Molecular characterization of ciprofloxacin resistance of gonococcal strains in Spain

Background: Over the past several years, the emergence of gonococcal isolates with intermediate or full resistance to fluoroquinolones has become a significant concern in several countries, including Spain. Goal. The goal was to determine the occurrence of ciprofloxacin resistance among Neisseria gonorrhoeae strains in Spain during 2000 to 2001 and determine the frequency and patterns of mutations at gyrA, gyrB, and parC genes in these isolates. Study Design: Eleven ciprofloxacin-resistant strains (with MICs ranging from 1 to 64 mug/mL) and two intermediate isolates (with MICs of 0.12 and 0.5 mug/mL) were found. Mutations were identified by polymerase chain reaction and direct sequencing of the amplified products. Results and Conclusions: Alterations at Ser-91 and Asp-95 in GyrA were detected in all strains except one, an isolate for which the MIC was 0.12 mug/mL. Alterations in ParC were more variable, and there was no clear correlation between the number of parC mutations and the level of resistance. No alterations at gyrB gene associated with ciprofloxacin resistance were found. The resistance was distributed among different types of strains, suggesting that the increase in the incidence of ciprofloxacin-resistant strains in Spain was not exclusively due to the appearance of a single-strain outbreak.