Development of a CRISPR/Cas-Based Detection Platform for Tracking Decreased Susceptibility to Cephalosporins in Neisseria gonorrheae.

Gonorrhea has become an escalating public health issue due to the rapid emergence of antimicrobial resistance (AMR). Developing efficient and accurate detection of resistant strains is urgently needed for their management and treatment. We have developed the Multiplex Integrated RPA-CRISPR/Cas12a detection Assay (MIRCA) for simultaneous detection of Neisseria gonorrheae (Ng) and mutations with decreased susceptibility to cephalosporins. MIRCA enables multiplex detection of Ng and single-nucleotide polymorphisms in resistance-associated genes within 40 min, with high specificity and sensitivity (10-20 copies/reaction). Clinical evaluation showed 100% concordance with qPCR for Ng identification and Sanger sequencing for FC428 strain tracking. For predicting decreased-susceptibility strains with A501 mutations, MIRCA achieved 98.33% agreement with Sanger sequencing. Simulated tests demonstrated 100% consistency between MIRCA results in centrifuge tubes and microfluidic chips. This robust and cost-effective approach addresses current challenges in AMR surveillance. Its integration with microfluidic chip offers an affordable and user-friendly diagnostic solution, making it highly valuable for timely infectious disease diagnosis and resistance monitoring. It also holds significant potential for point-of-care testing in resource-limited areas.