Emergence of a Neisseria gonorrhoeae clone showing decreased susceptibility to cefixime in England and Wales
Objectives The third-generation cephalosporins recommended in national guidelines are amongst the last remaining effective agents for treatment of gonorrhoea. This study characterizes gonococcal isolates with decreased cefixime susceptibility from England and Wales. Methods A total of 96 isolates of...
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| Veröffentlicht in: | Journal of antimicrobial chemotherapy 2011-11, Vol.66 (11), p.2509-2512 |
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| creator | Chisholm, Stephanie A. Alexander, Sarah Desouza-Thomas, Leah Maclure-Webster, Elisabeth Anderson, John Nichols, Tom Lowndes, Catherine M. Ison, Catherine A. |
| description | Objectives
The third-generation cephalosporins recommended in national guidelines are amongst the last remaining effective agents for treatment of gonorrhoea. This study characterizes gonococcal isolates with decreased cefixime susceptibility from England and Wales.
Methods
A total of 96 isolates of Neisseria gonorrhoeae exhibiting cefixime MICs of ≥0.125 mg/L, either collected as part of the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) between 2005 and 2008 (54 from a total of 4649 isolates) or referred to the national reference laboratory in 2008 and 2009 (42 isolates), were tested for susceptibility to a range of antimicrobial agents and were typed using N. gonorrhoeae multiantigen sequence typing (NG-MAST).
Results
All 96 isolates were also resistant to tetracycline (MIC ≥2 mg/L) and ciprofloxacin (MIC ≥16 mg/L) and 56% showed low-level chromosomal resistance to penicillin. Where data were available, the mean patient age was 31 years, and 88% (83/94) of patients were men. Isolates referred through GRASP were predominantly from men who have sex with men (MSM; 29/44, 66%) and from patients of white British ethnicity (25/43, 58%). The majority of isolates belonged either to sequence type (ST) 1407 (71/96, 74%) or to a highly related ST that shares the tpbB allele (allele 110), but with a different por allele (20/96, 21%). ST1407 was found in both MSM (22/29, 76%) and heterosexual patients (12/15, 80%) and among all eight isolates from patients reporting sex abroad.
Conclusions
The emergence of a clonal group of gonococci showing decreased susceptibility to cefixime in England and Wales highlights the need for continued surveillance. |
| doi_str_mv | 10.1093/jac/dkr332 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_920795952</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/jac/dkr332</oup_id><sourcerecordid>904224645</sourcerecordid><originalsourceid>FETCH-LOGICAL-c441t-faa045d5b7f0cdadb569802dc484a51d5b579305f44aff6b33345f91ed10cdb23</originalsourceid><addsrcrecordid>eNqN0c9rFDEUB_AgFbtdvfgHSBCKIEyb3zNzLGWtQrEXxeOQSV62WWeSNZmh7X9vll1d8CA9hBzy4eW990XoLSUXlLT8cqPNpf2ZOGcv0IIKRSpGWnqCFoQTWdVC8lN0lvOGEKKkal6hU0YboVTNFmhYjZDWEAzg6LDGX8HnDMlrvI4hpnQfQQM2QwyA83188GGNLZgEOoPFec4GtpPv_eCnJzxFbMD5Rz8C9gGvwnrQweLd-aEHyK_RS6eHDG8O9xJ9_7T6dv25ur27-XJ9dVsZIehUOa2JkFb2tSPGattL1TaEWSMaoSUtD7Juy2hOCO2c6jnnQrqWgqXF94wv0Yd93W2Kv2bIUzf60uhQuoE4565lpG5lK58hiWBMqLLCJXr_j9zEOYUyRkGENHUtVUEf98ikmHMC122TH3V66ijpdll1Jatun1XB7w4V534E-5f-CaeA8wPQ2ejBJR2Mz0cnFGtqxY8uztv_ffgbfMap8g</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>900087756</pqid></control><display><type>article</type><title>Emergence of a Neisseria gonorrhoeae clone showing decreased susceptibility to cefixime in England and Wales</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Oxford University Press Journals All Titles (1996-Current)</source><source>Alma/SFX Local Collection</source><source>Free Full-Text Journals in Chemistry</source><creator>Chisholm, Stephanie A. ; Alexander, Sarah ; Desouza-Thomas, Leah ; Maclure-Webster, Elisabeth ; Anderson, John ; Nichols, Tom ; Lowndes, Catherine M. ; Ison, Catherine A.</creator><creatorcontrib>Chisholm, Stephanie A. ; Alexander, Sarah ; Desouza-Thomas, Leah ; Maclure-Webster, Elisabeth ; Anderson, John ; Nichols, Tom ; Lowndes, Catherine M. ; Ison, Catherine A. ; GRASP Collaborative Group ; on behalf of the GRASP Collaborative Group</creatorcontrib><description>Objectives
The third-generation cephalosporins recommended in national guidelines are amongst the last remaining effective agents for treatment of gonorrhoea. This study characterizes gonococcal isolates with decreased cefixime susceptibility from England and Wales.
Methods
A total of 96 isolates of Neisseria gonorrhoeae exhibiting cefixime MICs of ≥0.125 mg/L, either collected as part of the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) between 2005 and 2008 (54 from a total of 4649 isolates) or referred to the national reference laboratory in 2008 and 2009 (42 isolates), were tested for susceptibility to a range of antimicrobial agents and were typed using N. gonorrhoeae multiantigen sequence typing (NG-MAST).
Results
All 96 isolates were also resistant to tetracycline (MIC ≥2 mg/L) and ciprofloxacin (MIC ≥16 mg/L) and 56% showed low-level chromosomal resistance to penicillin. Where data were available, the mean patient age was 31 years, and 88% (83/94) of patients were men. Isolates referred through GRASP were predominantly from men who have sex with men (MSM; 29/44, 66%) and from patients of white British ethnicity (25/43, 58%). The majority of isolates belonged either to sequence type (ST) 1407 (71/96, 74%) or to a highly related ST that shares the tpbB allele (allele 110), but with a different por allele (20/96, 21%). ST1407 was found in both MSM (22/29, 76%) and heterosexual patients (12/15, 80%) and among all eight isolates from patients reporting sex abroad.
Conclusions
The emergence of a clonal group of gonococci showing decreased susceptibility to cefixime in England and Wales highlights the need for continued surveillance.</description><identifier>ISSN: 0305-7453</identifier><identifier>EISSN: 1460-2091</identifier><identifier>DOI: 10.1093/jac/dkr332</identifier><identifier>PMID: 21846672</identifier><identifier>CODEN: JACHDX</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Adolescent ; Adult ; Aged ; Anti-Bacterial Agents - pharmacology ; Anti-Bacterial Agents - therapeutic use ; Antibiotics. Antiinfectious agents. Antiparasitic agents ; Antimicrobial agents ; Bacterial diseases ; Bacterial diseases of the genital system ; Biological and medical sciences ; Cefixime - pharmacology ; Ciprofloxacin - pharmacology ; Drug resistance ; Drug Resistance, Multiple, Bacterial - genetics ; Drug therapy ; England - epidemiology ; Epidemiology. Vaccinations ; Female ; General aspects ; Gonorrhea - drug therapy ; Gonorrhea - epidemiology ; Gonorrhea - microbiology ; Gram-negative bacteria ; Human bacterial diseases ; Humans ; Infectious diseases ; Male ; Medical sciences ; Microbial Sensitivity Tests ; Middle Aged ; Molecular Epidemiology ; Molecular Typing ; Neisseria gonorrhoeae ; Neisseria gonorrhoeae - drug effects ; Neisseria gonorrhoeae - genetics ; Neisseria gonorrhoeae - isolation & purification ; Penicillin ; Penicillins - pharmacology ; Pharmacology. Drug treatments ; Sexual Behavior ; Tetracycline - pharmacology ; Wales</subject><ispartof>Journal of antimicrobial chemotherapy, 2011-11, Vol.66 (11), p.2509-2512</ispartof><rights>The Author 2011. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com 2011</rights><rights>2015 INIST-CNRS</rights><rights>Copyright Oxford Publishing Limited(England) Nov 2011</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c441t-faa045d5b7f0cdadb569802dc484a51d5b579305f44aff6b33345f91ed10cdb23</citedby><cites>FETCH-LOGICAL-c441t-faa045d5b7f0cdadb569802dc484a51d5b579305f44aff6b33345f91ed10cdb23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,782,786,1586,27933,27934</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24628763$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21846672$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chisholm, Stephanie A.</creatorcontrib><creatorcontrib>Alexander, Sarah</creatorcontrib><creatorcontrib>Desouza-Thomas, Leah</creatorcontrib><creatorcontrib>Maclure-Webster, Elisabeth</creatorcontrib><creatorcontrib>Anderson, John</creatorcontrib><creatorcontrib>Nichols, Tom</creatorcontrib><creatorcontrib>Lowndes, Catherine M.</creatorcontrib><creatorcontrib>Ison, Catherine A.</creatorcontrib><creatorcontrib>GRASP Collaborative Group</creatorcontrib><creatorcontrib>on behalf of the GRASP Collaborative Group</creatorcontrib><title>Emergence of a Neisseria gonorrhoeae clone showing decreased susceptibility to cefixime in England and Wales</title><title>Journal of antimicrobial chemotherapy</title><addtitle>J Antimicrob Chemother</addtitle><description>Objectives
The third-generation cephalosporins recommended in national guidelines are amongst the last remaining effective agents for treatment of gonorrhoea. This study characterizes gonococcal isolates with decreased cefixime susceptibility from England and Wales.
Methods
A total of 96 isolates of Neisseria gonorrhoeae exhibiting cefixime MICs of ≥0.125 mg/L, either collected as part of the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) between 2005 and 2008 (54 from a total of 4649 isolates) or referred to the national reference laboratory in 2008 and 2009 (42 isolates), were tested for susceptibility to a range of antimicrobial agents and were typed using N. gonorrhoeae multiantigen sequence typing (NG-MAST).
Results
All 96 isolates were also resistant to tetracycline (MIC ≥2 mg/L) and ciprofloxacin (MIC ≥16 mg/L) and 56% showed low-level chromosomal resistance to penicillin. Where data were available, the mean patient age was 31 years, and 88% (83/94) of patients were men. Isolates referred through GRASP were predominantly from men who have sex with men (MSM; 29/44, 66%) and from patients of white British ethnicity (25/43, 58%). The majority of isolates belonged either to sequence type (ST) 1407 (71/96, 74%) or to a highly related ST that shares the tpbB allele (allele 110), but with a different por allele (20/96, 21%). ST1407 was found in both MSM (22/29, 76%) and heterosexual patients (12/15, 80%) and among all eight isolates from patients reporting sex abroad.
Conclusions
The emergence of a clonal group of gonococci showing decreased susceptibility to cefixime in England and Wales highlights the need for continued surveillance.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Anti-Bacterial Agents - pharmacology</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antibiotics. Antiinfectious agents. Antiparasitic agents</subject><subject>Antimicrobial agents</subject><subject>Bacterial diseases</subject><subject>Bacterial diseases of the genital system</subject><subject>Biological and medical sciences</subject><subject>Cefixime - pharmacology</subject><subject>Ciprofloxacin - pharmacology</subject><subject>Drug resistance</subject><subject>Drug Resistance, Multiple, Bacterial - genetics</subject><subject>Drug therapy</subject><subject>England - epidemiology</subject><subject>Epidemiology. Vaccinations</subject><subject>Female</subject><subject>General aspects</subject><subject>Gonorrhea - drug therapy</subject><subject>Gonorrhea - epidemiology</subject><subject>Gonorrhea - microbiology</subject><subject>Gram-negative bacteria</subject><subject>Human bacterial diseases</subject><subject>Humans</subject><subject>Infectious diseases</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Microbial Sensitivity Tests</subject><subject>Middle Aged</subject><subject>Molecular Epidemiology</subject><subject>Molecular Typing</subject><subject>Neisseria gonorrhoeae</subject><subject>Neisseria gonorrhoeae - drug effects</subject><subject>Neisseria gonorrhoeae - genetics</subject><subject>Neisseria gonorrhoeae - isolation & purification</subject><subject>Penicillin</subject><subject>Penicillins - pharmacology</subject><subject>Pharmacology. Drug treatments</subject><subject>Sexual Behavior</subject><subject>Tetracycline - pharmacology</subject><subject>Wales</subject><issn>0305-7453</issn><issn>1460-2091</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqN0c9rFDEUB_AgFbtdvfgHSBCKIEyb3zNzLGWtQrEXxeOQSV62WWeSNZmh7X9vll1d8CA9hBzy4eW990XoLSUXlLT8cqPNpf2ZOGcv0IIKRSpGWnqCFoQTWdVC8lN0lvOGEKKkal6hU0YboVTNFmhYjZDWEAzg6LDGX8HnDMlrvI4hpnQfQQM2QwyA83188GGNLZgEOoPFec4GtpPv_eCnJzxFbMD5Rz8C9gGvwnrQweLd-aEHyK_RS6eHDG8O9xJ9_7T6dv25ur27-XJ9dVsZIehUOa2JkFb2tSPGattL1TaEWSMaoSUtD7Juy2hOCO2c6jnnQrqWgqXF94wv0Yd93W2Kv2bIUzf60uhQuoE4565lpG5lK58hiWBMqLLCJXr_j9zEOYUyRkGENHUtVUEf98ikmHMC122TH3V66ijpdll1Jatun1XB7w4V534E-5f-CaeA8wPQ2ejBJR2Mz0cnFGtqxY8uztv_ffgbfMap8g</recordid><startdate>20111101</startdate><enddate>20111101</enddate><creator>Chisholm, Stephanie A.</creator><creator>Alexander, Sarah</creator><creator>Desouza-Thomas, Leah</creator><creator>Maclure-Webster, Elisabeth</creator><creator>Anderson, John</creator><creator>Nichols, Tom</creator><creator>Lowndes, Catherine M.</creator><creator>Ison, Catherine A.</creator><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7QO</scope><scope>7T7</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>20111101</creationdate><title>Emergence of a Neisseria gonorrhoeae clone showing decreased susceptibility to cefixime in England and Wales</title><author>Chisholm, Stephanie A. ; Alexander, Sarah ; Desouza-Thomas, Leah ; Maclure-Webster, Elisabeth ; Anderson, John ; Nichols, Tom ; Lowndes, Catherine M. ; Ison, Catherine A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c441t-faa045d5b7f0cdadb569802dc484a51d5b579305f44aff6b33345f91ed10cdb23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Anti-Bacterial Agents - pharmacology</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Antibiotics. Antiinfectious agents. Antiparasitic agents</topic><topic>Antimicrobial agents</topic><topic>Bacterial diseases</topic><topic>Bacterial diseases of the genital system</topic><topic>Biological and medical sciences</topic><topic>Cefixime - pharmacology</topic><topic>Ciprofloxacin - pharmacology</topic><topic>Drug resistance</topic><topic>Drug Resistance, Multiple, Bacterial - genetics</topic><topic>Drug therapy</topic><topic>England - epidemiology</topic><topic>Epidemiology. Vaccinations</topic><topic>Female</topic><topic>General aspects</topic><topic>Gonorrhea - drug therapy</topic><topic>Gonorrhea - epidemiology</topic><topic>Gonorrhea - microbiology</topic><topic>Gram-negative bacteria</topic><topic>Human bacterial diseases</topic><topic>Humans</topic><topic>Infectious diseases</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Microbial Sensitivity Tests</topic><topic>Middle Aged</topic><topic>Molecular Epidemiology</topic><topic>Molecular Typing</topic><topic>Neisseria gonorrhoeae</topic><topic>Neisseria gonorrhoeae - drug effects</topic><topic>Neisseria gonorrhoeae - genetics</topic><topic>Neisseria gonorrhoeae - isolation & purification</topic><topic>Penicillin</topic><topic>Penicillins - pharmacology</topic><topic>Pharmacology. Drug treatments</topic><topic>Sexual Behavior</topic><topic>Tetracycline - pharmacology</topic><topic>Wales</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chisholm, Stephanie A.</creatorcontrib><creatorcontrib>Alexander, Sarah</creatorcontrib><creatorcontrib>Desouza-Thomas, Leah</creatorcontrib><creatorcontrib>Maclure-Webster, Elisabeth</creatorcontrib><creatorcontrib>Anderson, John</creatorcontrib><creatorcontrib>Nichols, Tom</creatorcontrib><creatorcontrib>Lowndes, Catherine M.</creatorcontrib><creatorcontrib>Ison, Catherine A.</creatorcontrib><creatorcontrib>GRASP Collaborative Group</creatorcontrib><creatorcontrib>on behalf of the GRASP Collaborative Group</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of antimicrobial chemotherapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chisholm, Stephanie A.</au><au>Alexander, Sarah</au><au>Desouza-Thomas, Leah</au><au>Maclure-Webster, Elisabeth</au><au>Anderson, John</au><au>Nichols, Tom</au><au>Lowndes, Catherine M.</au><au>Ison, Catherine A.</au><aucorp>GRASP Collaborative Group</aucorp><aucorp>on behalf of the GRASP Collaborative Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Emergence of a Neisseria gonorrhoeae clone showing decreased susceptibility to cefixime in England and Wales</atitle><jtitle>Journal of antimicrobial chemotherapy</jtitle><addtitle>J Antimicrob Chemother</addtitle><date>2011-11-01</date><risdate>2011</risdate><volume>66</volume><issue>11</issue><spage>2509</spage><epage>2512</epage><pages>2509-2512</pages><issn>0305-7453</issn><eissn>1460-2091</eissn><coden>JACHDX</coden><abstract>Objectives
The third-generation cephalosporins recommended in national guidelines are amongst the last remaining effective agents for treatment of gonorrhoea. This study characterizes gonococcal isolates with decreased cefixime susceptibility from England and Wales.
Methods
A total of 96 isolates of Neisseria gonorrhoeae exhibiting cefixime MICs of ≥0.125 mg/L, either collected as part of the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) between 2005 and 2008 (54 from a total of 4649 isolates) or referred to the national reference laboratory in 2008 and 2009 (42 isolates), were tested for susceptibility to a range of antimicrobial agents and were typed using N. gonorrhoeae multiantigen sequence typing (NG-MAST).
Results
All 96 isolates were also resistant to tetracycline (MIC ≥2 mg/L) and ciprofloxacin (MIC ≥16 mg/L) and 56% showed low-level chromosomal resistance to penicillin. Where data were available, the mean patient age was 31 years, and 88% (83/94) of patients were men. Isolates referred through GRASP were predominantly from men who have sex with men (MSM; 29/44, 66%) and from patients of white British ethnicity (25/43, 58%). The majority of isolates belonged either to sequence type (ST) 1407 (71/96, 74%) or to a highly related ST that shares the tpbB allele (allele 110), but with a different por allele (20/96, 21%). ST1407 was found in both MSM (22/29, 76%) and heterosexual patients (12/15, 80%) and among all eight isolates from patients reporting sex abroad.
Conclusions
The emergence of a clonal group of gonococci showing decreased susceptibility to cefixime in England and Wales highlights the need for continued surveillance.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>21846672</pmid><doi>10.1093/jac/dkr332</doi><tpages>4</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of antimicrobial chemotherapy, 2011-11, Vol.66 (11), p.2509-2512 |
| issn | 0305-7453 1460-2091 |
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| subjects | Adolescent Adult Aged Anti-Bacterial Agents - pharmacology Anti-Bacterial Agents - therapeutic use Antibiotics. Antiinfectious agents. Antiparasitic agents Antimicrobial agents Bacterial diseases Bacterial diseases of the genital system Biological and medical sciences Cefixime - pharmacology Ciprofloxacin - pharmacology Drug resistance Drug Resistance, Multiple, Bacterial - genetics Drug therapy England - epidemiology Epidemiology. Vaccinations Female General aspects Gonorrhea - drug therapy Gonorrhea - epidemiology Gonorrhea - microbiology Gram-negative bacteria Human bacterial diseases Humans Infectious diseases Male Medical sciences Microbial Sensitivity Tests Middle Aged Molecular Epidemiology Molecular Typing Neisseria gonorrhoeae Neisseria gonorrhoeae - drug effects Neisseria gonorrhoeae - genetics Neisseria gonorrhoeae - isolation & purification Penicillin Penicillins - pharmacology Pharmacology. Drug treatments Sexual Behavior Tetracycline - pharmacology Wales |
| title | Emergence of a Neisseria gonorrhoeae clone showing decreased susceptibility to cefixime in England and Wales |
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