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JAC Advance Access originally published online on April 8, 2009
Journal of Antimicrobial Chemotherapy 2009 63(6):1200-1204; doi:10.1093/jac/dkp118
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© The Author 2009. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Original research

Azithromycin-resistant Neisseria gonorrhoeae strains recently isolated in Italy

S. Starnino, P. Stefanelli* and on behalf of the Neisseria gonorrhoeae Italian Study Group{dagger}

Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy

Received 19 November 2008; returned 31 December 2008; revised 2 March 2009; accepted 7 March 2009

* Corresponding author. Tel: +39-0649902126; Fax: +39-0649387112; E-mail: paola.stefanelli{at}iss.it

Objectives: The aim of this study was to characterize 22 azithromycin-resistant Neisseria gonorrhoeae isolates, collected in Italy from January 2007 through June 2008, during a study of the prevalence of antibiotic resistance.

Methods: MICs of azithromycin, ciprofloxacin, ceftriaxone, penicillin and tetracycline were determined by the Etest method. Azithromycin-resistant strains (MIC ≥ 1 mg/L) were genetically analysed by N. gonorrhoeae multi-antigen sequence typing (NG-MAST) and PFGE.

Results: A total of 22 azithromycin-resistant isolates were found among the 219 collected. Five of the 22 isolates showed high-level azithromycin resistance (MICs of 128 or 256 mg/L). Sixteen of the 22 were isolated from men who have sex with men. Among the 14 sequence types (STs) found by NG-MAST, 5 STs, containing clusters of two, three or four strains, were homogeneous with respect to epidemiology and/or antibiotic susceptibility. PFGE divided the 22 strains into two main groups that were possibly related.

Conclusions: This is the first report of gonococci with high-level resistance to azithromycin circulating in Italy. Correlation between NG-MAST results and epidemiological data for some of the analysed strains and patients could be established. This study represents a reference point for future surveillance in Italy and suggests the need to add azithromycin to the antibiotic susceptibility panel for gonococci.

Keywords: antimicrobial susceptibility , gonorrhoea , macrolides

{dagger} Members of the Neisseria gonorrhoeae Italian Study Group are listed in the Acknowledgements section.


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