Acquisition of Ciprofloxacin Resistance Among an Expanding Clade of β-Lactamase–Positive, Serogroup Y Neisseria meningitidis in the United States. (26th April 2021)

• Record Type: Journal Article
• Authors: Potts, Caelin C; Retchless, Adam C; McNamara, Lucy A; Marasini, Daya; Reese, Natashia; Swint, Stephanie; Hu, Fang; Sharma, Shalabh; Blain, Amy E; Lonsway, David; Karlsson, Maria; Hariri, Susan; Fox, LeAnne M; Wang, Xin
• Is Part Of: Clinical infectious diseases. Volume 73:Number 7(2021)
• Page Start: 1185
• Page End: 1193
• Publication Date: 2021-04-26
• Subjects: Neisseria meningitides -- ciprofloxacin -- β-lactamase -- antibiotic resistance -- meningococcal disease; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciab358
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: Penicillin and ciprofloxacin are important for invasive meningococcal disease (IMD) management and prevention. IMD cases caused by penicillin- and ciprofloxacin-resistant Neisseria meningitidis containing a ROB-1 β-lactamase gene ( bla ROB-1 ) and a mutated DNA gyrase gene ( gyrA ) have been recently reported in the United States. Methods: We examined 2097 meningococcal genomes collected through US population-based surveillance from January 2011 to February 2020 to identify IMD cases caused by strains with bla ROB-1 - or gyrA- mediated resistance. Antimicrobial resistance was confirmed phenotypically. The US isolate genomes were compared to non-US isolate genomes containing bla ROB-1 . Interspecies transfer of ciprofloxacin resistance was assessed by comparing gyrA among Neisseria species. Results: Eleven penicillin- and ciprofloxacin-resistant isolates were identified after December 2018; all were serogroup Y, sequence type 3587, clonal complex (CC) 23, and contained bla ROB-1 and a T91I-containing gyrA allele. An additional 22 penicillin-resistant, bla ROB-1 - containing US isolates with wild-type gyrA were identified from 2013 to 2020. All 33 bla ROB-1 -containing isolates formed a single clade, along with 12 bla ROB-1 -containing isolates from 6 other countries. Two-thirds of bla ROB-1 - containing US isolates were from Hispanic individuals. Twelve additional ciprofloxacin-resistant isolates with gyrA T91 mutations were identified. Ciprofloxacin-resistant isolates belonged to 6 CCs and contained 10 unique gyrA alleles; 7 were similar or identical to alleles from Neisseria lactamica or Neisseria gonorrhoeae. Conclusions: Recent IMD cases caused by a dual resistant serogroup Y suggest changing antimicrobial resistance patterns in the United States. The emerging dual resistance is due to acquisition of ciprofloxacin resistance by β-lactamase–containing N. meningitidis . Routine antimicrobial resistance surveillance will effectively monitor resistance changes and spread. Abstract : Ciprofloxacin- and penicillin-resistant Neisseria meningitidis caused 11 cases of invasive meningococcal disease in the United States during a 14-month period. The dual-resistant N. meningitidis were not detected before 2019 and belong to a single genetic lineage, suggesting changing antimicrobial resistance patterns.