Molecular Mechanisms of Antibiotic Resistance Expressed by the Pathogenic Neisseria
Magnus Unemo, Robert A. Nicholas, Ann E. Jerse, Christopher Davies and William M. Shafer
from: Pathogenic Neisseria: Genomics, Molecular Biology and Disease Intervention (Edited by: John K. Davies and Charlene M. Kahler). Caister Academic Press, U.K. (2014)
Diseases caused by the pathogenic Neisseria (N. gonorrhoeae and N. meningitidis) have been successfully treated by antibiotics for the past 70-80 years. However, particularly for treatment of gonorrhea, the high prevalence of gonococcal strains with resistance to inexpensive and widely available antibiotics (e.g., penicillins, narrow-spectrum cephalosporins, tetracyclines, macrolides and fluoroquinolones) and the recent emergence of strains exhibiting resistance to the last remaining options for empiric first-line antibiotic monotherapy, i.e. the expanded-spectrum cephalosporins, is of great concern. For meningococci, decreased susceptibility/resistance to most antibiotics used for chemoprophylaxis or treatment of invasive meningococcal disease is considerably rarer worldwide. Given the global nature of gonococcal and meningococcal diseases, the high rate of usage of antibiotics, suboptimal control and monitoring of antibiotic resistance, geographical differences in treatment regimens and the extraordinary capacity of the pathogenic Neisseria (particularly gonococci) to develop and retain antibiotic resistance, it is likely that the global problem of antibiotic resistance will worsen in the foreseeable future. By understanding the molecular and phenotypic mechanisms of antibiotic resistance in gonococci and meningococci, resistance to antibiotics used clinically can be anticipated, future methods for genetic resistance testing might permit region-specific antibiotic therapy, and the design of novel antimicrobials to circumvent the resistance problems can be undertaken more rationally. Herein, we review the genetic, phenotypic and physiologic basis by which the pathogenic Neisseria have developed resistance to historically important antibiotics and how resistance to newer, and the last remaining, antibiotics is emerging read more ...