Abstract
ObjectivesInvasive disease caused by Neisseria meningitidis is a significant health concern globally, but our knowledge of the prevailing serogroups, antimicrobial susceptibility patterns, and genetics of N. meningitidis in Southeast Asia is limited. Chloramphenicol resistance in N. meningitidis has rarely been reported, but was first described in isolates from Vietnam in 1998. We aimed to characterise eight chloramphenicol resistant meningococcal isolates collected between 2007 and 2018 from diagnostic microbiology laboratories in Cambodia, Thailand and the Lao People's Democratic Republic (Laos). MethodsWhole-genome sequencing was used to generate genome sequences from 18 meningococcal isolates including the eight chloramphenicol resistant isolates. We identified antimicrobial resistance genes present in these strains, and examined the phylogenetic relationships between strains. ResultsThe eight resistant strains all contain the same chloramphenicol resistance gene first described in 1998, and are closely related to each other. Strains resistant to penicillin, tetracycline, and ciprofloxacin were also observed, including a chloramphenicol-resistant strain which has acquired penicillin and ciprofloxacin resistance. ConclusionsThis study suggests that chloramphenicol-resistant N. meningitidis is more widespread than previously thought, and that the previously-identified resistant lineage is now found in multiple countries in Southeast Asia.
Highlights
Invasive disease caused by Neisseria meningitidis is an important global health concern, being associated with significant rates of mortality and long-term sequelae (Vyse et al, 2013)
Eighteen isolates of N. meningitidis (11 from Thailand, 5 from Cambodia, 2 from Lao People's Democratic Republic (Laos)) from 18 patients were included in the analysis (Table 1)
All isolates were susceptible to ceftriaxone, but 10/18 (55.5%) isolates had reduced susceptibility to penicillin, including one isolate which was resistant according to Clinical and Laboratory Standards Institute (CLSI) criteria (Table 2)
Summary
Invasive disease caused by Neisseria meningitidis is an important global health concern, being associated with significant rates of mortality and long-term sequelae (Vyse et al, 2013). The burden of meningococcal disease in Southeast Asia is poorly described, with few data on prevailing serogroups and antimicrobial susceptibility patterns (Vyse et al, 2011). Network (MORU) includes diagnostic microbiology laboratories in Thailand, Laos and Cambodia, where N. meningitidis is an infrequently isolated pathogen. Detection of a chloramphenicolresistant strain of N. meningitidis at our laboratory site in Laos in November 2017 prompted a review of published reports of chloramphenicol resistance in N. meningitidis and review of chloramphenicol susceptibility amongst meningococcal isolates in our laboratory network. Batty et al / International Journal of Infectious Diseases 95 (2020) 198–203
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