{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T02:16:25Z","timestamp":1784081785108,"version":"3.55.0"},"reference-count":69,"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":2142,"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:p>Background: In the last two decades, gonococcal strains with decreased cefixime susceptibility and cases of clinical treatment failure have been reported worldwide. Gonococcal strains with a cefixime minimum inhibitory concentration (MIC) =0.12 \u00b5g mL-1 are significantly more likely to fail cefixime treatment than strains with an MIC &amp;lt;0.12 \u00b5g mL-1. Various researchers have described the molecular characteristics of gonococcal strains with reduced cefixime susceptibility, and many have proposed critical molecular alterations that contribute to this decreased susceptibility. Methods: A systematic review of all published articles in PubMed through 1 November 2018 was conducted that report findings on the molecular characteristics and potential mechanisms of resistance for gonococcal strains with decreased cefixime susceptibility. The findings were summarised and suggestions were made for the development of a molecular-based cefixime susceptibility assay. Results: The penicillin-binding protein 2 (PBP2) encoded by the penA gene is the primary target of cefixime antimicrobial activity. Decreased cefixime susceptibility is conferred by altered penA genes with mosaic substitute sequences from other Neisseria (N.) species (identifiable by alterations at amino acid position 375\u2013377) or by non-mosaic penA genes with at least one of the critical amino acid substitutions at positions 501, 542 and 551. Based on this review of 415 international cefixime decreased susceptible N. gonorrhoeae isolates, the estimated sensitivity for an assay detecting the aforementioned amino acid alterations would be 99.5% (413\/415). Conclusions: Targeting mosaic penA and critical amino acid substitutions in non-mosaic penA are necessary and may be sufficient to produce a robust, universal molecular assay to predict cefixime susceptibility.<\/jats:p>","DOI":"10.1071\/sh18227","type":"journal-article","created":{"date-parts":[[2019,6,23]],"date-time":"2019-06-23T23:16:46Z","timestamp":1561331806000},"page":"488-499","source":"Crossref","is-referenced-by-count":29,"title":["Using the genetic characteristics of Neisseria gonorrhoeae strains with decreased susceptibility to cefixime to develop a molecular assay to predict cefixime susceptibility"],"prefix":"10.1071","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7095-1560","authenticated-orcid":true,"given":"Xiaomeng","family":"Deng","sequence":"first","affiliation":[{"name":"ADavid Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA."},{"name":"FCorresponding author. Email: dengxiaomeng0416@gmail.com"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lao-Tzu","family":"Allan-Blitz","sequence":"additional","affiliation":[{"name":"BDepartment of Medicine, Brigham and Women\u2019s Hospital, 75 Francis Street, Boston, MA 02115, USA."},{"name":"CDepartment of Medicine, Children\u2019s Hospital of Boston, 300 Longwood Avenue, Boston, MA 02115, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey D.","family":"Klausner","sequence":"additional","affiliation":[{"name":"ADavid Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA."},{"name":"DDivision of Infectious Disease, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Center for Health Sciences, 37\u2013121, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA."},{"name":"EDepartment of Epidemiology, Fielding School of Public Health, University of California Los Angeles, 650 Charles E. Young Drive S., Los Angeles, CA 90095, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"67","published-online":{"date-parts":[[2019,6,24]]},"reference":[{"key":"2025102419092965500_R1","doi-asserted-by":"publisher","first-page":"E19","DOI":"10.1111\/j.1749-6632.2011.06215.x","article-title":"Antibiotic resistance in Neisseria gonorrhoeae: origin, evolution, and lessons learned for the future.","volume":"1230","author":"Unemo","year":"2011","journal-title":"Ann N Y Acad Sci"},{"issue":"7","key":"2025102419092965500_R2","doi-asserted-by":"publisher","first-page":"821","DOI":"10.1586\/eri.09.63","article-title":"Meeting the public health challenge of multidrug- and extensively drug-resistant Neisseria gonorrhoeae.","volume":"7","author":"Tapsall","year":"2009","journal-title":"Expert Rev Anti Infect Ther"},{"issue":"5","key":"2025102419092965500_R3","first-page":"90","article-title":"Systematic review and meta-analysis on efficacy of cefixime for treating gonococcal 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