{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T02:16:22Z","timestamp":1784081782085,"version":"3.55.0"},"reference-count":49,"publisher":"American Society for Microbiology","issue":"5","license":[{"start":{"date-parts":[[2016,5,1]],"date-time":"2016-05-01T00:00:00Z","timestamp":1462060800000},"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":[[2016,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:p>\n            The emergence of\n            <jats:named-content content-type=\"genus-species\">Neisseria gonorrhoeae<\/jats:named-content>\n            strains with decreased susceptibility to cephalosporins and azithromycin (AZM) resistance (AZM\n            <jats:sup>r<\/jats:sup>\n            ) represents a public health threat of untreatable gonorrhea infections. Genomic epidemiology through whole-genome sequencing was used to describe the emergence, dissemination, and spread of AZM\n            <jats:sup>r<\/jats:sup>\n            strains. The genomes of 213 AZM\n            <jats:sup>r<\/jats:sup>\n            and 23 AZM-susceptible\n            <jats:named-content content-type=\"genus-species\">N. gonorrhoeae<\/jats:named-content>\n            isolates collected in Canada from 1989 to 2014 were sequenced. Core single nucleotide polymorphism (SNP) phylogenomic analysis resolved 246 isolates into 13 lineages. High-level AZM\n            <jats:sup>r<\/jats:sup>\n            (MICs \u2265 256 \u03bcg\/ml) was found in 5 phylogenetically diverse isolates, all of which possessed the A2059G mutation (\n            <jats:named-content content-type=\"genus-species\">Escherichia coli<\/jats:named-content>\n            numbering) in all four 23S rRNA alleles. One isolate with high-level AZM\n            <jats:sup>r<\/jats:sup>\n            collected in 2009 concurrently had decreased susceptibility to ceftriaxone (MIC = 0.125 \u03bcg\/ml). An increase in the number of 23S rRNA alleles with the C2611T mutations (\n            <jats:named-content content-type=\"genus-species\">E. coli<\/jats:named-content>\n            numbering) conferred low to moderate levels of AZM\n            <jats:sup>r<\/jats:sup>\n            (MICs = 2 to 4 and 8 to 32 \u03bcg\/ml, respectively). Low-level AZM\n            <jats:sup>r<\/jats:sup>\n            was also associated with\n            <jats:italic>mtrR<\/jats:italic>\n            promoter mutations, including the \u221235A deletion and the presence of\n            <jats:named-content content-type=\"genus-species\">Neisseria meningitidis<\/jats:named-content>\n            -like sequences. Geographic and temporal phylogenetic clustering indicates that emergent AZM\n            <jats:sup>r<\/jats:sup>\n            strains arise independently and can then rapidly expand clonally in a region through local sexual networks.\n          <\/jats:p>","DOI":"10.1128\/jcm.03195-15","type":"journal-article","created":{"date-parts":[[2016,3,3]],"date-time":"2016-03-03T04:03:22Z","timestamp":1456977802000},"page":"1304-1313","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":123,"title":["Genomic Epidemiology and Molecular Resistance Mechanisms of Azithromycin-Resistant Neisseria gonorrhoeae in Canada from 1997 to 2014"],"prefix":"10.1128","volume":"54","author":[{"given":"Walter","family":"Demczuk","sequence":"first","affiliation":[{"name":"Bacteriology and Enteric Diseases Program, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Martin","sequence":"additional","affiliation":[{"name":"Bacteriology and Enteric Diseases Program, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shelley","family":"Peterson","sequence":"additional","affiliation":[{"name":"Bacteriology and Enteric Diseases Program, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amrita","family":"Bharat","sequence":"additional","affiliation":[{"name":"Bacteriology and Enteric Diseases Program, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary","family":"Van Domselaar","sequence":"additional","affiliation":[{"name":"Science Technology Cores and Services Division, National Microbiology Laboratory, Public Health Agency of Canada, and Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morag","family":"Graham","sequence":"additional","affiliation":[{"name":"Science Technology Cores and Services Division, National Microbiology Laboratory, Public Health Agency of Canada, and Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brigitte","family":"Lefebvre","sequence":"additional","affiliation":[{"name":"Laboratoire de Sant\u00e9 Publique du Qu\u00e9bec, Ste-Anne-de-Bellevue, Qu\u00e9bec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Allen","sequence":"additional","affiliation":[{"name":"Public Health Ontario Laboratories, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Hoang","sequence":"additional","affiliation":[{"name":"British Columbia Centres for Disease Control Public Health Microbiology &amp; Reference Laboratory, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greg","family":"Tyrrell","sequence":"additional","affiliation":[{"name":"Provincial Laboratory for Public Health, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greg","family":"Horsman","sequence":"additional","affiliation":[{"name":"Saskatchewan Disease Control Laboratory, Regina, Saskatchewan, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Wylie","sequence":"additional","affiliation":[{"name":"Cadham Provincial Laboratory, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Haldane","sequence":"additional","affiliation":[{"name":"Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Archibald","sequence":"additional","affiliation":[{"name":"Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Wong","sequence":"additional","affiliation":[{"name":"First Nations and Inuit Health Branch, Health Canada, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magnus","family":"Unemo","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, \u00d6rebro University, \u00d6rebro, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael R.","family":"Mulvey","sequence":"additional","affiliation":[{"name":"Bacteriology and Enteric Diseases Program, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_3_2_2","volume-title":"Notifiable diseases on-line","author":"Public Health Agency of Canada","year":"2014","unstructured":"Public Health Agency of Canada. 2014. 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