azithromycin (Azimac)

Antimicrobial resistance in Neisseria gonorrhoeae isolates at the Bangrak STIs Center, Bangkok, Thailand and WGS of antimicrobial-resistant isolates, 2018-23.

Paopang Porntip P, Sangprasert Pongsathorn P, Golparian Daniel D, Girdthep Natnaree N et al.

Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a global public health concern, particularly due to increasing resistance to the last remaining monotherapy, ceftriaxone, in several Asian countries. We examined the AMR of gonococcal isolates obtained at the Bangrak STIs Center, Bangkok, Thailand in 2018-23, and used WGS on isolates resistant to ceftriaxone, cefixime and/or azithromycin. Genital and extragenital swabs from males, females and transgender women were cultured. Etest (five antimicrobials) and EUCAST breakpoints (v16.0), or disc diffusion method (ciprofloxacin) were used to determine AMR. WGS was performed using Illumina NextSeq 550. In 2018-23, 765 gonococcal isolates from 739 patients were cultured. Resistance to ceftriaxone, cefixime, azithromycin, tetracycline and ciprofloxacin was 0.5%, 0.8%, 1.7%, 83.7% and 95.7%, respectively. Ceftriaxone-resistant isolates, all resistant also to cefixime, were first detected in 2023 (n = 3, 1.2%). Additional cefixime-resistant isolates were found in 2022 (n = 2, 1.4%). Azithromycin-resistant isolates first emerged in 2020 (n = 1, 0.9%) and increased to nine (3.7%) isolates in 2023. All ceftriaxone-resistant isolates contained penA-60.001, but cefixime resistance was additionally caused by penA-34.019 and penA-10.001. All azithromycin-resistant isolates had 23S rRNA mutations and/or mosaic/semi-mosaic MtrD (subunit of the MtrCDE efflux pump). Resistance to ceftriaxone, cefixime and azithromycin has emerged in gonococcal strains circulating in Bangkok, Thailand, and resistance appears to be increasing. Resistance to these last options for monotherapy or dual therapy emphasize the need for strengthened national culture-based and genomic surveillance to prevent the spread of MDR and XDR strains in Thailand and globally, and implementation of the novel oral treatments, i.e. zoliflodacin and gepotidacin.

Case Report: Intestinal mycobacterium abscessus infection in a child.

Zhang Linlin L, Huang Dixi D, Song Jie J, Zhao Tianming T et al.

The diagnosis and treatment of Mycobacterium abscessus infections present significant challenges, especially in the rare cases of extrapulmonary involvement in pediatric patients. These cases are characterized by diagnostic difficulties, limited therapeutic options, scarce clinical experience, and a lack of evidence-based treatment guidelines. This article reports on a 6-year-old child who experienced fever and abdominal pain. Metagenomic next-generation sequencing (mNGS) facilitated the rapid and accurate identification of Mycobacterium abscessus as the causative pathogen. Under a standardized full-course protocol, an individualized therapy regimen (that includes Imipenem, Azithromycin, and Linezolid) led to favorable clinical outcomes. Through the analysis of this successfully treated case, we aim to derive clinical insights and identify potential limitations, with the goal of exploring effective diagnostic and therapeutic approaches for pediatric patients with non-tuberculous mycobacterial (NTM) infections in the future.

Erratum.

This corrects the article "Rationale and Design of the Roflumilast or Azithromycin to Prevent COPD Exacerbations Clinical Trial" in Volume 13, Issue 1, pp 17-28.

In vitro activity of zoliflodacin against Neisseria gonorrhoeae collected in the United States from 2020 to 2022.

McLeod Sarah M SM, Moussa Samir H SH, Hackel Meredith M, Au Carmen C et al.

Zoliflodacin is a first-in-class spiropyrimidinetrione, oral, single-dose antibacterial recently approved by the US FDA for treatment of uncomplicated urogenital gonorrhea. Isolates of Neisseria gonorrhoeae (n = 322) collected in the United States in 2020-2022 by the Centers for Disease Control and Prevention, as well as two ceftriaxone-resistant isolates, were tested for susceptibility to zoliflodacin. All isolates were susceptible to zoliflodacin with MIC50/90 values of 0.12 µg/mL. Zoliflodacin activity was consistent over time and against ceftriaxone-, ciprofloxacin-, and tetracycline-resistant and azithromycin-non-susceptible isolates.