AMR Clinical Report - FC428

⚠️ MACROLIDE RESISTANCE GENE DETECTED

erm gene present - Complete macrolide resistance

Treatment: DO NOT use azithromycin
Recommended: Ceftriaxone monotherapy or alternative agent
Test of Cure: MANDATORY

🚨 FC428 CLONE DETECTED - CRITICAL ALERT

penA-60.001 allele (FC428) detected

Strain: Internationally spreading extensively drug-resistant (XDR) clone
Resistance: High-level cephalosporin resistance
Treatment: Ceftriaxone 1-2g IM/IV + mandatory test of cure
Action: IMMEDIATE public health notification required
Contact Tracing: Enhanced partner notification

📋 Executive Summary

Resistance Profile

⚠️ 1 CRITICAL resistance marker(s) detected

• 1 acquired resistance gene(s) present

Resistance mechanisms identified:

Macrolide resistance (erm genes)

💊 Treatment Recommendation

Recommended Regimen

Resistance Profile: penA-60.001 present

First-line: Ceftriaxone + Azithromycin

Dose: 1-2g IM/IV + 2g PO

Second-line: Ceftriaxone + Gentamicin

Dose: 2g IM/IV + 240mg IM

Alternative: Ceftriaxone + Spectinomycin

Special Considerations: ID consult mandatory FC428 clone

Test of Cure: MANDATORY

🧬 Chromosomal Mutations Detected

No chromosomal mutations detected

🔄 Horizontally Acquired Resistance Genes

Gene	Status	Average Depth
blaTEM	Not_detected	1.99
tetM	Not_detected	0.00
ermB	Not_detected	0.00
ermC	Detected	39.41
ermF	Not_detected	0.00
mefA	Not_detected	0.00
Nm_sodC	Detected	67.54

🔍 Molecular Typing

Marker	Result	Identity	Significance
penA Allele	penA_795	100.000%	CHECK_MIC_TESTING
porB Allele	NEIS1600_1163	100.000%	Typing marker
mtrR Mosaic	True	99.280%	Efflux pump derepression

⚠️ Species Identification Warning

Neisseria meningitidis marker (Nm_sodC) detected

Possible co-infection, contamination, or misidentification. Repeat culture and identification.

Report generated by: AMR Profiler Workflow v2025.1

Reference: Based on WHO/CDC guidelines and PubMLST databases

© 2025 I Graviton, LLC. All rights reserved.
This report is for clinical and public health use only.

⚠️ Important: Treatment decisions should be made with medical provider, preferably incorporate phenotypic susceptibility testing when available and follow regional clinical guidelines. Genotypic resistance markers provide guidance but may not always correlate perfectly with phenotypic MICs.