cefixime CFIX cefteram pivoxil CFTM-PI ceftriaxone CTRX cefodizime CDZM spectinomycin

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1 00 3 STD JR Neisseria gonorrhoeae 77 cefiximecfixcefteram pivoxilcftm-piceftriaxonectrxcefodizimecdzmspectinomycinspcmlevofloxacinlvfx CFIX MIC µ gml 0 pulsed-field gel electrophoresispfge00 CFIX 5.9CFTM-PI 0. LVFX 0. CTRXCDZM SPCM 00 MIC90 MIC β -lactamase CFIX PFGE 0 7 CFIX Key words: Neisseria gonorrhoeaemale urethritisdrug-susceptibilitypulsed-field gel electrophoresispfge 00 MIC CFIX pulsed-field gel electrophoresispfge I minimary inhibitory concentration: MIC Clinical Laboratory Standards InstituteCLSI 3 cefiximecfixcefteram pivoxilcftm-piceftriaxonectrxcefodizimecdzmspectinomycin SPCM levofloxacinlvfx 6 NCCLS break point CFIXCFTM-PI CTRX µ gmlcdzm LVFX 5 µ gml SPCM 3 µ gml

2 Table. Distribution of MICs of each antimicrobial agent against N. gonorrhoeae agent year No. of strains MIC range g/ml MIC50 MIC90 g/ml g/ml breakpoint rate of susceptible strains% cefixime cefteram-pivoxil ceftriaxone cefodizime spectinomycin levofloxacin breakpoint of cefixime was substituted breakpoint of cefotaxime was substituted twice value of breakpoint of ofloxacin Centers for Disease Control and Prevention: CDC β -lactamase β -lactamase 3 PFGE CFIX MIC µ g ml 0 pulsed-field gel electrophoresispfge lysozyme proteinase k SpeITakara 35 CHEF-DRIIBio- Rad Laboratories 55 00V 0 II 00 MIC Table CFIX MIC90 µ gml µ gml MIC50 90 CFTM-PI CFIX MIC90 µ gml µ gml MIC50 CFTM-PI 70 CTRX MIC90 µ gml µ gml MIC µ gml µ gml 00 µ gml CTRX MIC90 breakpoint 00

3 Table. Comparison of MICs of each antimicrobial agent against N. gonorrhoeae strain isolated from urethra and Case No. Sample Cefixime Cefterampivoxil antimicrobial agent Ceftriaxone Cefodizime Spectinomycin Levofloxacin -lactamase kb Y L B C D Fig.. PFGE patterns of CFIX-resistant N. gonorrhoeae strains. CTRX CDZM MIC50MIC90 CDZM 00 SPCM MIC50 MIC90 CDZM 00 SPCM LVFX MIC50 MIC Table β -lactamase CFIX PFGE CFIX MIC µ gml CFIX PFGE Fig. D PFGE Table 3 III 9 STD β-lactamase penicillinase-producing Neisseria gonorrhoeae: PPNG CDC Chlamydia trachomatis 0

4 Table 3 PFGE patterns of CFIX-resistant N. gonorrhoeae strains and their drug-susceptibility No year of isolation PFGE pattern CFIX CFTM-PI MIC g/ml CTRX CDZM LVFX SPCM 3 B 5 C 6 D SPCM.0 g CTRX.0 g CDZM.0 g CFIX 00 mg 3 5 CTRXCDZM SPCM 3 CTRX MIC90 CTRX CDC STD STD CFIX MIC µ gml 0 PFGE CFIX CFIX : 630, mg 3 :, 3 National Committee for Clinical Laboratory Standards. Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobicallyfour edi-

5 tion. pproved standard M7-. NCCLS, Pennsylvania, 997 National Committee for Clinical Laboratory Standards. Methods for dilution antimicrobial susceptibility testing: Eleventh informational M-S. NCCLS, Wayne. Pa., : 0 60, 6 6: 3337, : 37376, Fox K K, Knapp J S, Holmes K K, et al: ntimicrobial resistance in Neisseria gonorrhoeae in the United States, 999: The emergence of decreased susceptibility to the fluoroquinolones. J Infect Dis 75: 39603, : 95, : 33, 00 guide line 0: 33, 00 5: 3, 00 3 Gonococcal infections. Sexually Transmitted Disease Treatment Guidelines: CDC : MMWR Recommendations and Reports Vol. 5 No. RR-6, 36, 00 STD 3: 6, 00 5 STD 3: 5, 00 5: 6769, 00 7 Tanaka M, Nakayama H, Sakumoto M, et al: Reduced chlamydial infection and gonorrhoea among commercial sex workers in Fukuoka City, Japan. Int J Urol 5: 775, 99 Neisseria gonorrhoeae :, Drug-susceptibilities of Neisseria gonorrhoeae strains isolated from male patients with gonococcal urethritis against antimicrobial agents Their comparisons from to 00 Yutaka Kagami, Katsuhisa Endo, Hiroo Suzuki 3,HiroshiKiyota, Shoichi Onodera and Tokyo STD study group Department of Urology, The Jikei University School of Medicine Present: Department of Urology, The Jikei University affiliated oto Hospital, 6 oto Katsushika-ku, Tokyo, Japan Department of Urology, JR Tokyo General Hospital 3 Department of Urology, Kosei Hospital We investigated drug-susceptibility of Neisseria gonorrhoeae strains, which were isolated from the urethras and of the male patients with urethritis between and 00, against cefiximecfix, cefteram pivoxilcftm-pi, ceftriaxonectrx, cefodizimecdzm, spectinomycinspcm, levofloxacinlvfx. mong these strains, 0 strains, which were highly resistant to CFIXMIC µ gml, were analyzed their gene pattern using pulsed-field gel electrophoresispfge. Drug-resistant rates in 00 against CFIX, CFTM-PI, CTRX, CDZM, SPCM and LVFX were 5.9, 0., 0, 0, 0, and 0., respectively. MICs 90 against the strains isolated in 00 did not change compared to those in. MICs against four strains isolated from were twice higher than those from urethras. The incidences of β -lactamase producing strain were. in, 5. in, 5.0 in 00, respectively. From gene analysis using PFGE, four gene patterns were recognized. mong them, 7 had the same gene pattern, which was detected from the strains isolated in each year and from different areas, indicating that this appearance of CFIX-resistant strains was not due to an outbreak of the same clone.