International journal of antimicrobial agents · 2026
Characterization of a novel mosaic-like mtr operon and inter-regional transmission of dual-resistant Neisseria gonorrhoeae ST7363 sub-lineage in China.
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Zhu Bangyong, Wang Di, Zhang Chi, Yang Yang, Gan Quan, Huang Yinjie, Gu Weiming, Peng Junping
Аннотация
OBJECTIVE: The emergence of Neisseria gonorrhoeae (N. gonorrhoeae, NG) resistant to both ceftriaxone and azithromycin threatens the current treatment strategies. This study aimed to investigate the molecular basis of azithromycin resistance in a dual-resistant N. gonorrhoeae lineage and characterize its novel mosaic-like mtr operon and inter-regional transmission potential in China.
METHODS: Whole-genome sequencing and comparative genomic analyses were performed on the isolate GX21-687 (2021) and genomically similar isolates and publicly available ST7363 genomes. Antimicrobial resistance genotyping, phylogenetic analysis, and homologous recombination analyses were used to investigate resistance determinants and evolutionary relationships.
RESULTS: GX21-687 was assigned to MLST ST7363 and NG-STAR ST4510 and harboured the rare mosaic penA-232.001 allele, associated with resistance to ceftriaxone. Phylogenetic analysis demonstrated that GX21-687 clustered with two previously reported isolates from Sichuan province (CD20-24 and CD20-63, 2020) within the Australian A8806-associated lineage, providing genomic evidence for the silent inter-regional transmission of this ST7363 sub-lineage across southwest China. GX21-687 exhibited low-level azithromycin resistance in the absence of canonical 23S rRNA mutations, which was associated with a novel mosaic-like mtr operon structure derived from pathogenic Neisseria meningitidis, representing an independent evolutionary origin distinct from the commensal Neisseria-derived resistance mechanisms commonly reported in N. gonorrhoeae.
CONCLUSIONS: These findings characterize a novel dual-resistance mechanism within the ST7363 sub-lineage harbouring the penA-232.001 allele and mosaic mtr structure. The identification of genomically clustered isolates in geographically distant provinces may represent silent inter-regional spread, underscoring the importance of whole-genome sequencing-based surveillance to detect silent transmission and control the spread of multidrug-resistant gonococcal clones.
METHODS: Whole-genome sequencing and comparative genomic analyses were performed on the isolate GX21-687 (2021) and genomically similar isolates and publicly available ST7363 genomes. Antimicrobial resistance genotyping, phylogenetic analysis, and homologous recombination analyses were used to investigate resistance determinants and evolutionary relationships.
RESULTS: GX21-687 was assigned to MLST ST7363 and NG-STAR ST4510 and harboured the rare mosaic penA-232.001 allele, associated with resistance to ceftriaxone. Phylogenetic analysis demonstrated that GX21-687 clustered with two previously reported isolates from Sichuan province (CD20-24 and CD20-63, 2020) within the Australian A8806-associated lineage, providing genomic evidence for the silent inter-regional transmission of this ST7363 sub-lineage across southwest China. GX21-687 exhibited low-level azithromycin resistance in the absence of canonical 23S rRNA mutations, which was associated with a novel mosaic-like mtr operon structure derived from pathogenic Neisseria meningitidis, representing an independent evolutionary origin distinct from the commensal Neisseria-derived resistance mechanisms commonly reported in N. gonorrhoeae.
CONCLUSIONS: These findings characterize a novel dual-resistance mechanism within the ST7363 sub-lineage harbouring the penA-232.001 allele and mosaic mtr structure. The identification of genomically clustered isolates in geographically distant provinces may represent silent inter-regional spread, underscoring the importance of whole-genome sequencing-based surveillance to detect silent transmission and control the spread of multidrug-resistant gonococcal clones.