Abstract
Meningococcal disease is a sudden-onset, life-threatening illness caused by the bacterium Neisseria meningitidis. Prompt empiric antibiotic treatment can reduce morbidity and mortality among patients, and antibiotic prophylaxis can prevent secondary disease in close contacts. Historically, N. meningitidis isolates in the United States have largely been susceptible to the antibiotics recommended for treatment and prophylaxis, including penicillin and ciprofloxacin. This report describes detection of penicillin-resistant and ciprofloxacin-resistant N. meningitidis serogroup Y (NmY) isolates in the United States. NmY isolates containing a blaROB-1 β-lactamase enzyme gene conferring resistance to penicillins (1) were recovered from 33 cases reported during 2013-2020. Isolates from 11 of these cases, reported during 2019-2020, harbored a ciprofloxacin resistance-associated mutation in a chromosomal gene (gyrA). Cases were reported from 12 geographically disparate states; a majority of cases (22 of 33, 67%) occurred in Hispanic persons. These cases represent a substantial increase in penicillin-resistant and ciprofloxacin-resistant meningococci in the United States since 2013. Ceftriaxone and cefotaxime, the recommended first-line agents for empiric bacterial meningitis treatment, can continue to be used for treatment, but health care providers should ascertain susceptibility of meningococcal isolates to penicillin before switching to penicillin or ampicillin. Ongoing monitoring for antimicrobial resistance among meningococcal isolates and prophylaxis failures will be important to inform treatment and prophylaxis recommendations.
Highlights
During 2019–2020, 11 meningococcal isolates from U.S patients had isolates containing a blaROB-1 β-lactamase gene associated with penicillin resistance and mutations associated with ciprofloxacin resistance
An additional 22 cases reported during 2013–2020 contained blaROB-1 but did not have mutations associated with ciprofloxacin resistance
Ceftriaxone and cefotaxime can continue to be used for empiric bacterial meningitis treatment; meningococcal isolate susceptibility to penicillin should be determined before switching to penicillin or ampicillin
Summary
Detection of Ciprofloxacin-Resistant, β-Lactamase–Producing Neisseria meningitidis Serogroup Y Isolates — United States, 2019–2020. This report describes detection of penicillin-resistant and ciprofloxacin-resistant N. meningitidis serogroup Y (NmY) isolates in the United States. In January 2020, an NmY isolate that produced a β-lactamase and was resistant to penicillin and ciprofloxacin was cultured from a meningococcal disease case in a Maryland resident (Gillian Taormina, Benjamin Hanisch, Children’s National Hospital, Washington, DC, personal communication; 2020). When a second case of infection with a β-lactamase– producing, ciprofloxacin-resistant NmY isolate was reported by the Maryland Department of Health in February 2020, a systematic analysis of N. meningitidis isolates in the United States was conducted to determine whether this resistance pattern was more widespread. Analysis of WGS data identified 11 serogroup Y isolates that contained a blaROB-1 β-lactamase gene and a T91I gyrA mutation associated with resistance to ciprofloxacin.
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