Codon 91 Gyrase A Testing Is Necessary and Sufficient to Predict Ciprofloxacin Susceptibility in Neisseria gonorrhoeae.
Codon 91 Gyrase A Testing Is Necessary and Sufficient to Predict Ciprofloxacin Susceptibility in Neisseria gonorrhoeae.
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密码子 91 旋转酶 A 测试对于预测淋病奈瑟菌对环丙沙星的敏感性是必要且充分的。
DOI：
10.1093/infdis/jiw551
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
Klausner,JeffreyD
中科院分区：
文献类型：
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作者：
Allan-Blitz,Lao-Tzu;Klausner,JeffreyD
致编辑-我们怀着极大的兴趣阅读了格拉德等人的文章[1]。我们同意他们的结论，即gyrA基因型检测淋病奈瑟菌是一种有价值的耐药检测手段;然而，我们认为gyrA检测，特别是密码子91，对于预测环丙沙星的敏感性是必要和充分的。已有11项研究（N= 4777份标本）将实时聚合酶链反应（RT-PCR）基因型结果与传统的抗菌药物敏感性检测方法进行了比较，所有研究均显示出较高的灵敏度和特异性（分别为93.8%-100%和93.2%-100%）。阳性和阴性预测值同样令人印象深刻（分别为94.4%-100%和87.5%-100%）。此外，4项研究发现，通过RT-PCR检测的gyrA基因第91位密码子突变对N.淋病奈瑟菌与其他奈瑟菌属的比较[2-5]。其他突变已被证明有助于环丙沙星耐药性，但以前的研究表明，其他突变通常与gyrA基因突变一起发生[6，7]。美国的淋病感染对环丙沙星敏感[8]。这两个事实支持实施gyrA基因型检测，以促进使用靶向环丙沙星治疗。这反过来可能会减少头孢曲松的过度使用。最近的一篇文章表明，治疗可能是淋病奈瑟菌头孢曲松耐药性的主要驱动因素[9]，淋病奈瑟菌被疾病控制和预防中心称为对公共卫生的三大紧迫威胁之一[10]。
To the Editor—We read with great interest the article by Grad et al [1]. We agree with their conclusion that gyrase A (gyrA) genotype testing of Neisseria gonorrhoeae is a valuable means of resistance testing; however, we believe that gyrA testing, specifically of codon 91, is both necessary and sufficient for predicting susceptibility to ciprofloxacin. There have been 11 studies (N= 4777 specimens) comparing real-time polymerase chain reaction (RT-PCR) genotype results with conventional antimicrobial susceptibility testing methods, all of which have demonstrated high sensitivity and specificity (93.8%–100% and 93.2%–100%, respectively). Positive and negative predictive values were similarly impressive (94.4%–100% and 87.5%–100%, respectively). Furthermore, 4 studies found that mutation at codon 91 of the gyrA gene as determined by RT-PCR was 100% specific for N. gonorrhoeae compared with other Neisseria species [2–5]. Other mutations have been shown to contribute to ciprofloxacin resistance, but previous studies have shown that other mutations in general occur in conjunction with a mutation in the gyrA gene [6, 7].In addition, it is estimated that approximately 80% of N. gonorrhoeae infections in the United States are susceptible to ciprofloxacin [8]. Those 2 facts support the implementation of gyrA genotype testing to promote the use of targeted ciprofloxacin therapy. That may in turn reduce overuse of ceftriaxone. A recent article showed that treatment may be a major driver of ceftriaxone resistance in Neisseria gonorrhoeae [9], which has been called one of the top 3 urgent threats to public health by the Centers for Disease Control and Prevention [10].