{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T09:02:41Z","timestamp":1771059761984,"version":"3.50.1"},"reference-count":41,"publisher":"American Society for Microbiology","issue":"5","license":[{"start":{"date-parts":[[2014,5,1]],"date-time":"2014-05-01T00:00:00Z","timestamp":1398902400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Antimicrob Agents Chemother"],"published-print":{"date-parts":[[2014,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:p>\n            Azithromycin (AZM) is routinely recommended as a component of dual therapy for gonorrhea in combination with third-generation cephalosporins (3GC). In this study, we examined the prevalence of AZM-resistant (AZM\n            <jats:sup>r<\/jats:sup>\n            )\n            <jats:named-content xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" content-type=\"genus-species\" xlink:type=\"simple\">Neisseria gonorrhoeae<\/jats:named-content>\n            from July 2010 to February 2013, assessed the rate of concurrent cephalosporin resistance under the current treatment recommendations, and analyzed the clonal distribution of AZM\n            <jats:sup>r<\/jats:sup>\n            isolates in Ontario, Canada. Nineteen AZM\n            <jats:sup>r<\/jats:sup>\n            clinical isolates (one per patient; MIC, \u22652 \u03bcg\/ml) were included in the study. Susceptibility profiles of these isolates to 11 antibiotics, molecular typing, characterization of macrolide resistance mechanisms, and penicillin-binding protein 2 (PBP2) patterns were determined for all the isolates. Two groups were defined based on AZM\n            <jats:sup>r<\/jats:sup>\n            level; group A isolates displayed high-level resistance (MIC, \u22652,048 \u03bcg\/ml) due to mutations (A2143G) in the four copies of the 23S rRNA\n            <jats:italic>rrl<\/jats:italic>\n            gene, and group B isolates had moderate resistance to AZM (MICs, 2 to 8 \u03bcg\/ml, C2599T mutation in the\n            <jats:italic>rrl<\/jats:italic>\n            gene), with a subgroup belonging to sequence type 3158 (ST3158) (\n            <jats:italic>n<\/jats:italic>\n            = 8), which also showed reduced susceptibility to 3GC (MICs, 0.12 to 0.25 \u03bcg\/ml, PBP2 pattern XXXIV). This AZM\n            <jats:sup>r<\/jats:sup>\n            phenotype was not observed in previous provincial surveillance in 2008 (the ST3158 clone was found, with AZM MICs of 0.25 to 0.5 \u03bcg\/ml associated with\n            <jats:italic>mtrR<\/jats:italic>\n            mutations). We hypothesized that the AZM mutant prevention concentration (MPC) in the ST3158 subpopulation we found in 2008 was higher than the MPC in wild-type isolates (AZM MIC, \u22640.031 \u03bcg\/ml), increasing the chances of additional selection of AZM\n            <jats:sup>r<\/jats:sup>\n            mutations. Full AZM resistance is now emerging in this clone together with reduced susceptibility to 3GC, threatening the future efficacy of these antibiotics as therapeutic options for treatment of gonorrhea.\n          <\/jats:p>","DOI":"10.1128\/aac.02608-13","type":"journal-article","created":{"date-parts":[[2014,2,11]],"date-time":"2014-02-11T05:12:30Z","timestamp":1392095550000},"page":"2528-2534","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":51,"title":["Azithromycin Resistance Is Coevolving with Reduced Susceptibility to Cephalosporins in Neisseria gonorrhoeae in Ontario, Canada"],"prefix":"10.1128","volume":"58","author":[{"given":"Vanessa G.","family":"Allen","sequence":"first","affiliation":[{"name":"Public Health Ontario Laboratories, Toronto, Ontario, Canada"},{"name":"Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"Seah","sequence":"additional","affiliation":[{"name":"Public Health Ontario Laboratories, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irene","family":"Martin","sequence":"additional","affiliation":[{"name":"National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto G.","family":"Melano","sequence":"additional","affiliation":[{"name":"Public Health Ontario Laboratories, Toronto, Ontario, Canada"},{"name":"Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada"},{"name":"Mount Sinai Hospital, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00325-11"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.05760-11"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dks162"},{"key":"e_1_3_2_5_2","first-page":"590","article-title":"Update to CDC's sexually transmitted diseases treatment guidelines, 2010: oral cephalosporins no longer a recommended treatment for gonococcal infections","volume":"61","author":"Centers for Disease Control and Prevention","year":"2012","unstructured":"Centers for Disease Control and Prevention. 2012. Update to CDC's sexually transmitted diseases treatment guidelines, 2010: oral cephalosporins no longer a recommended treatment for gonococcal infections. Morb. Mortal. Wkly. Rep. 61:590\u2013594.","journal-title":"Morb. Mortal. Wkly. Rep."},{"key":"e_1_3_2_6_2","unstructured":"Public Health Agency of Canada. 21 December 2011. Canadian guidelines on sexually transmitted infections: gonococcal infections. http:\/\/www.phac-aspc.gc.ca\/std-mts\/sti-its\/alert\/2011\/alert-gono-eng.php."},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1258\/ijsa.2011.011267"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10156-006-0445-z"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1258\/095646207781568556"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cit084"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.46.9.3020-3025.2002"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkn235"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkp188"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00309-10"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkp118"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01506-09"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0b013e318219cdb5"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir929"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00788-10"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkt059"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.05481-11"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0b013e3182401b69"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.176575"},{"key":"e_1_3_2_24_2","volume-title":"Performance standards for antimicrobial susceptibility testing; 22nd informational supplement","author":"Clinical and Laboratory Standards Institute","year":"2012","unstructured":"Clinical and Laboratory Standards Institute. 2012. Performance standards for antimicrobial susceptibility testing; 22nd informational supplement. M100-S22. Clinical and Laboratory Standards Institute, Wayne, PA."},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkp098"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1086\/383047"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1093\/molbev\/msr121"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00564-13"},{"key":"e_1_3_2_29_2","volume-title":"Guidelines for testing and treatment of gonorrhea in Ontario","author":"Ontario Agency for Health Protection and Promotion (Public Health Ontario)","year":"2013","unstructured":"Ontario Agency for Health Protection and Promotion (Public Health Ontario). 2013. Guidelines for testing and treatment of gonorrhea in Ontario. Queen's Printer for Ontario, Toronto, Ontario, Canada. http:\/\/www.publichealthontario.ca\/en\/eRepository\/Guidelines_Gonorrhea_Ontario_2013.pdf."},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1086\/321841"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1086\/338571"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkg269"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1177\/0956462412472837"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkt034"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.2217\/fmb.12.117"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkr332"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00326-12"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/47.5.651"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00036-12"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00860-10"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00245-10"},{"key":"e_1_3_2_42_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.05665-11"}],"container-title":["Antimicrobial Agents and Chemotherapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/AAC.02608-13","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/AAC.02608-13","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,21]],"date-time":"2022-02-21T22:38:14Z","timestamp":1645483094000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.asm.org\/doi\/10.1128\/AAC.02608-13"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,5]]},"references-count":41,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2014,5]]}},"alternative-id":["10.1128\/AAC.02608-13"],"URL":"https:\/\/doi.org\/10.1128\/aac.02608-13","relation":{},"ISSN":["0066-4804","1098-6596"],"issn-type":[{"value":"0066-4804","type":"print"},{"value":"1098-6596","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,5]]},"assertion":[{"value":"2013-11-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2014-02-02","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2014-04-10","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}