José Eduardo Oliva Marín1, Esmeralda Villatoro2, María Jose Luna2, Ana María Barrientos3, Elmer Mendoza3, Ana Paula S Lemos4, Carlos H Camargo4, Claudio T Sacchi5, Marcos Paulo V Cunha6, Marcelo Galas7, Jean-Marc Gabastou8. 1. Instituto Nacional de Salud, Ministerio de Salud, San Salvador, El Salvador. 2. Departamento de Laboratorio Nacional de Salud Pública, Ministerio de Salud, San Salvador, El Salvador. 3. Unidad de Investigación y Epidemiología de Campo, Ministerio de Salud, San Salvador, El Salvador. 4. Centro de Bacteriologia, Instituto Adolfo Lutz, São Paulo, Brazil. 5. Laboratório Estratégico, Instituto Adolfo Lutz, São Paulo, Brazil. 6. Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, Brazil. 7. Servicio de Resistencia a los Antimicrobianos, Enfermedades Transmisibles y Determinantes Ambientales de la Salud, OPS, Washington, DC, USA. 8. Servicios de Laboratorio de Salud Pública y Redes, Emergencias de Salud de la OPS, Ciudad de México, México.
Abstract
BACKGROUND: Invasive meningococcal disease (IMD) is an acute, highly transmissible and potentially fatal disease caused by Neisseria meningitidis. Prompt antimicrobial therapy and prophylaxis are recommended, where penicillin or ciprofloxacin are the available choices. However, the emergence of resistant isolates of N. meningitidis poses a challenge for antimicrobial therapy. OBJECTIVES: To describe the clinical, epidemiological and biological characteristics of six penicillin- and ciprofloxacin-resistant, culture-confirmed IMD cases reported in El Salvador, Central America, between 2017 and 2019. METHODS: Following the detection of six patients presenting with IMD in El Salvador, clinical data were collected and epidemiological action plans conducted. Isolates were subjected to antimicrobial susceptibility testing by broth microdilution and WGS for genotyping and molecular characterization analysis, including phylogeny comparison with global sequences available from public databases. RESULTS: A total of six IMD cases caused by N. meningitidis serogroup Y, resistant to both penicillin (MIC >8.0 mg/L) and ciprofloxacin (MIC 0.125 mg/L), were detected from 2017 to 2019. Genomic analysis showed that penicillin resistance was mediated by the production of β-lactamase ROB-1. Ciprofloxacin resistance was attributed to an amino acid substitution in DNA gyrase (T91I). All isolates were classified as ST3587, clonal complex 23, and were genetically highly similar, based on core-genome SNP analysis. CONCLUSIONS: To the best of our knowledge, we report the first cases of MDR N. meningitidis causing IMD in Latin America. Our findings highlight the emergence of this potential public health threat, with a profound impact on the efficacy of IMD treatment and prophylaxis protocols.
BACKGROUND:Invasive meningococcal disease (IMD) is an acute, highly transmissible and potentially fatal disease caused by Neisseria meningitidis. Prompt antimicrobial therapy and prophylaxis are recommended, where penicillin or ciprofloxacin are the available choices. However, the emergence of resistant isolates of N. meningitidis poses a challenge for antimicrobial therapy. OBJECTIVES: To describe the clinical, epidemiological and biological characteristics of six penicillin- and ciprofloxacin-resistant, culture-confirmed IMD cases reported in El Salvador, Central America, between 2017 and 2019. METHODS: Following the detection of six patients presenting with IMD in El Salvador, clinical data were collected and epidemiological action plans conducted. Isolates were subjected to antimicrobial susceptibility testing by broth microdilution and WGS for genotyping and molecular characterization analysis, including phylogeny comparison with global sequences available from public databases. RESULTS: A total of six IMD cases caused by N. meningitidis serogroup Y, resistant to both penicillin (MIC >8.0 mg/L) and ciprofloxacin (MIC 0.125 mg/L), were detected from 2017 to 2019. Genomic analysis showed that penicillin resistance was mediated by the production of β-lactamase ROB-1. Ciprofloxacin resistance was attributed to an amino acid substitution in DNA gyrase (T91I). All isolates were classified as ST3587, clonal complex 23, and were genetically highly similar, based on core-genome SNP analysis. CONCLUSIONS: To the best of our knowledge, we report the first cases of MDR N. meningitidis causing IMD in Latin America. Our findings highlight the emergence of this potential public health threat, with a profound impact on the efficacy of IMD treatment and prophylaxis protocols.
Authors: Caelin C Potts; Adam C Retchless; Lucy A McNamara; Daya Marasini; Natashia Reese; Stephanie Swint; Fang Hu; Shalabh Sharma; Amy E Blain; David Lonsway; Maria Karlsson; Susan Hariri; LeAnne M Fox; Xin Wang Journal: Clin Infect Dis Date: 2021-10-05 Impact factor: 20.999