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We investigated the<jats:italic>in vitro<\/jats:italic>activity of ertapenem, relative to ceftriaxone, against<jats:named-content xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" content-type=\"genus-species\" xlink:type=\"simple\">N. gonorrhoeae<\/jats:named-content>isolates and the effects of ESC resistance determinants on ertapenem. MICs were determined using agar dilution technique or Etest for international reference strains (<jats:italic>n<\/jats:italic>= 17) and clinical<jats:named-content xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" content-type=\"genus-species\" xlink:type=\"simple\">N. gonorrhoeae<\/jats:named-content>isolates (<jats:italic>n<\/jats:italic>= 257), which included the two extensively drug-resistant (XDR) strains H041 and F89 and additional isolates with high ESC MICs, clinical ESC resistance, and other types of clinical high-level and multidrug resistance (MDR). Genetic resistance determinants for ESCs (<jats:italic>penA<\/jats:italic>,<jats:italic>mtrR<\/jats:italic>, and<jats:italic>penB<\/jats:italic>) were sequenced. In general, the MICs of ertapenem (MIC<jats:sub>50<\/jats:sub>= 0.032 \u03bcg\/ml; MIC<jats:sub>90<\/jats:sub>= 0.064 \u03bcg\/ml) paralleled those of ceftriaxone (MIC<jats:sub>50<\/jats:sub>= 0.032 \u03bcg\/ml; MIC<jats:sub>90<\/jats:sub>= 0.125 \u03bcg\/ml). The ESC resistance determinants mainly increased the ertapenem MIC and ceftriaxone MIC at similar levels. However, the MIC ranges for ertapenem (0.002 to 0.125 \u03bcg\/ml) and ceftriaxone (&lt;0.002 to 4 \u03bcg\/ml) differed, and the four (1.5%) ceftriaxone-resistant isolates (MIC = 0.5 to 4 \u03bcg\/ml) had ertapenem MICs of 0.016 to 0.064 \u03bcg\/ml. Accordingly, ertapenem had<jats:italic>in vitro<\/jats:italic>advantages over ceftriaxone for isolates with ceftriaxone resistance. These<jats:italic>in vitro<\/jats:italic>results suggest that ertapenem might be an effective treatment option for gonorrhea, particularly for the currently identified ESC-resistant cases and possibly in a dual antimicrobial therapy regimen. However, further knowledge regarding the genetic determinants (and their evolution) conferring resistance to both antimicrobials, and clear correlates between genetic and phenotypic laboratory parameters and clinical treatment outcomes, is essential.<\/jats:p>","DOI":"10.1128\/aac.00326-12","type":"journal-article","created":{"date-parts":[[2012,5,1]],"date-time":"2012-05-01T02:53:11Z","timestamp":1335840791000},"page":"3603-3609","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":69,"title":["<i>In Vitro<\/i>Activity of Ertapenem versus Ceftriaxone against Neisseria gonorrhoeae Isolates with Highly Diverse Ceftriaxone MIC Values and Effects of Ceftriaxone Resistance Determinants: Ertapenem for Treatment of Gonorrhea?"],"prefix":"10.1128","volume":"56","author":[{"given":"Magnus","family":"Unemo","sequence":"first","affiliation":[{"name":"WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Clinical Microbiology, \u00d6rebro University Hospital, \u00d6rebro, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Golparian","sequence":"additional","affiliation":[{"name":"WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Clinical Microbiology, \u00d6rebro University Hospital, \u00d6rebro, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athena","family":"Limnios","sequence":"additional","affiliation":[{"name":"WHO Collaborating Centre for STD, Prince of Wales Hospital, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Whiley","sequence":"additional","affiliation":[{"name":"Queensland Paediatric Infectious Diseases Laboratory, Queensland Children's Medical Research Institute, Children's Health Service District, Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makoto","family":"Ohnishi","sequence":"additional","affiliation":[{"name":"National Institute of Infectious Diseases, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica M.","family":"Lahra","sequence":"additional","affiliation":[{"name":"WHO Collaborating Centre for STD, Prince of Wales Hospital, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John W.","family":"Tapsall","sequence":"additional","affiliation":[{"name":"WHO Collaborating Centre for STD, Prince of Wales Hospital, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.46.12.3744-3749.2002"},{"key":"e_1_3_2_3_2","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.ijantimicag.2008.08.005","article-title":"Safety and tolerability of ertapenem versus ceftriaxone in a double-blind study performed in children with complicated urinary tract infection, community-acquired pneumonia or skin and soft-tissue infection","volume":"33","author":"Arguedas A","year":"2009","unstructured":"ArguedasA . 2009. 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