Intercity spread of gonococci with decreased susceptibility to fluoroquinolones: a unique focus in the United States.

Patients and gonococcal isolates (n = 783) from five sexually transmitted disease clinics in Ohio and western Pennsylvania were studied to investigate the spread of gonococci with decreased fluoroquinolone susceptibility. Among patients with gonorrhea, rates of infection with strains with decreased fluoroquinolone susceptibility (MIC of 0.125-0.25 microg ciprofloxacin/mL) were 20% for Cleveland, 9% for Akron, 7% for Columbus, 1% for Toledo, and 0.5% for Pittsburgh. Persons infected with strains with decreased susceptibility were more likely than those with susceptible strains to be male and older; no significant differences in sex behaviors, residence of sex partners, or recent antibiotic use were detected. Prevalence of decreased susceptibility was not correlated with reported levels of community fluoroquinolone use. The Pro/IB-3 auxotype/serovar class accounted for 80% (44/55) of isolates with decreased susceptibility. Pro/IB-3 isolates from three cities had indistinguishable pulsed-field gel electrophoresis patterns, suggesting intercity spread of a clone.

The emergence of Neisseria gonorrhoeae with decreased susceptibility to ciprofloxacin in Cleveland, Ohio: epidemiology and risk factors.

BACKGROUND: Until 1992, almost all strains of Neisseria gonorrhoeae that had been tested in the United States were susceptible to fluoroquinolones, including ciprofloxacin. However, among men with urethral gonococcal infections who attended one sexually transmitted disease clinic in Cleveland, Ohio, the prevalence of gonococci with decreased susceptibility to ciprofloxacin increased from 2% in 1991 to 16% in 1994. OBJECTIVE: To describe the emergence of and risk factors for gonococcal urethritis caused by gonococci with decreased susceptibility to ciprofloxacin. Resistance to ciprofloxacin was considered to be decreased if the mean inhibitory concentration was at least 0.12 microgram/mL, and was less than or equal to 0.25 microgram/mL; this definition did not equate with the definition of clinical resistance. DESIGN: Case-control study. SETTING: An urban sexually transmitted disease clinic. PARTICIPANTS: 51 case-patients and 106 controls. MEASUREMENTS: Pulsed-field gel electrophoresis was used to identify individual genotypes of ciprofloxacin-resistant and ciprofloxacin-susceptible isolates. RESULTS: 55 of the 746 isolates of N. gonorrhoeae that were tested (7.4%) had decreased susceptibility to ciprofloxacin, and the prevalence of N. gonorrhoeae with decreased susceptibility significantly increased during the study period. Case-patients were significantly less likely to have gram-negative diplococci seen on microscopic examination of urethral discharge (P < or = 0.01) and were less likely to be treated for gonococcal urethritis than were controls (P < or = 0.001). Molecular typing suggested the spread of a single genotype of N. gonorrhoeae. CONCLUSIONS: Strains of gonococci with decreased susceptibility to ciprofloxacin appear to have become endemic in Cleveland, Ohio. The clinical significance of these isolates is not clear, but the potential for the emergence of clinically important resistance may preclude the use of fluoroquinolones as an alternative treatment for uncomplicated gonorrhea.

Activities of three investigational fluoroquinolones (BAY y 3118, DU-6859a, and clinafloxacin) against Neisseria gonorrhoeae isolates with diminished susceptibilities to ciprofloxacin and ofloxacin.

Between 1 January 1992 and 31 December 1993, our laboratory, as part of the Gonococcal Isolate Surveillance Project, found that 39 of 673 isolates of Neisseria gonorrhoeae from one local sexually transmitted diseases clinic demonstrated decreased susceptibilities to both ciprofloxacin and ofloxacin. The MICs of BAY y 3118, DU-6859a, and clinafloxacin at which 90% of the gonococci with decreased susceptibility to ciprofloxacin and ofloxacin were inhibited were all 0.016 microgram/ml, which was eightfold higher than those for ciprofloxacin-susceptible gonococci. Our report substantiates prior observations that diminished susceptibility to one quinolone is often associated with diminished susceptibility to other quinolones.

Persistence of Neisseria gonorrhoeae strains with decreased susceptibilities to ciprofloxacin and ofloxacin in Cleveland, Ohio, from 1992 through 1993.

Twenty-five isolates of beta-lactamase-negative strains of Neisseria gonorrhoeae exhibiting decreased susceptibilities to ciprofloxacin (MIC, > or = 0.125 microgram/ml) were isolated from men with uncomplicated gonococcal urethritis in Cleveland, Ohio, from January 1992 through June 1993. The strains belonged to three auxotype-serovar classes: Pro-IB-1 (2 isolates), Pro-IB-2 (21 isolates), and Pro-IB-3 (2 isolates). MICs for strains were in the intermediate or resistant categories for penicillin, the intermediate or susceptible categories for tetracycline (with the exception of one strain that had acquired the 25.2-MDa TetM-containing plasmid) and cefoxitin, and the susceptible categories for ceftriaxone and cefixime (MICs, < or = 0.25 microgram/ml) and spectinomycin (MIC, < or = 256 micrograms/ml). MICs for strains were also in the susceptible category for ofloxacin (MIC, 0.25 microgram/ml) and in categories higher than susceptible for ciprofloxacin (MICs, 0.125 to 0.25 microgram/ml) and ofloxacin (MIC, 0.5 microgram/ml). The diameters of zones of inhibition for these strains ranged from 31 to 39 mm for ciprofloxacin to 28 to 35 mm for ofloxacin. The persistence of these strains over an 18-month period supports the need for routine sentinel surveillance and monitoring of gonococcal isolates, particularly posttreatment isolates, for resistance to quinolones when these agents are used for the primary therapy of uncomplicated gonorrhea.

Recent biogenic phosphorite: concretions in mollusk kidneys.

Phosphorite concretions have been detected in the kidneys of two widespread species of mollusks, Mercenaria mercenaria and Argopecten irradians, which have relatively high population densities. These concretions are the first documentation of the direct biogenic formation of phosphorite grains. The concretions are principally amorphous calcium phosphate, which upon being heated yields an x-ray diffraction pattern which is essentially that of chlorapatite. These concretions appear to be a normal formation of the excretory process of mollusks under reproductive, environmental, or pollutant-induced stress. Biogenic production of phosphorite concretions over long periods of time and diagenetic change from amorphous to crystalline structure, coupled with secondary enrichment, may account for the formation of some marine phosphorite desposits which are not easily explained by the chemical precipitation-replacement hypothesis.

Black magnetic spherule fallout in the eastern gulf of Mexico.

Large numbers of black metallic spherules ranging in diameter from a few micrometers to over 800 micrometers are raining into the eastern Gulf of Mexico and adjacent areas of western Florida. The composition of the flux, its association with glass spherules and coky particles, and its magnitude point to industrial pollution, probably coal- and coke-burning facilities around the perimeter of the gulf, as the source. Since metallic particles represent only a small fraction of most fly ash, such an influx of large numbers of black magnetic spherules must be symptomatic of a much higher rate of sedimentation of fly ash. The internal microstructures and the general appearance of spherules derived from industrial processes are similar to those of particles derived from cosmic sources. Because of the high potential for contamination in micrometeorite studies, a complete compositional verification of each "cosmic" particle may be necessary.