Antimicrobial Susceptibility Pattern and Molecular Characteristic of Multidrug-resistant Neisseria gonorrhoeae in Jakarta, Indonesia

Background and Objectives: There is an increasing resistance of Neisseria gonorrhoeae to various antibiotics. Numerous problems affect the culture and susceptibility testing of N. gonorrhoeae. Materials and Methods: Forty-one endocervical specimens were  streaked onto chocolate agar and then gently rolled onto a glass object. The suspected colony was identified by Gram staining, oxidase testing and biochemical identification using VITEK® 2 NH cards. Antimicrobial susceptibility testing was performed using the disk diffusion or E-test method. Molecular detection of N. gonorrhoeae was carried out using the SYBR green real-time PCR targeting the opa gene. Multiplex real-time PCR with high-resolution melting (HRM) was used to analyse gene mutations in penA and 23S rRNA. DNA sequencing was used to confirm penA and 23S rRNA mutations Results: SYBR green real-time PCR from direct specimens using the opa gene can detect N. gonorrhoeae with a higher positivity rate compared to culturing, namely 49% and 34%, respectively. Susceptibility testing found that N. gonorrhoeae resistance to cefixime was 11.1%, whereas to azithromycin and ceftriaxone, it was 0%. The resistance of N. gonorrhoeae to levofloxacin and kanamycin was 33.3% and 88.9%, respectively. All isolates were resistant to penicillin, tetracycline and ciprofloxacin. There were no mutations in the penA genes Ala501, Gly545Ser, 23S rRNA A2059G and C2611T. Conclusion: Cefixime resistance was found in Indonesia,  it was not correlated with penA gene mutations. All isolates were still susceptiblle to azithromycin, in line with its molecular characteristics. The SYBR green real time PCR targeting the opa gene successfully detected the DNA extracted from endocervical swabs as N. gonorrhoeae.

Antimicrobial Susceptibility Pattern and Molecular Characteristic of Multidrug-resistant Neisseria gonorrhoeae in Jakarta, Indonesia Keywords:

Molecular Characteristic , Neisseria gonorrhoeae , Susceptibility Pattern , SYBR green real-time PCR