1. Recent dynamics in Neisseria gonorrhoeae genomic epidemiology in Brazil: antimicrobial resistance and genomic lineages in 2017-20 compared to 2015-16.
- Author
-
Golparian D, Bazzo ML, Ahlstrand J, Schörner MA, Gaspar PC, de Melo Machado H, Martins JM, Bigolin A, Ramos MC, Ferreira WA, Pereira GFM, Miranda AE, and Unemo M
- Subjects
- Brazil epidemiology, Humans, Male, Genome, Bacterial, Female, Adult, Molecular Epidemiology, Young Adult, Genomics, RNA, Ribosomal, 23S genetics, Middle Aged, Ceftriaxone pharmacology, Adolescent, Multilocus Sequence Typing, Cefixime pharmacology, Neisseria gonorrhoeae genetics, Neisseria gonorrhoeae drug effects, Neisseria gonorrhoeae classification, Gonorrhea microbiology, Gonorrhea epidemiology, Anti-Bacterial Agents pharmacology, Drug Resistance, Bacterial genetics, Azithromycin pharmacology, Microbial Sensitivity Tests, Whole Genome Sequencing
- Abstract
Objectives: Regular quality-assured WGS with antimicrobial resistance (AMR) and epidemiological data of patients is imperative to elucidate the shifting gonorrhoea epidemiology, nationally and internationally. We describe the dynamics of the gonococcal population in 11 cities in Brazil between 2017 and 2020 and elucidate emerging and disappearing gonococcal lineages associated with AMR, compare to Brazilian WGS and AMR data from 2015 to 2016, and explain recent changes in gonococcal AMR and gonorrhoea epidemiology., Methods: WGS was performed using Illumina NextSeq 550 and genomes of 623 gonococcal isolates were used for downstream analysis. Molecular typing and AMR determinants were obtained and links between genomic lineages and AMR (determined by agar dilution/Etest) examined., Results: Azithromycin resistance (15.6%, 97/623) had substantially increased and was mainly explained by clonal expansions of strains with 23S rRNA C2611T (mostly NG-STAR CC124) and mtr mosaics (mostly NG-STAR CC63, MLST ST9363). Resistance to ceftriaxone and cefixime remained at the same levels as in 2015-16, i.e. at 0% and 0.2% (1/623), respectively. Regarding novel gonorrhoea treatments, no known zoliflodacin-resistance gyrB mutations or gepotidacin-resistance gyrA mutations were found. Genomic lineages and sublineages showed a phylogenomic shift from sublineage A5 to sublineages A1-A4, while isolates within lineage B remained diverse in Brazil., Conclusions: Azithromycin resistance, mainly caused by 23S rRNA C2611T and mtrD mosaics/semi-mosaics, had substantially increased in Brazil. This mostly low-level azithromycin resistance may threaten the recommended ceftriaxone-azithromycin therapy, but the lack of ceftriaxone resistance is encouraging. Enhanced gonococcal AMR surveillance, including WGS, is imperative in Brazil and other Latin American and Caribbean countries., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
- Published
- 2024
- Full Text
- View/download PDF