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Open Access Highly Accessed Research article

Antimicrobial susceptibility and genetic characteristics of Neisseria gonorrhoeae isolates from India, Pakistan and Bhutan in 2007–2011

Sunil Sethi1, Daniel Golparian2, Manju Bala3, Dorji Dorji4, Muhammad Ibrahim2, Kausar Jabeen5 and Magnus Unemo2*

Author affiliations

1 Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

2 WHO Collaborating Centre for Gonorrhoea and other STIs, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Clinical Microbiology, Örebro University Hospital, SE-701 85, Örebro, Sweden

3 WHO GASP SEAR Regional Reference Laboratory, Apex Regional STD Teaching, Training & Research Centre, VMMC & Safdarjang Hospital, New Delhi, India

4 JDW/NR Hospital, Thimphu, Bhutan

5 The Aga Khan University, Karachi, Pakistan

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Citation and License

BMC Infectious Diseases 2013, 13:35  doi:10.1186/1471-2334-13-35

Published: 24 January 2013

Abstract

Background

Knowledge on antimicrobial drug resistance and genetic characteristics of Neisseria gonorrhoeae isolates circulating in India, Pakistan, and Bhutan is sorely lacking. In this paper, we describe the prevalence of antimicrobial resistance and molecular characteristics of N. gonorrhoeae isolates from India, Pakistan, and Bhutan in 2007–2011.

Methods

Antimicrobial susceptibility and β-lactamase production were tested for 65 N. gonorrhoeae isolates from India (n=40), Pakistan (n=18) and Bhutan (n=7) using Etest methodology (eight antimicrobials) and nitrocefin solution, respectively. Resistance determinants, i.e. penA, mtrR, porB1b, gyrA, and parC, were sequenced. N. gonorrhoeae multiantigen sequence typing (NG-MAST) was performed for molecular epidemiology.

Results

The highest resistance level was observed for ciprofloxacin (94%), followed by penicillin G (68%), erythromycin (62%), tetracycline (55%), and azithromycin (7.7%). All the isolates were susceptible to ceftriaxone, cefixime, and spectinomycin. Thirty-four (52%) of the isolates were producing β-lactamase. No penA mosaic alleles or A501-altered alleles of penicillin-binding protein 2 were identified. Forty-nine NG-MAST STs were identified, of which 42 STs have not been previously described worldwide.

Conclusions

Based on this study, ceftriaxone, cefixime, and spectinomycin can be used as an empirical first-line therapy for gonorrhoea in India, Pakistan, and Bhutan, whereas ciprofloxacin, penicillin G, tetracycline, erythromycin, and azithromycin should not be. It is imperative to strengthen the laboratory infrastructure in this region, as well as to expand the phenotypic and genetic surveillance of antimicrobial resistance, emergence of new resistance, particularly, to extended-spectrum cephalosporins, and molecular epidemiology.

Keywords:
Gonorrhoea; Antimicrobial resistance; penA; Ceftriaxone; Southeast Asia; India; Bhutan; Pakistan