Extensively Drug-Resistant Neisseria gonorrhoeae Strain, Canada

Area of Science:

• Microbiology
• Infectious Diseases
• Antimicrobial Resistance

Background:

• Neisseria gonorrhoeae is a significant public health concern, with increasing antimicrobial resistance threatening treatment efficacy.
• The emergence of extensively drug-resistant (XDR) strains poses a critical challenge to gonorrhea control globally.

Purpose of the Study:

• To report the identification and characterization of an extensively drug-resistant Neisseria gonorrhoeae strain in Canada.
• To detail the genetic determinants conferring resistance in this novel strain.

Main Methods:

• Antimicrobial susceptibility testing was performed to determine resistance profiles.
• Whole-genome sequencing was utilized to identify genetic mutations associated with drug resistance.

Main Results:

• A Neisseria gonorrhoeae isolate exhibited resistance to ceftriaxone, cefixime, and high-level azithromycin, classifying it as extensively drug-resistant (XDR).
• The strain carried the penA 60.001 allele, featuring A311V and 23S rRNA A2059G single-nucleotide polymorphisms, known contributors to azithromycin resistance.
• The infection was epidemiologically linked to recent travel in Cambodia.

Conclusions:

• This case highlights the urgent need for enhanced surveillance of XDR Neisseria gonorrhoeae globally.
• The identified genetic markers provide insight into mechanisms of high-level azithromycin resistance.
• International travel may facilitate the spread of resistant gonorrhea strains across borders.