Antibiotic resistance among invasive Neisseria meningitidis isolates in England, Wales and Northern Ireland (2010/11 to 2018/19)

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.

Penicillin- and Ciprofloxacin-Resistant Invasive Neisseria meningitidis Isolates from Japan

“…No isolate was found nonsusceptible or resistant to ceftriaxone, meropenem, chloramphenicol, or rifampin. These results agree with previous studies that showed reduced susceptibility to penicillin among invasive isolates ( 7 – 9 , 13 , 14 ), suggesting that penicillin might not be suitable to treat IMD cases in Japan. However, we could not clarify the reason for the observation in this study, and it might have been associated with the antibiotic choice for the treatment of bacterial meningitis in Japan.…”

“…This indicates, for the first time, that the penicillin-resistant invasive serogroup W, ST-11 CC lineage circulating in several countries ( 5 , 6 ) has already emerged in Japan. Three penicillin and ciprofloxacin-resistant isolates, NIID576, NIID614, and NIID620, recovered from individuals in different prefectures, were classified as the same nontypeable serogroup ST-32 CC strains harboring both penA33 (identified previously in penicillin-nonsusceptible strains) ( 14 ) and gyrA376 with a T91I substitution responsible for ciprofloxacin resistance ( Fig. 1 ).…”

“…A penicillin-resistant isolate NIID669 was classified into serogroup W, ST-11 clonal complex (CC) harboring penA9 , a mosaic penA allele that has been reported in strains with reduced penicillin susceptibility ( 6 , 9 , 14 ), which clustered to a clade of the same serogroup and CC containing penicillin-resistant strains from New Zealand ( penA9 ) ( Fig. 1 ).…”

Carriage of Neisseria meningitidis Among Umrah Pilgrims: Circulating Serogroups and Antibiotic Resistance

“…8,11 Moreover, increased prevalence of antibiotic resistance among N. meningitidis isolates worldwide, including Muslim-majority countries, is concerning. [12][13][14]…”

Penicillin and Cefotaxime Resistance of Quinolone-Resistant Neisseria meningitidis Clonal Complex 4821, Shanghai, China, 1965–2020

“…N. meningitidis resistance to 3GCs is rare, and only 1 cefotaxime-resistant isolate has been reported in the United Kingdom ( 12 ). In recent years, Pen NS meningococci have become more frequent worldwide ( 13 , 14 ), but data for meningococci from China with Pen NS and 3GCs resistance remain poorly described.…”