{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T03:57:05Z","timestamp":1771991825295,"version":"3.50.1"},"reference-count":48,"publisher":"American Society for Microbiology","issue":"11","license":[{"start":{"date-parts":[[2023,11,21]],"date-time":"2023-11-21T00:00:00Z","timestamp":1700524800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/doi.org\/10.1128\/ASMCopyrightv2"},{"start":{"date-parts":[[2023,11,21]],"date-time":"2023-11-21T00:00:00Z","timestamp":1700524800000},"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":["J Clin Microbiol"],"published-print":{"date-parts":[[2023,11,21]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:p>\n            Agar dilution is the gold standard method for phenotypic antimicrobial susceptibility testing (AST) for\n            <jats:italic>Neisseria gonorrhoeae<\/jats:italic>\n            . However, this method is laborious and requires expertise, so laboratories that perform\n            <jats:italic>N. gonorrhoeae<\/jats:italic>\n            AST may choose alternative methods such as disk diffusion and gradient diffusion. In this study, we retrospectively compare the performance of gradient diffusion to agar dilution for 2,394 unique\n            <jats:italic>N. gonorrhoeae<\/jats:italic>\n            isolates identified in Alberta from 2017 to 2020 against azithromycin, cefixime, ceftriaxone, ciprofloxacin, penicillin, and tetracycline. Genome sequencing was utilized to resolve discrepancies between AST methods, detect antimicrobial resistance markers, and identify trends between error rates and sequence types (STs) of isolates. Over 90% of\n            <jats:italic>N. gonorrhoeae<\/jats:italic>\n            isolates were susceptible to azithromycin, cefixime, and ceftriaxone, whereas decreased susceptibility was observed for ciprofloxacin, penicillin, and tetracycline. Categorical (CA) and essential agreement (EA) was poorest between the two methods for penicillin (CA: 86.02%; EA: 77.69%) and tetracycline (CA: 47.22%; EA: 55.96%); however, the low CA was primarily attributed to minor errors. Antimicrobial agents with errors outside of acceptable limits included azithromycin (very major error: 18.42%; major error: 7.73%) and tetracycline (very major error: 6.17%). Genome sequencing on a subset of isolates resolved 30.3% of the azithromycin major errors and confirmed the azithromycin or tetracycline very major errors. Significant associations between certain STs and error types for azithromycin and tetracycline were also identified. Overall, gradient diffusion compared well to agar dilution for cefixime, ceftriaxone, and ciprofloxacin, and genome sequencing was identified as a useful tool to arbitrate discrepant susceptibility testing results between gradient diffusion and agar dilution for\n            <jats:italic>N. gonorrhoeae<\/jats:italic>\n            .\n          <\/jats:p>","DOI":"10.1128\/jcm.00606-23","type":"journal-article","created":{"date-parts":[[2023,10,26]],"date-time":"2023-10-26T13:00:28Z","timestamp":1698325228000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":5,"title":["Use of genome sequencing to resolve differences in gradient diffusion and agar dilution antimicrobial susceptibility testing performance of\n            <i>Neisseria gonorrhoeae<\/i>\n            isolates in Alberta, Canada"],"prefix":"10.1128","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6166-9934","authenticated-orcid":false,"given":"Angela","family":"Ma","sequence":"first","affiliation":[{"name":"Division of Diagnostic and Applied Microbiology, Department of Laboratory Medicine and Pathology, University of Alberta , Edmonton, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina","family":"Ferrato","sequence":"additional","affiliation":[{"name":"Alberta Precision Laboratories\u2014Provincial Laboratory for Public Health , Edmonton, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3941-5583","authenticated-orcid":false,"given":"Irene","family":"Martin","sequence":"additional","affiliation":[{"name":"National Microbiology Laboratory, Public Health Agency of Canada , Winnipeg, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Petra","family":"Smyczek","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Alberta , Edmonton, Canada"},{"name":"Alberta Health Services, STI Services , Edmonton, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Gratrix","sequence":"additional","affiliation":[{"name":"Alberta Health Services, STI Services , Edmonton, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6936-406X","authenticated-orcid":false,"given":"Tanis C.","family":"Dingle","sequence":"additional","affiliation":[{"name":"Alberta Precision Laboratories\u2014Provincial Laboratory for Public Health , Edmonton, Canada"},{"name":"Department of Pathology and Laboratory Medicine, University of Calgary , Calgary, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"235","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-021-06381-4"},{"key":"e_1_3_3_4_2","unstructured":"Reported cases from 1991 to 2020 in Canada - notifiable diseases on-line. Available from: https:\/\/diseases.canada.ca\/notifiable\/charts?c=yl. Retrieved 17 Apr 2023."},{"key":"e_1_3_3_5_2","unstructured":"Interactive Health Data Application. Available from: http:\/\/www.ahw.gov.ab.ca\/IHDA_Retrieval. Retrieved. 17 April 2023"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2010.01.007"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00010-14"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00430-020-00669-z"},{"key":"e_1_3_3_11_2","unstructured":"Gonorrhea guide: treatment and follow-up - Canada.Ca. Available from: https:\/\/www.canada.ca\/en\/public-health\/services\/infectious-diseases\/sexual-health-sexually-transmitted-infections\/canadian-guidelines\/gonorrhea\/treatment-follow-up.html. 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