Global epidemiology of antimicrobial resistance in commensal Neisseria species: A systematic review

Ecological Effects of Daily Antiseptic Treatment on Microbial Composition of Saliva-Grown Microcosm Biofilms and Selection of Resistant Phenotypes

“…Remarkably, the MIC of 6 μg/ml found here for penicillin G is higher than all reported for commensal Neisseria spp. in this systematic review ( Vanbaelen et al, 2022 ). Campylobacter spp.…”

“…N. perflava isolated from CHX-treated biofilms on CHX-containing agar was found resistant to penicillin G, ampicillin, and ceftriaxone/cefotaxime, which is in line with a recent systematic review stating that antimicrobial susceptibilities in commensal as well as pathogenic Neisseria spp. have been increasing considerably following decades of antibiotic exposure ( Vanbaelen et al, 2022 ). Remarkably, the MIC of 6 μg/ml found here for penicillin G is higher than all reported for commensal Neisseria spp.…”

Canary in the Coal Mine: How Resistance Surveillance in Commensals Could Help Curb the Spread of AMR in Pathogenic Neisseria

“…Bystander selection is the unintentional selection of resistance in bacteria not targeted by the prescribed antimicrobial therapy, and is higher in bacteria with high carriage rates, as they more frequently experience exposure to consumed drugs ( 132 ). Extrapolating this finding to Neisseria suggests that commensals (carriage rate ~100%) should experience higher bystander selection from antibiotic use compared with their pathogenic relatives (carriage rate between 0.01 and 10%) ( 29 , 30 , 133 ), and should be more likely to “take up arms” and display resistance to clinically important antimicrobials. Reduced drug susceptibility in commensal Neisseria populations has been shown to be directly selected for after antibiotic usage in a study of Vietnamese men, in which recent antibiotic use (within 1 month) was strongly associated with increased MICs to cefixime, ceftriaxone, and cefpodoxime in commensal Neisseria compared with a control population with no antibiotic use between 1 and 6 months prior to the study ( 28 ).…”

“…Antibiotic resistance in many bacterial species increases with the consumption of antibiotics in the community ( 122 – 126 ), and in gonococci several studies have suggested a link between antibiotic use and the emergence and spread of AMR ( 29 , 30 ). For example, a survey across 24 European countries found that cephalosporin and fluoroquinolone use significantly increased ceftriaxone/cefixime and ciprofloxacin MICs, respectively ( 127 ).…”

“…Kenyon et al have previously championed a call for surveillance of commensal Neisseria as part of their model considering a “pan- Neisseria ” approach for choosing appropriate antibiotic therapy for gonorrhea ( 27 ), which we expand upon here as an important next step in addressing AMR within the pathogenic Neisseria. Collection and characterization of commensal Neisseria isolates as part of routine surveillance programs by clinical and academic laboratories should provide broad epidemiological surveillance of AMR in commensals, as the carriage rate of commensals (around 100%) is higher than that of their pathogenic relatives (0.01% to 10%) ( 28 – 30 ), and we believe could ultimately serve as an early warning indicator of possible resistance outbreaks in pathogenic Neisseria.…”