Molecular epidemiology of penicillinase-producing Neisseria gonorrhoeae isolates and their bla TEM-135 gene variant in Bangkok, Thailand, 2015-2017.

Penicillinase-producing Neisseria gonorrhoeae (PPNG) possessing blaTEM-135 is a serious public health threat. With only a single change in amino acid sequence, blaTEM-135 could evolve into TEM-type extended-spectrum beta-lactamase (ESBL), which hydrolyzes extended-spectrum cephalosporins, including ceftriaxone and cefixime. We investigated the molecular epidemiological characteristics, types of plasmids of PPNG isolates, and prevalence of PPNG clinical isolates producing TEM-135 beta-lactamases. N. gonorrhoeae multiantigen sequence typing (NG-MAST) was used to determine the molecular epidemiological characteristics of 99 PPNG isolates collected from 2015 to 2017. A mismatch amplification mutation assay examined the blaTEM-135 gene prevalence. Of 89 NG-MAST sequence types identified, 65 (73.0%) were novel. Only 17.7% (43/243) of the PPNG isolates belonged to 16 genogroups. The most frequent plasmid was African, followed by Rio/Toronto and Asian. The blaTEM-135 allele was in Rio/Toronto plasmids. The blaTEM-135 allele was present in 23.2% (23/99) of PPNG isolates. PPNG isolates expressing TEM-135 beta-lactamase exhibited significantly higher penicillin MIC values than TEM-1 PPNG isolates. PPNG isolates showed high genetic diversity and high proportions of blaTEM-135 alleles. Mutation of the blaTEM-135 allele is worrisome: only 1 mutation could see TEM-1 evolve into an ESBL variant degrading ceftriaxone. Ongoing surveillance of blaTEM-135 and new PPNG isolate variants is imperative.