桃園地區之淋病菌株藥物敏感性分析與馬賽克基因結構盛行率調查

The clinical antimicrobial susceptibility studies in Neisseria gonorrhea and the prevalence of those harboring mosaic-like structures in Taoyuan

淋病菌株帶有青黴素結合蛋白（Penicillin binding protein A, PBP penA）基因馬賽克結構與藥物敏感性降低有關。本研究分析2008至2022年間桃園某醫院泌尿科收集的927株淋病菌株之藥物敏感性試驗結果，並挑選其中37株菌株以聚合酶連鎖反應（Polymerase chain reaction, PCR）方式進行PBP penA基因馬賽克結構調查。藥物敏感性結果顯示，菌株對頭孢曲松（Ceftriaxone）敏感率為99.7%，但對環丙沙星（Ciprofloxacin）、青黴素（Penicillin）與四環黴素（Tetracycline）的敏感性分別僅為0.7%、0.0%、0.0%。在37株分析菌株中，有26株（26/37, 70.3%）具馬賽克基因結構，且具多重抗藥性，僅對Ceftriaxone具敏感性。PBP penA型別中以XXXIV型（23/37, 62.2%）最為常見，其次為XIII型（5/37, 13.5%）、XVIII型（3/37, 8.1%）、XIX（2/37, 5.4%）、X（2/37, 5.4%）、V（1/37, 2.7%），有一株顯示為X型和XXXIV基因的重組株（1/37, 2.7%）。總而言之，我們提供了桃園地區淋病菌株之抗藥性與分子流行病學調查，以期在淋病防範與治療能有更多的資訊。

Spread of Neisseria gonorrhoeae strains with mosaic penA alleles is associated with decreased antimicrobial susceptibility. This study analyzed the antimicrobial susceptibility of 927 Neisseria gonorrhoeae isolates collected from the urology department of a regional hospital in Taoyuan, Taiwan, between 2008 and 2022.
Among these samples, 37 isolates were selected for PBP penA mosaic structure investigation by polymerase chain reaction. The results of susceptibility testing revealed that 99.7% of the isolates remained sensitive to ceftriaxone, whereas these isolates were resistant to ciprofloxacin, penicillin, and tetracycline (sensitivity: 0.7%, 0.0%, and 0.0%, respectively). A high prevalence (26/37, 70.3%) of isolates carried mosaic penA structures, which exhibited multidrug resistance but retaining susceptibility to ceftriaxone. The most prevalent penA genotype was XXXIV (23/37, 62.2%), followed by XIII (5/37, 13.5%), XVIII (3/37, 8.1%), XIX (2/37, 5.4%), X (2/37, 5.4%), and V (1/37, 2.7%). One isolate (1/37, 2.7%) was identified as a recombinant strain between types X and XXXIV. In conclusion, our results might not be representative of trends in N. gonorrhoeae resistance in other regions or healthcare systems. The present study offers the molecular epidemiological analysis on the spread of Neisseria gonorrhoeae in Taoyuan.