinical ineffectiveness of the treatment of gonorrhea with this drug. Three urogenital isolates of N. gonorrhoeae, resistant to penicillin, tetracycline, ciprofloxacin and with reduced susceptibility to cefixime, were isolated from three patients. This report on the first multi-drug resistant strains of gonococci resistant to several antibiotics traditionally used to treat STDs indicates serious problems for clinicians and health professionals in the treatment and control of the spread of this infection.

The 4 isolates isolated from the patients were typed and identical. When determining the sensitivity of the strains isolated at the Seattle microbiology laboratory and then at the laboratory of the Centers for Disease Control and Prevention (CDC, USA), it was found that all the isolates are resistant to penicillin (MPC = 8 mg / l, borderline greater than 2 mg / l), tetracycline (MPC = 4-8 mg / l, limit value greater than 2 mg / l), ciprofloxacin (MPC = 8-16 mg / l, limit value greater than 2 mg / l). The criteria for resistance of strains N.gonorrhoeae to generation III cephalosporins (ceftriaxone and cefixime) have not been established, however, the MIC values of these antibiotics are considered as limit values less than 0 , 25 mg / l. The isolates studied had an MIC of ceftriaxone of 0.125 mg / L and of cefixime 0.5 mg / L, which is already outside the established sensitive range.

Reports of the emergence of multidrug-resistant strains of N. gonorrhoeae with reduced susceptibility to cefixime are of serious concern to specialists, as the spread of these strains will further limit the possibilities for empirically prescribing antibiotic therapy in patients with gonorrhea patients.

For uncomplicated gonococcal infections, the CDC currently recommends treatment with a single dose of cefixime (400 mg) or ceftriaxone (125 mg) or fluoroquinolones: ciprofloxacin (500 mg), ofloxacin (400 mg) or levofloxacin (250 mg ). However, according to various reports, in 2001, resistance to fluoroquinolones in N.gonorrhoeae strains was 86.9% in China, 64.0% in Japan and 54.3% in the Philippines. and tends to increase rapidly in other countries.

In the event of clinical ineffectiveness of the recommended regimens of empirical antibacterial therapy for gonococcal infection, a microbiological study and the sensitivity of the selected pathogen to antibiotics are indicated. If polyresistant isolates N.gonorrhoeae are detected, efforts should be made to identify, examine and treat all of the patient's sexual partners in order to prevent further transmission of this strain.

To optimize antimicrobial therapy and take effective measures to prevent the spread of gonococcal infection, data from local studies of N.gonorrhoeae antibiotic resistance in a specific population or region are required.