BREAKING! US CDC Warns Of Emergence Of New Strain of Antibiotic-Resistant Meningitis
Meningitis: The US CDC is warning about the emergence of a new strain of antibiotic-resistant meningitis bacteria.
Neisseria meningitidis
A detailed analysis of meningococcus isolates from US health departments has identified a novel strain of ciprofloxacin-resistant and beta-lactamase–producing
Neisseria meningitidis, scientists with the Centers for Disease Control and Prevention (CDC) and the Maryland Department of Health reported yesterday in the
Morbidity and Mortality Weekly Report.
https://www.cdc.gov/mmwr/volumes/69/wr/mm6924a2.htm?s_cid=mm6924a2_w
The research findings prompted the US CDC to issue an immediate health advisory with recommendations for healthcare providers and public health officials.
The bacterium
N meningitidis causes meningococcal disease, a sudden-onset, life-threatening infection of the lining of the brain and spinal cord or the bloodstream.
Despite rates of meningococcal disease declining in the United States since the 1990s, the CDC warns that the emergence of this new resistant strain could see a new spike in cases.
So far,
N meningitidis isolates in the United States have been susceptible to penicillin and ciprofloxacin, two of the antibiotics used for treatment in people with confirmed infections and for prophylaxis (prevention) in those with close contact with infected patients. Quick treatment with antibiotics is considered essential, as the disease can cause death within a matter of hours.
However in January this year, an isolate that produced a beta-lactamase enzyme (which breaks down beta-lactam antibiotics) and was resistant to penicillin and ciprofloxacin was cultured from a meningococcal disease patient in Maryland, followed by a second case reported by the Maryland Department of Health in February.
These disturbing findings prompted the CDC to request isolates from meningococcal disease cases from state health departments and conduct a systematic analysis.
The department researchers identified 33 resistant isolates, prompting the department to raise an alert that this occurrence was more widely that initially thought.
In the study, whole-genome sequencing (WGS) of 2,097
N meningitidis isolates found 33 beta-lactamase–producing isolates from cases in 12 states.
Significantly, eleven of the isolates, collected from 9 states in 2019 and 2020, belonged to
N meningitidis serogroup Y (NmY) and contained both the
blaROB-1 beta-lactamase gene associated with penicillin resistance and a mutation of the T91I
gyrA chromosome associated with resistance to ciprofloxacin. Antimicrobial susceptibility testing confirmed resistance to penicillin and ciprofloxacin.
It was observed that twenty-two of the isolates contained
blaROB-1 but did not have mutations associated with ciprofloxacin resistance. All
33 isolates belonged to clonal complex 23, and 30 belonged to sequence type (ST)-3587.
However there were no known epidemiologic links among the 33 cases, but 22 (67%) occurred in Hispanic people, including 8 of the 11 cases with ciprofloxacin-resistant isolates.
Dr LeAnne M. Fox, MD an US CDC co-researcher told Thailand Medical News, "The detection of geographically diverse cases with penicillin-resistant and ciprofloxacin-resistant NmY isolates has implications for treatment and prophylaxis of meningococcal disease in the United States."
The US CDC health advisory urges providers to test meningococcal isolates for susceptibility to penicillin before changing from empiric treatment with cefotaxime or ceftriaxone to penicillin or ampicillin. The agency also called on public health officials in states that have experienced meningococcal disease caused by ciprofloxacin-resistant strains over the past 2 years to conduct susceptibility testing of isolates to inform prophylaxis decisions.
The US CDC is also asking state health departments to report any suspected meningococcal treatment or prophylaxis failures.
There is also worrying concerns that along with the current COVID-19 crisis in the United States, the emergence of such a resistance bacterial strain could spike as a secondary illness among those already being compromised by the COVID-19.
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