Abstract
Invasive meningococcal disease (IMD), caused by Neisseria meningitidis, can have a fatality rate as high as 10%, even with appropriate treatment. In the UK, penicillin is administered to patients in primary care whilst third generation cephalosporins, cefotaxime and ceftriaxone, are administered in secondary care. The first-choice antibiotic for chemoprophylaxis of close contacts is ciprofloxacin, followed by rifampicin. Immunocompromised individuals are often recommended antibiotic chemoprophylaxis and vaccination due to a greater risk of IMD. Resistance to antibiotics among meningococci is relatively rare, however reduced susceptibility and resistance to penicillin are increasing globally. Resistance to third generation cephalosporins is seldom reported, however reduced susceptibility to both cefotaxime and ceftriaxone has been observed. Rifampicin resistance has been reported among meningococci, mainly following prophylaxis, and ciprofloxacin resistance, whilst uncommon, has also been reported across the globe. The Public Health England Meningococcal Reference Unit receives and characterises the majority of isolates from IMD cases in England, Wales and Northern Ireland. This study assessed the distribution of antibiotic resistance to penicillin, rifampicin, ciprofloxacin and cefotaxime among IMD isolates received at the MRU from 2010/11 to 2018/19 (n = 4,122). Out of the 4,122 IMD isolates, 113 were penicillin-resistant, five were ciprofloxacin-resistant, two were rifampicin-resistant, and one was cefotaxime-resistant. Penicillin resistance was due to altered penA alleles whilst rifampicin and ciprofloxacin resistance was due to altered rpoB and gyrA alleles, respectively. Cefotaxime resistance was observed in one isolate which had an altered penA allele containing additional mutations to those harboured by the penicillin-resistant isolates. This study identified several isolates with resistance to antibiotics used for current treatment and prophylaxis of IMD and highlights the need for continued surveillance of resistance among meningococci to ensure continued effective use.
Highlights
Invasive meningococcal disease (IMD), including meningitis and/or septicaemia, is a severe, life-threatening illness caused by the bacterium Neisseria meningitidis
Meningococci can be further differentiated into sequence types (STs), with related STs grouped into lineages termed clonal complexes (CCs) [4]
From 2010/11 to 2018/19, antibiotic resistance was uncommon among IMD isolates in E, W and NI
Summary
Invasive meningococcal disease (IMD), including meningitis and/or septicaemia, is a severe, life-threatening illness caused by the bacterium Neisseria meningitidis (the meningococcus). Six meningococcal serogroups (A, B, C, W, X and Y) are responsible for the majority of IMD cases worldwide [1,2,3]. Meningococci can be further differentiated into sequence types (STs), with related STs grouped into lineages termed clonal complexes (CCs) [4]. Serogroup B meningococcal disease is the most prevalent in the UK and is the most diverse in terms of clonal complex distribution [5]. Ciprofloxacin is the chemoprophylactic agent of choice for close contacts of cases and rifampicin is a suitable alternative [8]. Chemoprophylaxis is recommended for close contact of IMD cases and for individuals with deficiencies of the terminal complement pathway, where the risk for IMD development is up to 10,000 fold higher than in the general population [9]
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