{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T16:24:10Z","timestamp":1791563050990,"version":"4.3.4"},"reference-count":58,"publisher":"American Society for Microbiology","issue":"3","license":[{"start":{"date-parts":[[2012,3,1]],"date-time":"2012-03-01T00:00:00Z","timestamp":1330560000000},"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":[[2012,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p>Recently, the first<jats:named-content xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" content-type=\"genus-species\" xlink:type=\"simple\">Neisseria gonorrhoeae<\/jats:named-content>strain (H041) highly resistant to the expanded-spectrum cephalosporins (ESCs) ceftriaxone and cefixime, which are the last remaining options for first-line gonorrhea treatment, was isolated in Japan. Here, we confirm and characterize a second strain (F89) with high-level cefixime and ceftriaxone resistance which was isolated in France and most likely caused a treatment failure with cefixime. F89 was examined using six species-confirmatory tests, antibiograms (33 antimicrobials),<jats:italic>porB<\/jats:italic>sequencing,<jats:named-content xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" content-type=\"genus-species\" xlink:type=\"simple\">N. gonorrhoeae<\/jats:named-content>multiantigen sequence typing (NG-MAST), multilocus sequence typing (MLST), and sequencing of known gonococcal resistance determinants (<jats:italic>penA<\/jats:italic>,<jats:italic>mtrR<\/jats:italic>,<jats:italic>penB<\/jats:italic>,<jats:italic>ponA<\/jats:italic>, and<jats:italic>pilQ<\/jats:italic>). F89 was assigned to MLST sequence type 1901 (ST1901) and NG-MAST ST1407, which is a successful gonococcal clone that has spread globally. F89 has high-level resistance to cefixime (MIC = 4 \u03bcg\/ml) and ceftriaxone (MIC = 1 to 2 \u03bcg\/ml) and resistance to most other antimicrobials examined. A novel<jats:italic>penA<\/jats:italic>mosaic allele (<jats:italic>penA-CI<\/jats:italic>), which was<jats:italic>penA-XXXIV<\/jats:italic>with an additional A501P alteration in penicillin-binding protein 2, was the primary determinant for high-level ESC resistance, as determined by transformation into a set of recipient strains.<jats:named-content xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" content-type=\"genus-species\" xlink:type=\"simple\">N. gonorrhoeae<\/jats:named-content>appears to be emerging as a superbug, and in certain circumstances and settings, gonorrhea may become untreatable. Investigations of the biological fitness and enhanced understanding and monitoring of the ESC-resistant clones and their international transmission are required. Enhanced disease control activities, antimicrobial resistance control and surveillance worldwide, and public health response plans for global (and national) perspectives are also crucial. Nevertheless, new treatment strategies and\/or drugs and, ideally, a vaccine are essential to develop for efficacious gonorrhea management.<\/jats:p>","DOI":"10.1128\/aac.05760-11","type":"journal-article","created":{"date-parts":[[2011,12,13]],"date-time":"2011-12-13T05:21:18Z","timestamp":1323753678000},"page":"1273-1280","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":575,"title":["High-Level Cefixime- and Ceftriaxone-Resistant Neisseria gonorrhoeae in France: Novel<i>penA<\/i>Mosaic Allele in a Successful International Clone Causes Treatment Failure"],"prefix":"10.1128","volume":"56","author":[{"given":"Magnus","family":"Unemo","sequence":"first","affiliation":[{"name":"WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, 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, Department of Laboratory Medicine, Microbiology, \u00d6rebro University Hospital, \u00d6rebro, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Nicholas","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, University of North Carolina, Chapel Hill, North Carolina, USA"}],"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":"Anne","family":"Gallay","sequence":"additional","affiliation":[{"name":"Institut de Veille Sanitaire, Saint-Maurice, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrice","family":"Sednaoui","sequence":"additional","affiliation":[{"name":"Institut Alfred Fournier, Centre National de R\u00e9f\u00e9rence des Gonocoques, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00788-10"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.46.12.3744-3749.2002"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1517\/14656560902731993"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198707303170504"},{"key":"e_1_3_2_6_2","first-page":"873","article-title":"Cephalosporin susceptibility among Neisseria gonorrhoeae isolates\u2014United States, 2000-2010","volume":"60","author":"Centers for Disease Control and Prevention","year":"2011","unstructured":"Centers for Disease Control and Prevention. 2011. 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