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To address these goals, 149 isolates were collected over a 1-month period (October-November 2008) at the Ontario Public Health Laboratory, Toronto, Canada, and susceptibility profiles (8 antibiotics) were examined. Mutations in previously identified targets or the presence of some enzymes related to resistance (r), nonsusceptibility (ns) (resistant plus intermediate categories), or reduced susceptibility (rs) to the antibiotics tested were also studied. A significant proportion of nonsusceptibility to penicillin (PEN) (89.2%), tetracycline (TET) (72.3%), ciprofloxacin (CIP) (29%), and macrolides (erythromycin [ERY] and azithromycin; 22.3%) was found in these strains. Multidrug resistance was observed in 18.8% of the collection. Although all the strains were susceptible to spectinomycin and extended-spectrum cephalosporins (ESC) (ceftriaxone and cefixime), 9.4% of them displayed reduced susceptibility to extended-spectrum cephalosporins. PBP 2 mosaic structures were found in all of these ESC<jats:sup>rs<\/jats:sup>isolates. Alterations in the<jats:italic>mtrR<\/jats:italic>promoter, MtrR repressor (TET<jats:sup>r<\/jats:sup>, PEN<jats:sup>ns<\/jats:sup>, ESC<jats:sup>rs<\/jats:sup>, and ERY<jats:sup>ns<\/jats:sup>), porin PIB (TET<jats:sup>r<\/jats:sup>and PEN<jats:sup>ns<\/jats:sup>), and ribosomal protein S10 (TET<jats:sup>r<\/jats:sup>) and double mutations in<jats:italic>gyrA<\/jats:italic>and<jats:italic>parC<\/jats:italic>quinolone resistance-determining regions (QRDRs) (CIP<jats:sup>r<\/jats:sup>) were associated with and presumably responsible for the resistance phenotypes observed. This is the first description of ESC<jats:sup>rs<\/jats:sup>in Canada. The detection of this phenotype indicates a change in the epidemiology of this resistance and highlights the importance of continued surveillance to preserve the last antimicrobial options available.<\/jats:p>","DOI":"10.1128\/aac.00788-10","type":"journal-article","created":{"date-parts":[[2010,11,23]],"date-time":"2010-11-23T05:25:01Z","timestamp":1290489901000},"page":"703-712","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":91,"title":["Molecular Analysis of Antimicrobial Resistance Mechanisms in<i>Neisseria gonorrhoeae<\/i>Isolates from Ontario, Canada"],"prefix":"10.1128","volume":"55","author":[{"given":"Vanessa G.","family":"Allen","sequence":"first","affiliation":[{"name":"Ontario Agency for Health Protection and Promotion, Public Health Laboratory\u2014Toronto, Ontario, Canada"},{"name":"Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David J.","family":"Farrell","sequence":"additional","affiliation":[{"name":"Ontario Agency for Health Protection and Promotion, Public Health Laboratory\u2014Toronto, Ontario, Canada"},{"name":"Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anuradha","family":"Rebbapragada","sequence":"additional","affiliation":[{"name":"Ontario Agency for Health Protection and Promotion, Public Health Laboratory\u2014Toronto, Ontario, Canada"},{"name":"Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingyuan","family":"Tan","sequence":"additional","affiliation":[{"name":"Ontario Agency for Health Protection and Promotion, Public Health Laboratory\u2014Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathalie","family":"Tijet","sequence":"additional","affiliation":[{"name":"Ontario Agency for Health Protection and Promotion, Public Health Laboratory\u2014Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen J.","family":"Perusini","sequence":"additional","affiliation":[{"name":"Ontario Agency for Health Protection and Promotion, Public Health Laboratory\u2014Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lynn","family":"Towns","sequence":"additional","affiliation":[{"name":"Ontario Agency for Health Protection and Promotion, Public Health Laboratory\u2014Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Lo","sequence":"additional","affiliation":[{"name":"Ontario Agency for Health Protection and Promotion, Public Health Laboratory\u2014Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donald E.","family":"Low","sequence":"additional","affiliation":[{"name":"Ontario Agency for Health Protection and Promotion, Public Health Laboratory\u2014Toronto, Ontario, Canada"},{"name":"Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada"},{"name":"Mount Sinai Hospital, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto G.","family":"Melano","sequence":"additional","affiliation":[{"name":"Ontario Agency for Health Protection and Promotion, Public Health Laboratory\u2014Toronto, Ontario, Canada"},{"name":"Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada"},{"name":"Mount Sinai Hospital, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"235","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s101560170034"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007435-200305000-00004"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.46.12.3744-3749.2002"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007435-200306000-00010"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2958.1994.tb01297.x"},{"key":"e_1_3_1_7_2","first-page":"1","volume":"55","year":"2006","unstructured":"Centers for Disease Control and Prevention. 2006. 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