Emergence and Characterization of a Ceftriaxone-Resistant Neisseria gonorrhoeae FC428 Clone Evolving Moderate-Level Resistance to Azithromycin in Shenzhen, China

Lulu Zhang,1,2,* Chi Zhang,1,2,* Yaling Zeng,3,* Yamei Li,1,2 Shuhong Huang,3 Feng Wang,3 Junping Peng1,2 1NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China; 2Key Laboratory of Respiratory Disease Pathogenomics, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China; 3Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, People’s Republic of China*These authors contributed equally to this workCorrespondence: Feng WangShenzhen Center for Chronic Disease Control, No. 2021, Buxin Road, Luohu District, Shenzhen, Guangdong, People’s Republic of ChinaTel/Fax +86-10-25504463Email biowangfeng@163.comJunping PengNHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College; Key Laboratory of Respiratory Disease Pathogenomics, Chinese Academy of Medical Sciences, No. 6, Rongjing Eastern Street, BDA, Beijing, People’s Republic of ChinaTel/Fax +86-10-67878493Email pengjp@hotmail.comAbstract: We here described a ceftriaxone-resistant Neisseria gonorrhoeae FC428 clone (YL201) with moderate-level resistance to azithromycin in Shenzhen, South China in 2020. The NG-STAR type of YL201 is ST2238, containing a mosaic penA-60.001 allele, which is a typical characteristic of FC428 clone. YL201 harbours four copies of the 23S rRNA C2611T mutation, conferring moderate-level resistance to azithromycin. The MLST type is ST1600, identical with two N. gonorrhoeae FC428 clones identified in Hangzhou. Genome-wide phylogeny analysis demonstrates that YL201 is clustered with other FC428 clones from Hangzhou (South-east China) and Chengdu (South-west China). Isolates within this cluster have relatively higher MIC for ceftriaxone and display closely related MLST STs (ST1600 and ST7363) but are different from the ST of typical FC428 clone (ST1903). As ST1600 and ST7363 are common STs in Shenzhen, the further spread of FC428 clones may increase the severity of gonococcal resistance. In summary, identifying a multidrug-resistant (MDR) N. gonorrhoeae isolate in Shenzhen showed FC428 clones have undergone further transmission in China and presented more extensive and concerning antimicrobial resistance (AMR) characteristics during the spread.Keywords: Neisseria gonorrhoeae, ceftriaxone, azithromycin, phylogeny, antimicrobial resistanc