Detection of non-travel-associated, ceftriaxone non-susceptible Neisseria gonorrhoeae FC428-like harbouring the mosaic penA60 allele in Ontario, Canada
Bibliographic record
Abstract
Background: This case report describes a young male with multidrug-resistant Neisseria gonorrhoeae infection acquired in Ontario, Canada with no travel history.Methods: Case follow-up was conducted following routine public health practice in Ontario.Antimicrobial susceptibility testing of the isolate was done by agar dilution.Strain typing and other molecular characterization was done by whole genome sequencing.Results: The patient was treated successfully with intramuscular ceftriaxone and oral azithromycin.Agar dilution testing demonstrated reduced susceptibility to all tested agents, except for azithromycin and spectinomycin, including non-susceptibility to ceftriaxone (minimum inhibitory concentration [MIC]=0.5 mg/L) and cefixime (MIC=2 mg/L), resistance to tetracycline (MIC=2 mg/mL) and ciprofloxacin (MIC=32 mg/L), and testing intermediate to penicillin (MIC=1 mg/L).Whole-genome sequencing revealed the isolate was closely related to the FC428 clone, which harbours the mosaic penA60 allele responsible for elevated MICs to extended-spectrum cephalosporins, such as ceftriaxone or cefixime, both currently recommended as first-line or alternative treatment options for uncomplicated anogenital gonorrhea infections in Ontario.Conclusion: Identification of this case suggests previously unrecognized local transmission of this multidrug-resistant N. gonorrhoeae strain is occurring in Ontario and highlights the need for ongoing surveillance to monitor trends and inform treatment recommendations.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".