Molecular Epidemiology ofNeisseria gonorrheaeIsolates with Plasmid-Mediated Tetracycline Resistance in Canada: Temporal and Geographical Trends (1986-1997)

Abstract

Plasmid-mediated resistance to tetracycline in Neisseria gonorrhoeae (TRNG) isolates is caused by the acquisition of a 25.2-MDa conjugative, tetM-containing plasmid (TetM plasmid). The presence of the TetM plasmid is the leading cause of gonococcal resistance to tetracycline in most countries. Between 1986 and 1997, 6,306 TRNG isolates were isolated in different Canadian provincial laboratories and subsequently submitted to the national laboratory for further strain characterization. Because nonculture-based identification of N. gonorrhoeae was more widely used after 1995, this snapshot of the molecular epidemiology of TRNG in Canada, which is only possible if bacteria are cultured, represents a comprehensive data baseline that may no longer be achievable. Temporal trends indicate that TRNG isolations peaked in 1994 (18.9% of isolates tested). Antimicrobial susceptibilities (MIC) to tetracycline and penicillin were determined for 4,064 TRNG isolated between 1986 and 1994. The MICs of TRNG isolates ranged from 16μg/ml to 32μg/ml of tetracycline, although one isolate had an MIC of 8μg/ml and the MICs of four isolates were 2μg/ml. Penicillinase-producing TRNG (i.e., PP/TRNG) comprised 34.1% of all TRNG (n = 1,386) and 52 TRNG isolates exhibited chromosomal resistance to penicillin. Most of the PP/TRNG (94.1%) carried Africa type (3.2 MDa) β-lactamase-producing plasmids; only 76 (5.5%) PP/TRNG carried Asia type (4.4 MDa) penicillinase-producing plasmids and three isolates carried Toronto type (3.05 MDa) plasmids. TRNG isolates were also retrospectively typed by auxotype (A), serovar (S), and plasmid (P) content analysis. Eleven auxotype/serovar (A/S) groups comprised the majority (93%) of 4,064 typed TRNG isolates with A/S classes NR/IB-2, NR/IB-3, and NR/IB-1 accounting for 75.1% of the strains characterized. Classification of 670 TRNG for tetM type demonstrated that the Dutch (n = 531) type TetM plasmids predominated over the American (n = 139) type TetM plasmids.