Antibiotic-resistant N. meningitidis emerges in US

ByKen Downey Jr.

The most recent MMWR included a report about a novel, emerging strain of beta-lactamase-producing Neisseria meningitidis in the United States that is resistant to both penicillin and ciprofloxacin.

Perspective from Carlos del Rio, MD

According to the report, 33 cases of penicillin-resistant N. meningitidis were reported from 2013 to 2020 in 12 states, including 11 cases in 2019 and 2020 that were resistant to both penicillin and ciprofloxacin. In all 33 cases, patients had isolates containing a bla_ROB-1 beta-lactamase enzyme gene associated with penicillin resistance. Twenty-two of the cases occurred in Hispanic patients. Most patients were young children or older adults.

A novel strain of antibiotic-resistant Neisseria meningitidis has emerged in the U.S. Credit: CDC/ Sarah Bailey Cutchin — A novel strain of antibiotic-resistant *Neisseria meningitidis* has emerged in the U.S. **Credit:** CDC/ Sarah Bailey Cutchin

“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,” Lucy A. McNamara, PhD, an epidemiologist in the CDC’s Division of Bacterial Diseases, and colleagues s wrote. “Prophylaxis failures and antimicrobial resistance among meningococcal isolates should be monitored to inform meningococcal prophylaxis recommendations.”

According to McNamara and colleagues, it is unknown how widely the novel strain is circulating in other countries. They said isolates were detected in El Salvador from 2017 to 2019, but cases have not been reported in other countries. Strains resistant to penicillin only have been reported in Canada and France.

McNamara and colleagues recommend that state and territorial health departments continue to send isolates to the CDC for antimicrobial testing and whole-genome sequencing. They said the CDC received isolates from only 72% of Americans with meningococcal disease in 2017 and 78% in 2018.

Perspective

Carlos del Rio, MD

Carlos del Rio

Obviously, this is very concerning. If there is one thing about N. meningitidis that we have all enjoyed, it is the fact that it has been incredibly sensitive to antibiotics, and resistance has not been an issue. But now that we have started seeing resistance emerge in N. meningitidis, to me, it is incredibly concerning.

We saw some strains of N. meningitidis a couple of years ago that were showing up and causing urethritis. We published a paper in Proceedings of the National Academy of Sciences of the United States of America, showing that this N. meningitidis was causing urethritis in Ohio and had acquired a mutation from gonococcal strains that made them more likely to attach.

Gonococcal strains have this great ability to develop resistance to almost anything, so my concern is, could we now be seeing a similar thing? Whenever I see N. meningitidis, I get very concerned.

Reference: