Invasive Disease Caused by Neisseria meningitidis Relatively Resistant to Penicillin in North Carolina

Woods, Charles R.; Smith, Arnold L.; Wasilauskas, Benedict L.; Campos, José; Givner, Laurence B.

doi:10.1093/infdis/170.2.453

Cited by 55 publications

(17 citation statements)

References 15 publications

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“…Penicillin is used effectively in the treatment of meningococcal infections; however, strains with decreased susceptibility to penicillin (MICs, Ͼ0.06 g/ml) have been reported in several countries (8,11,20,44,49), and some studies have shown that decreased susceptibility has been linked to a single clone (13,38). The clinical significance of this increased resistance is unknown, and infections with these strains appear to respond to penicillin therapy (44).…”

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Neisseria meningitidis Intermediately Resistant to Penicillin and Causing Invasive Disease in South Africa in 2001 to 2005

et al. 2008

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Neisseria meningitidis strains (meningococci) with decreased susceptibility to penicillin (MICs, >0.06 g/ml) have been reported in several parts of the world, but the prevalence of such isolates in Africa is poorly described. Data from an active national laboratory-based surveillance program from January 2001 through December 2005 were analyzed. A total of 1,897 cases of invasive meningococcal disease were reported, with an average annual incidence of 0.83/100,000 population. Of these cases, 1,381 (73%) had viable isolates available for further testing; 87 (6%) of these isolates tested intermediately resistant to penicillin (Pen i ). Pen i meningococcal isolates were distributed throughout all provinces and age groups, and there was no association with outcome or human immunodeficiency virus infection. The prevalence of Pen i was lower in serogroup A (7/295; 2%) than in serogroup B (24/314; 8%), serogroup C (9/117; 8%), serogroup Y (22/248; 9%), or serogroup W135 (25/396; 6%) (P ‫؍‬ 0.02). Pulsed-field gel electrophoresis grouped 63/82 Pen i isolates into nine clusters, mostly according to serogroup. The clustering of patterns from Pen i isolates was not different from that of penicillinsusceptible isolates. Twelve sequence types were identified among 18 isolates arbitrarily selected for multilocus sequence typing. DNA sequence analysis of the penA gene identified 26 different alleles among the Pen i isolates. Intermediate penicillin resistance is thus widespread among meningococcal serogroups, has been selected in a variety of lineages, and, to date, does not appear to be associated with increased mortality. This is the first report describing the prevalence and molecular epidemiology of Pen i meningococcal isolates from sub-Saharan Africa.

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Neisseria meningitidis Intermediately Resistant to Penicillin and Causing Invasive Disease in South Africa in 2001 to 2005

et al. 2008

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“…Penicillin has historically been an effective antibiotic, but strains with reduced susceptibility to penicillin (often referred to as relatively resistant or penicillinintermediate strains) have been reported in Europe, South America, Asia, Australia, and, less frequently, in the United States (3,7,17,21,23,24,30,32,36,38). Such strains have been shown to have alterations in penicillin-binding protein 2 (PBP2; encoded by the penA gene), thought to be the result of formation of mosaic genes derived through transformation with DNA from commensal Neisseria species in the nasopharynx of colonized individuals (2,33).…”

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Susceptibility of Neisseria meningitidis to 16 Antimicrobial Agents and Characterization of Resistance Mechanisms Affecting Some Agents

2005

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Neisseria meningitidis represents a pathogen of great public health importance in both developed and developing countries. Resistance to some antimicrobial agents used either for therapy of invasive infections or for prophylaxis of case contacts has long been recognized, although specific guidelines for susceptibility testing have not been fully developed. We have examined the susceptibilities of a collection of 442 meningococcal clinical isolates from 15 countries to 16 antimicrobial agents. These included isolates recovered between 1917 and 2004, with representatives of all major serogroups. All isolates were tested by the Clinical and Laboratory Standards Institute (formerly NCCLS) broth microdilution method using Mueller-Hinton lysed horse blood broth, while a subset of 102 isolates was tested by agar dilution using Mueller-Hinton sheep blood agar. Most isolates provided adequate growth for MIC determinations by both broth and agar methods. Growth in broth was enhanced by CO 2 incubation and was required for two strains (1.7%). MICs of the study drugs compared favorably between the broth and agar methods (79 to 100% essential agreement), and MICs also generally agreed closely (92 to 100% essential agreement, excluding azithromycin) between broth tests incubated in the two different atmospheres. Elevated penicillin and ampicillin MICs (>0.12 g/ml and >0.25 g/ml, respectively) occurred in 14.3% and 8.6% of strains and were associated with polymorphisms of the penA gene encoding a modified penicillin-binding protein 2. None of the 442 isolates produced beta-lactamase. Elevated tetracycline and doxycycline (but not minocycline) MICs were associated with efflux-mediated resistance encoded by tet(B) in 13 strains. Resistance to sulfisoxazole in 21.7% of strains and to trimethoprim-sulfamethoxazole in 21.0% resulted from polymorphisms of folP encoding a modified dihydropteroate synthetase. Seven strains were resistant to rifampin due to mutations in the rpoB gene, and two strains were resistant to chloramphenicol due to production of chloramphenicol acetyltransferase mediated by catP. Two strains had reduced quinolone susceptibility due to mutations of gyrA. The determination of the susceptibilities of a large group of meningococcal strains (including strains with characterized resistance mechanisms) to 16 antimicrobial agents has served as the essential first step in defining susceptibility testing breakpoints specific for this organism.

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“…Sáez Nieto et al (1997) described an increase of meningococcal strains showing MICs between 0.12 and 1 mg/l from 0.4% in 1985 and reaching 42.6% in 1990. Such isolates have been reported elsewhere in Europe, in South Africa, and in Canada (Woods et al 1994). Six meningococci, isolated from patients and carriers during a large epidemic of meningococcal meningitis in Malawi had MICs of penicillin (> or = 2 mg/l) high enough to render them clinically resistant (Bellete et al 1994).…”

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confidence: 71%

Typing and susceptibility to penicillin of Neisseria meningitidis isolated from patients in Cuba (1993-1999)

Sosa

Llanes

Guzmán

et al. 2001

Mem. Inst. Oswaldo Cruz

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Invasive Disease Caused by Neisseria meningitidis Relatively Resistant to Penicillin in North Carolina

Cited by 55 publications

References 15 publications

Neisseria meningitidis Intermediately Resistant to Penicillin and Causing Invasive Disease in South Africa in 2001 to 2005

Neisseria meningitidis Intermediately Resistant to Penicillin and Causing Invasive Disease in South Africa in 2001 to 2005

Susceptibility of Neisseria meningitidis to 16 Antimicrobial Agents and Characterization of Resistance Mechanisms Affecting Some Agents

Typing and susceptibility to penicillin of Neisseria meningitidis isolated from patients in Cuba (1993-1999)

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