AUTHOR=Agbodzi Bright , Duodu Samuel , Dela Helena , Kumordjie Selassie , Yeboah Clara , Behene Eric , Ocansey Karen , Yanney Jennifer N. , Boateng-Sarfo George , Kwofie Samuel Kojo , Egyir Beverly , Colston Sophie M. , Miranda Hugo V. , Watters Chaselynn , Sanders Terrel , Fox Anne T. , Letizia Andrew G. , Wiley Michael R. , Attram Naiki 

TITLE=Whole genome analysis and antimicrobial resistance of Neisseria gonorrhoeae isolates from Ghana

JOURNAL=Frontiers in Microbiology

VOLUME=14

YEAR=2023

URL=https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2023.1163450

DOI=10.3389/fmicb.2023.1163450

ISSN=1664-302X

ABSTRACT=<sec><title>Introduction</title><p>Gonorrhoea is a major public health concern. With the global emergence and spread of resistance to last-line antibiotic treatment options, gonorrhoea threatens to be untreatable in the future. Therefore, this study performed whole genome characterization of <italic>Neisseria gonorrhoeae</italic> collected in Ghana to identify lineages of circulating strains as well as their phenotypic and genotypic antimicrobial resistance (AMR) profiles.</p></sec><sec><title>Methods</title><p>Whole genome sequencing (WGS) was performed on 56 isolates using both the Oxford Nanopore MinION and Illumina MiSeq sequencing platforms. The Comprehensive Antimicrobial Resistance Database (CARD) and <ext-link xlink:href="http://PUBMLST.org/neisseria" ext-link-type="uri" xmlns:xlink="http://www.w3.org/1999/xlink">PUBMLST.org/neisseria</ext-link> databases were used to catalogue chromosomal and plasmid genes implicated in AMR. The core genome multi-locus sequence typing (cgMLST) approach was used for comparative genomics analysis.</p></sec><sec><title>Results and Discussion</title><p><italic>In vitro</italic> resistance measured by the E-test method revealed 100%, 91.0% and 85.7% resistance to tetracycline, penicillin and ciprofloxacin, respectively. A total of 22 sequence types (STs) were identified by multilocus sequence typing (MLST), with ST-14422 (<italic>n</italic> = 10), ST-1927 (<italic>n</italic> = 8) and ST-11210 (<italic>n</italic> = 7) being the most prevalent. Six novel STs were also identified (ST-15634, 15636-15639 and 15641). All isolates harboured chromosomal AMR determinants that confer resistance to beta-lactam antimicrobials and tetracycline. A single cefixime-resistant strain, that belongs to <italic>N. gonorrhoeae</italic> multiantigen sequence type (NG-MAST) ST1407, a type associated with widespread cephalosporin resistance was identified. <italic>Neisseria gonorrhoeae</italic> Sequence Typing for Antimicrobial Resistance (NG-STAR), identified 29 unique sequence types, with ST-464 (<italic>n</italic> = 8) and the novel ST-3366 (<italic>n</italic> = 8) being the most prevalent. Notably, 20 of the 29 STs were novel, indicative of the unique nature of molecular AMR determinants in the Ghanaian strains. Plasmids were highly prevalent: pTetM and p<italic>bla</italic>TEM were found in 96% and 92% of isolates, respectively. The TEM-135 allele, which is an amino acid change away from producing a stable extended-spectrum β-lactamase that could result in complete cephalosporin resistance, was identified in 28.5% of the isolates. Using WGS, we characterized <italic>N. gonorrhoeae</italic> strains from Ghana, giving a snapshot of the current state of gonococcal AMR in the country and highlighting the need for constant genomic surveillance.</p></sec>