{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T18:35:56Z","timestamp":1780511756507,"version":"3.54.1"},"reference-count":28,"publisher":"CSIRO Publishing","issue":"5","license":[{"start":{"date-parts":[[2025,5,5]],"date-time":"2025-05-05T00:00:00Z","timestamp":1746403200000},"content-version":"vor","delay-in-days":2104,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,9,13]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>High rates of antimicrobial resistance (AMR) in Neisseria gonorrhoeae hinder effective treatment, but molecular AMR diagnostics may help address the challenge. This study aimed to appraise the literature for resistance-associated genotypic markers linked to fluoroquinolones and macrolides, to identify and review their use in diagnostics. Methods: Medline and EMBASE databases were searched and data pooled to evaluate associations between genotype and phenotypic resistance. The minimum inhibitory concentration (MIC) cut-offs were = 0.06 mg L-1 for non-resistance to ciprofloxacin and = 0.5 mg L-1 for non-resistance to azithromycin. Results: Diagnostic accuracy estimates were limited by data availability and reporting. It was found that: 1) S91 and D95 mutations in the GyrA protein independently predicted ciprofloxacin resistance and, used together, gave 98.6% (95% confidence interval (CI) 98.0\u201399.0%) sensitivity and 91.4% (95%CI 88.6\u201393.7%) specificity; 2) the number of 23S rRNA gene alleles with C2611T or A2059G mutations was highly correlated with azithromycin resistance, with mutation in any allele giving a sensitivity and specificity of 66.1% (95%CI 62.1\u201370.0%) and 98.9% (95%CI 97.5\u201399.5%) respectively. Estimated negative (NPV) and positive predictive values (PPV) for a 23S rRNA diagnostic were 98.6% (95%CI 96.8\u201399.4%) and 71.5% (95%CI 68.0\u201374.8%) respectively; 3) mutation at amino acid position G45 in the MtrR protein independently predicted azithromycin resistance; however, when combined with 23S rRNA, did not improve the PPV or NPV. Conclusions: Viable candidates for markers of resistance detection for incorporation into diagnostics were demonstrated. Such tests may enhance antibiotic stewardship and treatment options.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1071\/sh18225","type":"journal-article","created":{"date-parts":[[2019,7,31]],"date-time":"2019-07-31T21:53:47Z","timestamp":1564610027000},"page":"479-487","source":"Crossref","is-referenced-by-count":19,"title":["Genotypic determinants of fluoroquinolone and macrolide resistance in Neisseria gonorrhoeae"],"prefix":"10.1071","volume":"16","author":[{"given":"Catherine L.","family":"Hall","sequence":"first","affiliation":[{"name":"AApplied Diagnostic Research and Evaluation Unit, St George\u2019s University of London, Institute for Infection & Immunity, Cranmer Terrace, Tooting, London SW17 0RE, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark A.","family":"Harrison","sequence":"additional","affiliation":[{"name":"AApplied Diagnostic Research and Evaluation Unit, St George\u2019s University of London, Institute for Infection & Immunity, Cranmer Terrace, Tooting, London SW17 0RE, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus J.","family":"Pond","sequence":"additional","affiliation":[{"name":"AApplied Diagnostic Research and Evaluation Unit, St George\u2019s University of London, Institute for Infection & Immunity, Cranmer Terrace, Tooting, London SW17 0RE, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Chow","sequence":"additional","affiliation":[{"name":"AApplied Diagnostic Research and Evaluation Unit, St George\u2019s University of London, Institute for Infection & Immunity, Cranmer Terrace, Tooting, London SW17 0RE, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma M.","family":"Harding-Esch","sequence":"additional","affiliation":[{"name":"AApplied Diagnostic Research and Evaluation Unit, St George\u2019s University of London, Institute for Infection & Immunity, Cranmer Terrace, Tooting, London SW17 0RE, UK."},{"name":"BNational Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. Tariq","family":"Sadiq","sequence":"additional","affiliation":[{"name":"AApplied Diagnostic Research and Evaluation Unit, St George\u2019s University of London, Institute for Infection & Immunity, Cranmer Terrace, Tooting, London SW17 0RE, UK."},{"name":"BNational Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK."},{"name":"CSt George\u2019s University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London SW17 0QT, UK."},{"name":"DCorresponding author. Email: ssadiq@sgul.ac.uk"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"67","published-online":{"date-parts":[[2019,8,1]]},"reference":[{"key":"2025102419092908300_R1","unstructured":"The Review on Antimicrobial Resistance. Tackling drug-resistant infections globally: final report and recommendations. London: Review on Antimicrobial Resistance; 2016. Available online at: http:\/\/amr-review.org\/sites\/default\/files\/160518_Final%20paper_with%20cover.pdf [verified 3 November 2015].http:\/\/amr-review.org\/sites\/default\/files\/160518_Final%20paper_with%20cover.pdf"},{"issue":"5","key":"2025102419092908300_R2","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1136\/sextrans-2015-052312","article-title":"An outbreak of high-level azithromycin resistant Neisseria gonorrhoeae in England.","volume":"92","author":"Chisholm","year":"2016","journal-title":"Sex Transm Infect"},{"issue":"27","key":"2025102419092908300_R3","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2018.23.27.1800323","article-title":"Gonorrhoea treatment failure caused by a Neisseria gonorrhoeae strain with combined ceftriaxone and high-level azithromycin resistance, England, February 2018.","volume":"23","author":"Eyre","year":"2018","journal-title":"Euro 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Breakpoint tables for interpretation of MICs and zone diameters. Version 7.1. Basel: European Society of Clinical Microbiology and Infectious Diseases; 2017. Available online at: http:\/\/www.eucast.org [verified 3 November 2015].http:\/\/www.eucast.org"},{"key":"2025102419092908300_R19"},{"issue":"4","key":"2025102419092908300_R20","doi-asserted-by":"publisher","first-page":"1039","DOI":"10.1111\/j.1365-2958.2007.05975.x","article-title":"Novel mutations in ribosomal proteins L4 and L22 that confer erythromycin resistance in Escherichia coli.","volume":"66","author":"Zaman","year":"2007","journal-title":"Mol Microbiol"},{"issue":"2","key":"2025102419092908300_R21","doi-asserted-by":"publisher","first-page":"50","DOI":"10.3390\/jpm2020050","article-title":"Infectious disease management through point-of-care personalized medicine molecular diagnostic technologies.","volume":"2","author":"Bissonnette","year":"2012","journal-title":"J Pers Med"},{"issue":"1","key":"2025102419092908300_R22","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1136\/sti.74.1.59","article-title":"Analysis of quinolone resistance mechanisms in Neisseria gonorrhoeae isolates in vitro.","volume":"74","author":"Tanaka","year":"1998","journal-title":"Sex Transm Infect"},{"issue":"4","key":"2025102419092908300_R23","doi-asserted-by":"publisher","first-page":"879","DOI":"10.1128\/AAC.40.4.879","article-title":"Genetic evidence for a role of parC mutations in development of high-level fluoroquinolone resistance in Escherichia coli.","volume":"40","author":"Heisig","year":"1996","journal-title":"Antimicrob Agents Chemother"},{"issue":"8","key":"2025102419092908300_R24","doi-asserted-by":"publisher","first-page":"2118","DOI":"10.1128\/AAC.44.8.2118-2125.2000","article-title":"Mutations in 23S rRNA and ribosomal protein L4 account for resistance in pneumococcal strains selected in vitro by macrolide passage.","volume":"44","author":"Tait-Kamradt","year":"2000","journal-title":"Antimicrob Agents Chemother"},{"issue":"6","key":"2025102419092908300_R25","doi-asserted-by":"publisher","first-page":"2175","DOI":"10.1128\/AAC.01420-07","article-title":"Relation between genetic markers of drug resistance and susceptibility profile of clinical Neisseria gonorrhoeae strains.","volume":"52","author":"Ilina","year":"2008","journal-title":"Antimicrob Agents Chemother"},{"issue":"1","key":"2025102419092908300_R26","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.jmoldx.2012.08.005","article-title":"Multiplex bead suspension array for screening Neisseria gonorrhoeae antibiotic resistance genetic determinants in noncultured clinical samples.","volume":"15","author":"Balashov","year":"2013","journal-title":"J Mol Diagn"},{"issue":"2","key":"2025102419092908300_R27","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1586\/14737159.2014.871495","article-title":"Review of use of a new rapid real-time PCR, the Cepheid GeneXpert(R) (Xpert) CT\/NG assay, for Chlamydia trachomatis and Neisseria gonorrhoeae: results for patients while in a clinical setting.","volume":"14","author":"Gaydos","year":"2014","journal-title":"Expert Rev Mol Diagn"},{"issue":"9","key":"2025102419092908300_R28","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.1093\/cid\/ciw864","article-title":"Implementation of a rapid genotypic assay to promote targeted ciprofloxacin therapy of Neisseria gonorrhoeae in a large health system.","volume":"64","author":"Allan-Blitz","year":"2017","journal-title":"Clin Infect Dis"}],"container-title":["Sexual Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/connectsci.au\/sh\/article-pdf\/16\/5\/479\/149551\/sh18225.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/connectsci.au\/sh\/article-pdf\/16\/5\/479\/149551\/sh18225.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T23:09:36Z","timestamp":1761347376000},"score":1,"resource":{"primary":{"URL":"https:\/\/connectsci.au\/sh\/article\/16\/5\/479\/21551\/Genotypic-determinants-of-fluoroquinolone-and"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8,1]]},"references-count":28,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2019,9,13]]}},"URL":"https:\/\/doi.org\/10.1071\/sh18225","relation":{},"ISSN":["1448-5028","1449-8987"],"issn-type":[{"value":"1448-5028","type":"print"},{"value":"1449-8987","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,8,1]]}}}