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Mouss KA, Nzoyikorera N, Razki A, Zaki B, Soraa N, Zerouali K. Neisseria meningitidis with decreased susceptibility to penicillin G and molecular characterization of the penA gene in strains isolated at University Hospital Centers of Casablanca and Marrakech (Morocco). Pan Afr Med J 2024; 47:56. [PMID: 38646132 PMCID: PMC11032073 DOI: 10.11604/pamj.2024.47.56.42328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/09/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction the laboratory diagnosis of meningococcal meningitis relies on conventional techniques. This study aims to evaluate the correlation between the reduced sensitivity to penicillin G of Neisseria meningitidis (N.m) strains and the expression of the altered PBP 2 gene. Methods out of 190 strains of N.m isolated between 2010 and 2021 at the bacteriology laboratories of Ibn Rochd University Hospital Centre (IR-UHC) in Casablanca and the UHC Mohammed VI in Marrakech, 23 isolates were part of our study. We first determined their state of sensitivity to penicillin G by E-Test strips and searched for the expression of the penA gene by PCR followed by Sanger sequencing. Results of all the confirmed cases of N.m, 93.15% (n=177) are of serogroup B, 75.2% (n = 143) are sensitive to penicillin G and 24.73% (n = 47) are of intermediate sensitivity. No resistance to penicillin G was observed. Reduced sensitivity to penicillin G in N.m is characterized by mutations namely F504 L, A510 V, I515 V, G541 N and I566 V located in the C-terminal region of the penA gene encoding the penicillin-binding protein 2 (PBP2) (mosaic gene). Conclusion our study presents useful data for the phenotypic and genotypic monitoring of resistance to penicillin G in N.m and can contribute to the analysis of genetic exchanges between different Neisseria species.
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Affiliation(s)
- Khadija Ait Mouss
- Department of Microbiology, Laboratory of Clinical Immunology, Inflammation and Allergy, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco
- Bacteriology-Virology and Hospital Hygiene Laboratory, University Hospital Centre Ibn Rochd, 1 Rue des Hôpitaux, 20100, Casablanca, Morocco
- Institut Pasteur du Maroc, 1 Place Louis Pasteur, 20360, Casablanca, Morocco
| | - Néhémie Nzoyikorera
- Department of Microbiology, Laboratory of Clinical Immunology, Inflammation and Allergy, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco
| | - Aziza Razki
- Institut Pasteur du Maroc, 1 Place Louis Pasteur, 20360, Casablanca, Morocco
| | - Bahija Zaki
- Bacteriology-Virology and Hospital Hygiene Laboratory, University Hospital Centre Ibn Rochd, 1 Rue des Hôpitaux, 20100, Casablanca, Morocco
| | - Nabila Soraa
- Faculty of Medicine and Pharmacy of Marrakech Cadi Ayyad University, Microbiology Department, Mohamed VI University Hospital Center, Marrakech, Morocco
| | - Khalid Zerouali
- Department of Microbiology, Laboratory of Clinical Immunology, Inflammation and Allergy, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco
- Bacteriology-Virology and Hospital Hygiene Laboratory, University Hospital Centre Ibn Rochd, 1 Rue des Hôpitaux, 20100, Casablanca, Morocco
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Meningococcal carriage in men who have sex with men presenting at a sexual health unit in Spain. Eur J Clin Microbiol Infect Dis 2023; 42:287-296. [PMID: 36692604 DOI: 10.1007/s10096-023-04550-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/15/2023] [Indexed: 01/25/2023]
Abstract
Neisseria meningitidis (Nm) is asymptomatically carried in the nasopharynx of 5-10% adults, although certain populations, such as men who have sex with men (MSM), exhibit a higher colonisation rate. Interest in Nm carriage has been renewed, owed to meningitis outbreaks within populations of MSM. The aim of this study was to characterise Nm isolates and risk factors for its carriage among MSM attending a sexual health unit. A retrospective cross-sectional study was undertaken between June 2018 and December 2021. We took anal, oropharyngeal, urethral, and blood samples as part of the sexually transmitted infection screening procedures routinely implemented. Nm isolates were subjected to antimicrobial susceptibility testing; the serogroup and genogroup were determined by multi-locus sequence typing. A total of 399 subjects were recruited, and the Nm oropharyngeal carriage rate was 29%, similar among both people living with HIV (PLWH) and uninfected individuals. Nm carriage was less common in vaccinated individuals, especially those who had received the tetravalent vaccine (2.6% vs. 10.6%, p = 0.008). The most frequent serogroups were B (40%) and non-groupable (45%). Most of the isolates were susceptible to ciprofloxacin (96%) and ceftriaxone (100%). However, we identified 21 strains (20%) belonging to hyperinvasive lineages (CC11, CC4821, CC32, CC41/44, CC213, and CC269), most of which belonged to serogroup B. Given that vaccination with MenACWY was associated with a low Nm carriage, we encourage routine vaccination of all MSM. Moreover, the administration of the meningitis B vaccine should also be assessed considering that several invasive lines included in serogroup B are circulating among MSM.
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Romero R, Zarzycka A, Preussner M, Fischer F, Hain T, Herrmann JP, Roth K, Keber CU, Suryamohan K, Raifer H, Luu M, Leister H, Bertrams W, Klein M, Shams-Eldin H, Jacob R, Mollenkopf HJ, Rajalingam K, Visekruna A, Steinhoff U. Selected commensals educate the intestinal vascular and immune system for immunocompetence. MICROBIOME 2022; 10:158. [PMID: 36171625 PMCID: PMC9520927 DOI: 10.1186/s40168-022-01353-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 08/22/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The intestinal microbiota fundamentally guides the development of a normal intestinal physiology, the education, and functioning of the mucosal immune system. The Citrobacter rodentium-carrier model in germ-free (GF) mice is suitable to study the influence of selected microbes on an otherwise blunted immune response in the absence of intestinal commensals. RESULTS Here, we describe that colonization of adult carrier mice with 14 selected commensal microbes (OMM12 + MC2) was sufficient to reestablish the host immune response to enteric pathogens; this conversion was facilitated by maturation and activation of the intestinal blood vessel system and the step- and timewise stimulation of innate and adaptive immunity. While the immature colon of C. rodentium-infected GF mice did not allow sufficient extravasation of neutrophils into the gut lumen, colonization with OMM12 + MC2 commensals initiated the expansion and activation of the visceral vascular system enabling granulocyte transmigration into the gut lumen for effective pathogen elimination. CONCLUSIONS Consortium modeling revealed that the addition of two facultative anaerobes to the OMM12 community was essential to further progress the intestinal development. Moreover, this study demonstrates the therapeutic value of a defined consortium to promote intestinal maturation and immunity even in adult organisms. Video Abstract.
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Affiliation(s)
- Rossana Romero
- Institute for Medical Microbiology and Hygiene, Philipps-University Marburg, Marburg, Germany
- Cell Biology Unit, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Agnieszka Zarzycka
- Institute for Medical Microbiology and Hygiene, Philipps-University Marburg, Marburg, Germany
- Pfizer GmbH, Berlin, Germany
| | - Mathieu Preussner
- Institute for Medical Microbiology and Hygiene, Philipps-University Marburg, Marburg, Germany
| | - Florence Fischer
- Institute for Medical Microbiology and Hygiene, Philipps-University Marburg, Marburg, Germany
- Department of Environmental Immunology, Helmholtz Centre for Environmental Research - UFZ, Leipzig, Germany
| | - Torsten Hain
- Institute of Medical Microbiology, Justus Liebig University Giessen, Giessen, Germany
- Partner Site Giessen-Marburg-Langen, German Center for Infection Research (DZIF), Justus Liebig University Giessen, Giessen, Germany
| | - Jan-Paul Herrmann
- Institute of Medical Microbiology, Justus Liebig University Giessen, Giessen, Germany
| | - Katrin Roth
- Center for Tumor Biology and Immunology, Philipps University Marburg, Marburg, Germany
| | - Corinna U Keber
- Pathology, University Hospital of Giessen and Marburg (UKGM), Marburg, Germany
| | | | - Hartmann Raifer
- Flow Cytometry Core Facility, Philipps University Marburg, Marburg, Germany
| | - Maik Luu
- Institute for Medical Microbiology and Hygiene, Philipps-University Marburg, Marburg, Germany
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Hanna Leister
- Institute for Medical Microbiology and Hygiene, Philipps-University Marburg, Marburg, Germany
| | - Wilhelm Bertrams
- Institute for Lung Research, Universities of Giessen and Marburg Lung Center (UGMLC), Philipps University Marburg, Marburg, Germany
| | - Matthias Klein
- Institute for Immunology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - Hosam Shams-Eldin
- Tierexperimentelle Einrichtung, Philipps University of Marburg, Marburg, Germany
| | - Ralf Jacob
- Department of Cell Biology and Cell Pathology, Philipps University of Marburg, Marburg, Germany
| | | | - Krishnaraj Rajalingam
- Cell Biology Unit, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Alexander Visekruna
- Institute for Medical Microbiology and Hygiene, Philipps-University Marburg, Marburg, Germany
| | - Ulrich Steinhoff
- Institute for Medical Microbiology and Hygiene, Philipps-University Marburg, Marburg, Germany.
- Biomedical Research Center (BMFZ), Institute for Medical Microbiology and Hygiene, University of Marburg, Hans Meerwein Straße 2, 35043, Marburg, Germany.
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Vanbaelen T, Van Dijck C, Laumen J, Gonzalez N, De Baetselier I, Manoharan-Basil SS, De Block T, Kenyon C. Global epidemiology of antimicrobial resistance in commensal Neisseria species: A systematic review. Int J Med Microbiol 2022; 312:151551. [DOI: 10.1016/j.ijmm.2022.151551] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 01/19/2022] [Accepted: 02/21/2022] [Indexed: 11/16/2022] Open
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Alwassil OI, Chandrashekharappa S, Nayak SK, Venugopala KN. Design, synthesis, and structural elucidation of novel NmeNANAS inhibitors for the treatment of meningococcal infection. PLoS One 2019; 14:e0223413. [PMID: 31618227 PMCID: PMC6795526 DOI: 10.1371/journal.pone.0223413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 09/20/2019] [Indexed: 12/18/2022] Open
Abstract
Neisseria meningitidis is the primary cause of bacterial meningitis in many parts of the world, with considerable mortality rates among neonates and adults. In Saudi Arabia, serious outbreaks of N. meningitidis affecting several hundreds of pilgrims attending Hajj in Makkah were recorded in the 2000–2001 season. Evidence shows increased rates of bacterial resistance to penicillin and other antimicrobial agents that are used in the treatment of the meningococcal disease. The host’s immune system becomes unable to recognize the polysialic acid capsule of the resistant N. meningitidis that mimics the mammalian cell surface. The biosynthetic pathways of sialic acid (i.e., N-acetylneuraminic acid [NANA]) in bacteria, however, are somewhat different from those in mammals. The largest obstacle facing previously identified inhibitors of NANA synthase (NANAS) in N. meningitidis is that these inhibitors feature undesired chemical and pharmacological characteristics. To better comprehend the binding mechanism underlying these inhibitors at the catalytic site of NANAS, we performed molecular modeling studies to uncover essential structural aspects for the ultimate recognition at the catalytic site required for optimal inhibitory activity. Applying two virtual screening candidate molecules and one designed molecule showed promising structural scaffolds. Here, we report ethyl 3-benzoyl-2,7-dimethyl indolizine-1-carboxylate (INLZ) as a novel molecule with high energetic fitness scores at the catalytic site of the NmeNANAS enzyme. INLZ represents a promising scaffold for NmeNANAS enzyme inhibitors, with new prospects for further structural development and activity optimization.
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Affiliation(s)
- Osama I. Alwassil
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Kingdom of Saudi Arabia
- Department of Pharmaceutical Sciences, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
- * E-mail:
| | | | - Susanta K. Nayak
- Department of Chemistry, Visvesvaraya National Institute of Technology, Nagpur, Maharashtra, India
| | - Katharigatta N. Venugopala
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Kingdom of Saudi Arabia
- Department of Biotechnology and Food Technology, Faculty of Applied Science, Durban University of Technology, Durban, South Africa
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Neri A, Fazio C, Ambrosio L, Vacca P, Barbui A, Daprai L, Vocale C, Santino I, Conte M, Rossi L, Ciammaruconi A, Anselmo A, Lista F, Stefanelli P. Carriage meningococcal isolates with capsule null locus dominate among high school students in a non-endemic period, Italy, 2012-2013. Int J Med Microbiol 2019; 309:182-188. [PMID: 30878541 DOI: 10.1016/j.ijmm.2019.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/19/2019] [Accepted: 03/05/2019] [Indexed: 01/06/2023] Open
Abstract
Meningococcal disease incidence in Italy remains quite low in the overall population except for infants. Within a study on carriage isolates among high school students we aimed to define: i) the prevalence of carriage isolates, ii) the phenotypic and iii) the molecular features of meningococci by Whole Genome Sequencing (WGS). A total of 1697 pharyngeal samples from undergraduate students (age range 14-19 years) were collected from 2012 to 2013 from six larger cities in Italy. One hundred and twenty culture positive meningococci (7%) were analyzed. Carriage isolates were sent to the National Reference Laboratory for invasive meningococcal disease (IMD) for PCR-based serogroup identification, Multilocus Sequence Typing, PorA and FetA typing. Moreover, factor H binding protein (fHbp), Neisseria Heparin Binding Antigen (NHBA) and Neisserial adhesin A (NadA) were typed. Core genome MLST (cgMLST) was performed on a subsample of 75 carriage isolates. Capsule null locus (cnl) predominated (47%), followed by serogroup B (27%). The antimicrobial susceptibility profile revealed an high prevalence of reduced susceptibility to penicillin G (54%) and a full susceptibility to ceftriaxone, ciprofloxacin and rifampicin. Carriage isolates presented a high genetic diversity: the clonal complexes (ccs) cc1136, cc198 and cc41/44, were the predominant. An high heterogeneity was also observed for PorA and FetA types. The fhbp and nhba genes were identified in all the carriage isolates; only 5% of the carriage isolates presented the nadA gene. The core genome MLST analysis revealed that the majority of the cnl isolates clustered in a distinct group. The evidence gathered during this study provides the estimate of carriage isolates in high school students in a non-epidemic period in Italy that was lower than expected. Moreover, the highest proportion of carriage isolates were cnl and, overall, they were molecular heterogeneous.
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Affiliation(s)
- Arianna Neri
- Department of Infectious Diseases, Istituto Superiore di Sanità, Roma, Italy
| | - Cecilia Fazio
- Department of Infectious Diseases, Istituto Superiore di Sanità, Roma, Italy
| | - Luigina Ambrosio
- Department of Infectious Diseases, Istituto Superiore di Sanità, Roma, Italy
| | - Paola Vacca
- Department of Infectious Diseases, Istituto Superiore di Sanità, Roma, Italy
| | - Annamaria Barbui
- Microbiology and Virology Laboratory, Molinette Hospital, Torino, Italy
| | - Laura Daprai
- Microbiology Laboratory, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Caterina Vocale
- Unit of Clinical Microbiology, Regional Reference Center for Microbiological Emergencies (CRREM), St. Orsola-Malpighi Hospital, University of Bologna, Italy
| | - Iolanda Santino
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University "Sapienza", Roma, Italy
| | - Marco Conte
- Microbiology Laboratory, AO "Ospedale Domenico Cotugno'', Napoli, Italy
| | - Lucia Rossi
- Microbiology and Virology Unit, University Hospital, Padova, Italy
| | | | - Anna Anselmo
- Scientific Department, Army Medical Center, Roma, Italy
| | | | - Paola Stefanelli
- Department of Infectious Diseases, Istituto Superiore di Sanità, Roma, Italy.
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Mass chemoprophylaxis for control of outbreaks of meningococcal disease. THE LANCET. INFECTIOUS DISEASES 2018; 18:e272-e281. [PMID: 29858150 DOI: 10.1016/s1473-3099(18)30124-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 11/18/2017] [Accepted: 01/25/2018] [Indexed: 01/09/2023]
Abstract
Although vaccination is the main strategy used to control meningococcal disease outbreaks, mass chemoprophylaxis has also been used as an immediate response to outbreaks, either to supplement vaccination or when vaccination is not possible. However, public health guidelines regarding the use of mass chemoprophylaxis for outbreak control vary by country, partly because the impact of mass chemoprophylaxis on the course of an individual outbreak is difficult to assess. We have reviewed data for the use of mass chemoprophylaxis during 33 outbreaks that occurred both in military populations and in communities and non-military organisations. In most outbreaks, no additional cases of meningococcal disease occurred after mass chemoprophylaxis, or cases occurred only in individuals who had not received prophylaxis. A delay of several weeks was common before cases occurred among prophylaxis recipients. Overall, the outbreak reports that we reviewed suggest that mass chemoprophylaxis might provide temporary protection to chemoprophylaxis recipients during outbreaks.
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Chisholm RH, Campbell PT, Wu Y, Tong SYC, McVernon J, Geard N. Implications of asymptomatic carriers for infectious disease transmission and control. ROYAL SOCIETY OPEN SCIENCE 2018; 5:172341. [PMID: 29515909 PMCID: PMC5830799 DOI: 10.1098/rsos.172341] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 01/11/2018] [Indexed: 05/19/2023]
Abstract
For infectious pathogens such as Staphylococcus aureus and Streptococcus pneumoniae, some hosts may carry the pathogen and transmit it to others, yet display no symptoms themselves. These asymptomatic carriers contribute to the spread of disease but go largely undetected and can therefore undermine efforts to control transmission. Understanding the natural history of carriage and its relationship to disease is important for the design of effective interventions to control transmission. Mathematical models of infectious diseases are frequently used to inform decisions about control and should therefore accurately capture the role played by asymptomatic carriers. In practice, incorporating asymptomatic carriers into models is challenging due to the sparsity of direct evidence. This absence of data leads to uncertainty in estimates of model parameters and, more fundamentally, in the selection of an appropriate model structure. To assess the implications of this uncertainty, we systematically reviewed published models of carriage and propose a new model of disease transmission with asymptomatic carriage. Analysis of our model shows how different assumptions about the role of asymptomatic carriers can lead to different conclusions about the transmission and control of disease. Critically, selecting an inappropriate model structure, even when parameters are correctly estimated, may lead to over- or under-estimates of intervention effectiveness. Our results provide a more complete understanding of the role of asymptomatic carriers in transmission and highlight the importance of accurately incorporating carriers into models used to make decisions about disease control.
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Affiliation(s)
- Rebecca H. Chisholm
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Author for correspondence: Nicholas Geard e-mail:
| | - Patricia T. Campbell
- Modelling and Simulation Research Group, Murdoch Childrens Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
- The Peter Doherty Institute for Infection and Immunity, The University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Yue Wu
- Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, University of Western Australia, Subiaco, Western Australia, Australia
| | - Steven Y. C. Tong
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, and the University of Melbourne, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Jodie McVernon
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Modelling and Simulation Research Group, Murdoch Childrens Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
- The Peter Doherty Institute for Infection and Immunity, The University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Nicholas Geard
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- School of Computing and Information Systems, Melbourne School of Engineering, The University of Melbourne, Melbourne, Victoria, Australia
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Harcourt BH, Anderson RD, Wu HM, Cohn AC, MacNeil JR, Taylor TH, Wang X, Clark TA, Messonnier NE, Mayer LW. Population-Based Surveillance of Neisseria meningitidis Antimicrobial Resistance in the United States. Open Forum Infect Dis 2015; 2:ofv117. [PMID: 26357666 PMCID: PMC4561371 DOI: 10.1093/ofid/ofv117] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 08/03/2015] [Indexed: 01/14/2023] Open
Abstract
Isolates of Neisseria meningitidis collected in 2004, 2008, 2010, and 2011 from an active population-based surveillance system in the United States were tested for susceptibility to antimicrobials used for treatment and chemoprophylaxis of meningococcal disease. Susceptibility remains high and stable. Background. Antimicrobial treatment and chemoprophylaxis of patients and their close contacts is critical to reduce the morbidity and mortality and prevent secondary cases of meningococcal disease. Through the 1990's, the prevalence of antimicrobial resistance to commonly used antimicrobials among Neisseria meningitidis was low in the United States. Susceptibility testing was performed to ascertain whether the proportions of isolates with reduced susceptibility to antimicrobials commonly used for N meningitidis have increased since 2004 in the United States. Methods. Antimicrobial susceptibility testing was performed by broth microdilution on 466 isolates of N meningitidis collected in 2004, 2008, 2010, and 2011 from an active, population-based surveillance system for susceptibility to ceftriaxone, ciprofloxacin, penicillin G, rifampin, and azithromycin. The molecular mechanism of reduced susceptibility was investigated for isolates with intermediate or resistant phenotypes. Results. All isolates were susceptible to ceftriaxone and azithromycin, 10.3% were penicillin G intermediate (range, 8% in 2008–16.7% in 2010), and <1% were ciprofloxacin, rifampin, or penicillin G resistant. Of the penicillin G intermediate or resistant isolates, 63% contained mutations in the penA gene associated with reduced susceptibility to penicillin G. All ciprofloxacin-resistant isolates contained mutations in the gyrA gene associated with reduced susceptibility. Conclusions. Resistance of N meningitidis to antimicrobials used for empirical treatment of meningitis in the United States has not been detected, and resistance to penicillin G and chemoprophylaxis agents remains uncommon. Therapeutic agent recommendations remain valid. Although periodic surveillance is warranted to monitor trends in susceptibility, routine clinical testing may be of little use.
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Affiliation(s)
- Brian H Harcourt
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases , Centers for Disease Control and Prevention
| | - Raydel D Anderson
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases , Centers for Disease Control and Prevention
| | - Henry M Wu
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases , Centers for Disease Control and Prevention
| | - Amanda C Cohn
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases , Centers for Disease Control and Prevention
| | - Jessica R MacNeil
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases , Centers for Disease Control and Prevention
| | - Thomas H Taylor
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases , Centers for Disease Control and Prevention
| | - Xin Wang
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases , Centers for Disease Control and Prevention
| | - Thomas A Clark
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases , Centers for Disease Control and Prevention
| | - Nancy E Messonnier
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases , Centers for Disease Control and Prevention
| | - Leonard W Mayer
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases , Centers for Disease Control and Prevention
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Tropheryma whipplei natural resistance to trimethoprim and sulphonamides in vitro. Int J Antimicrob Agents 2014; 43:388-90. [DOI: 10.1016/j.ijantimicag.2014.01.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 01/21/2014] [Indexed: 12/17/2022]
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Abstract
The epidemiology of bacterial meningitis in the United States has changed tremendously in the past 20 years. Since the introduction of the Haemophilus influenzae type b vaccine in 1988, the incidence of H. influenzae type b meningitis has declined by at least 97%, and Streptococcus pneumoniae has emerged as the most common etiologic agent. The PCV7 (7-valent pneumococcal conjugate vaccine [Prevnar]; Wyeth Pharmaceuticals) vaccine, which targets 7 pneumococcal serotypes, was introduced in 2000 and has had an enormous impact on both the incidence and epidemiology of bacterial meningitis. This article reviews the impact of the PCV7 vaccine and the most up-to-date evidence on diagnosis and empiric therapy of suspected bacterial meningitis in the current day.
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Hedberg ST, Olcén P, Fredlund H, Unemo M. Antibiotic susceptibility of invasive Neisseria meningitidis isolates from 1995 to 2008 in Sweden—the meningococcal population remains susceptible. ACTA ACUST UNITED AC 2009; 42:61-4. [DOI: 10.3109/00365540903292682] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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13
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Tzanakaki G, Mastrantonio P. Aetiology of bacterial meningitis and resistance to antibiotics of causative pathogens in Europe and in the Mediterranean region. Int J Antimicrob Agents 2007; 29:621-9. [PMID: 17368858 DOI: 10.1016/j.ijantimicag.2006.11.031] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Accepted: 11/14/2006] [Indexed: 11/22/2022]
Abstract
Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae type b are most commonly associated with bacterial meningitis accounting for almost 90% of reported cases of acute bacterial meningitis in infants over 60 days of age and young children. This work reviews the epidemiology of bacterial meningitis in Europe and in the Mediterranean region as well as the antimicrobial susceptibility of the etiological agents.
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Affiliation(s)
- Georgina Tzanakaki
- National Meningitis Reference Laboratory, National School of Public Health, Athens, Greece
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14
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Lepe JA, Salcedo C, Alcalá B, Vázquez JA. [Evolution of Neisseria meningitidis sensitivity to various antimicrobial drugs over the course of chemoprophylaxis during an epidemic outbreak]. Enferm Infecc Microbiol Clin 2006; 24:608-12. [PMID: 17194385 DOI: 10.1157/13095371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The aim of this study was to assess the evolution of the population MICs for various antimicrobial drugs against Neisseria meningitidis isolates obtained from asymptomatic carriers during a chemoprophylaxis campaign carried out for an epidemic outbreak of meningococcal disease in Nerva, a small town in Huelva province (Spain). MATERIAL AND METHODS A nasopharyngeal carrier study including 427 people was carried out to determine the incidence rate of the epidemic strain among the general population. On the basis of the results, chemoprophylaxis with rifampicin was administered to the population aged 15 to 29 years (age group showing the highest incidence of the epidemic strain among carriers) living in Nerva. Three months later a new carrier study was performed (507 people) to evaluate the effects of chemoprophylaxis. Given the evolution of the outbreak, seven months later a new intervention was required with ciprofloxacin chemoprophylaxis; a second carrier study (399 people) was performed two months later to evaluate its effect. RESULTS The number of strains isolated during the three carrier studies was 59 (13.8%), 33 (6.5%), and 22 (5.5%), respectively. Analysis of the changes in the MIC50 and MIC90 for the various antibiotics from the first to the second carrier study (rifampicin chemoprophylaxis) showed statistical differences only in the distribution of rifampicin MICs. Similarly, when changes from the second to the third study were analyzed (ciprofloxacin chemoprophylaxis), significant variations were detected for the cefotaxime MICs. Nevertheless, although there were changes in the MICs, the percentages of susceptibility from the beginning to the end of the study did not vary. CONCLUSIONS Massive chemoprophylaxis in the age group with the highest incidence of the epidemic strain among carriers did not clearly modify the antibiotic susceptibility of the isolates. However, a slight increase in the MIC50 and MIC90 was observed for rifampicin after the first chemoprophylactic intervention and for cefotaxime at the end of the study. Consecutive chemoprophylactic interventions with rifampicin and ciprofloxacin had an impact on the percentage of meningococcal carriers in the overall population, with a clearly decreasing trend.
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Affiliation(s)
- José A Lepe
- Laboratorio de Microbiología, Hospital de Riotinto, Huelva, España.
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15
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FERREIRA E, DIAS R, CANIÇA M. Antimicrobial susceptibility, serotype and genotype distribution of meningococci in Portugal, 2001-2002. Epidemiol Infect 2006; 134:1203-7. [PMID: 16740192 PMCID: PMC2870526 DOI: 10.1017/s0950268806006492] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2006] [Indexed: 11/06/2022] Open
Abstract
One hundred and eighteen Neisseria meningitidis isolates were recovered from patients with invasive meningococcal disease in Portugal, over one year. Our study was undertaken to evaluate antimicrobial susceptibility, serogroup, serotype and genotype of isolates. One quarter (24.6%) of the isolates showed moderate resistance to penicillin and 47.4% were resistant to sulphadiazine. The two most common serosubtypes were C:2b:P1.5,2 (31.3%) and B:4:P1.15 (3.4%). Half (53.6%) of the isolates with moderate resistance to penicillin were phenotype C:2b:P1.5,2 (n=14), C:2b:P1.2 (n=1) or C:2b:NST (n=1); Pulsed-field gel electrophoresis (PFGE) showed that all these isolates were genetically related. Multilocus sequence typing (MLST) analysis of representative clones from each PFGE pattern showed the predominance of the ST-8 complex/cluster A4 among N. meningitidis with moderate resistance to penicillin. This clonal complex has been principally found in Southern Europe. The apparent emergence and dissemination of the hypervirulent ST-8 complex/cluster A4 among serogroup C strains increases the need for a continued surveillance of antimicrobial susceptibility of meningococci and of genotypic markers in Portugal.
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Affiliation(s)
- E. FERREIRA
- Antibiotic Resistance Unit, Centre of Bacteriology, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - R. DIAS
- Antibiotic Resistance Unit, Centre of Bacteriology, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - M. CANIÇA
- Antibiotic Resistance Unit, Centre of Bacteriology, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
- Author for correspondence: Dr M. Caniça, Antibiotic Resistance Unit, National Institute of Health Dr. Ricardo Jorge, Av. Padre Cruz, 1649-016 Lisbon, Portugal. ()
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16
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Glikman D, Matushek SM, Kahana MD, Daum RS. Pneumonia and empyema caused by penicillin-resistant Neisseria meningitidis: a case report and literature review. Pediatrics 2006; 117:e1061-6. [PMID: 16606681 DOI: 10.1542/peds.2005-1994] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pneumonia is an uncommon manifestation of Neisseria meningitidis infection, and empyema is rarely reported. Uniform penicillin susceptibility has been assumed for meningococcal infections for many years, but decreased penicillin susceptibility has been recognized recently with increasing frequency. Breakpoints to define different categories of susceptibility were published recently by the Clinical and Laboratory Standards Institute. We report the case of a teenage girl with sepsis and extensive bilateral pneumonia with empyema caused by an N meningitidis isolate that was resistant to penicillin. Her protracted clinical course suggested that penicillin resistance contributed to her delayed recovery. Our experience with this patient suggests that susceptibility testing should be performed in every case of N meningitidis isolation, and treatment with a third-generation cephalosporin should be provided until the susceptibility results are known. Clinical suspicion of N meningitidis as a possible cause of respiratory symptoms accompanied by hypotension, even in the absence of a rash, may aid in diagnosis and therefore in the treatment and provision of prophylaxis to contacts of patients with meningococcal disease.
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Affiliation(s)
- Daniel Glikman
- Department of Pediatrics, University of Chicago, Chicago, Illinois, USA.
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17
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Jorgensen JH, Crawford SA, Fiebelkorn KR. Susceptibility of Neisseria meningitidis to 16 antimicrobial agents and characterization of resistance mechanisms affecting some agents. J Clin Microbiol 2005; 43:3162-71. [PMID: 16000430 PMCID: PMC1169190 DOI: 10.1128/jcm.43.7.3162-3171.2005] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2004] [Revised: 02/28/2005] [Accepted: 03/25/2005] [Indexed: 11/20/2022] Open
Abstract
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 (> or =0.12 microg/ml and > or =0.25 microg/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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Affiliation(s)
- James H Jorgensen
- Department of Pathology, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA.
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18
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Caniça M, Dias R, Nunes B, Carvalho L, Ferreira E. Invasive culture-confirmed Neisseria meningitidis in Portugal: evaluation of serogroups in relation to different variables and antimicrobial susceptibility (2000–2001). J Med Microbiol 2004; 53:921-925. [PMID: 15314201 DOI: 10.1099/jmm.0.45556-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The first investigation of Neisseria meningitidis isolated from a large area covering an appreciable population in Portugal, before the voluntary vaccination period with the serogroup C conjugate vaccine, is reported. The serogroups and antimicrobial susceptibility of 116 isolates were studied. Serogroups C (50.0 %), B (47.4 %) and W135 (2.6 %) were found. Serogroup C was most common in the 1-15-years-old group and B in the less than 1-year-old and over 16-years-old groups (P = 0.042). Clinical diagnosis of meningococcal disease was primarily meningitis for patients with serogroup C and meningitis associated with sepsis for those with serogroup B. Penicillin resistance was significantly associated with serogroup C (P < 0.001). This work reinforces the importance for public health of monitoring the serogroup and antimicrobial susceptibility of isolates from patients with invasive meningococcal disease.
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MESH Headings
- Adolescent
- Anti-Bacterial Agents/pharmacology
- Child
- Child, Preschool
- Culture Media
- Female
- Humans
- Infant
- Male
- Meningitis, Meningococcal/epidemiology
- Meningitis, Meningococcal/microbiology
- Meningococcal Infections/epidemiology
- Meningococcal Infections/microbiology
- Microbial Sensitivity Tests
- Neisseria meningitidis/classification
- Neisseria meningitidis/drug effects
- Neisseria meningitidis/growth & development
- Neisseria meningitidis/isolation & purification
- Neisseria meningitidis, Serogroup B/classification
- Neisseria meningitidis, Serogroup B/drug effects
- Neisseria meningitidis, Serogroup B/isolation & purification
- Neisseria meningitidis, Serogroup C/classification
- Neisseria meningitidis, Serogroup C/drug effects
- Neisseria meningitidis, Serogroup C/isolation & purification
- Neisseria meningitidis, Serogroup W-135/classification
- Neisseria meningitidis, Serogroup W-135/drug effects
- Neisseria meningitidis, Serogroup W-135/isolation & purification
- Penicillins/pharmacology
- Portugal/epidemiology
- Serotyping
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Affiliation(s)
- Manuela Caniça
- Antibiotic Resistance Unit, Centre of Bacteriology1 and National Observatory for Health2, National Institute of Health Dr Ricardo Jorge, Lisboa, Portugal 3Paediatric Infectious Diseases Unit, Hospital de Dona Estefânia, Lisboa, Portugal
| | - Ricardo Dias
- Antibiotic Resistance Unit, Centre of Bacteriology1 and National Observatory for Health2, National Institute of Health Dr Ricardo Jorge, Lisboa, Portugal 3Paediatric Infectious Diseases Unit, Hospital de Dona Estefânia, Lisboa, Portugal
| | - Baltazar Nunes
- Antibiotic Resistance Unit, Centre of Bacteriology1 and National Observatory for Health2, National Institute of Health Dr Ricardo Jorge, Lisboa, Portugal 3Paediatric Infectious Diseases Unit, Hospital de Dona Estefânia, Lisboa, Portugal
| | - Leonor Carvalho
- Antibiotic Resistance Unit, Centre of Bacteriology1 and National Observatory for Health2, National Institute of Health Dr Ricardo Jorge, Lisboa, Portugal 3Paediatric Infectious Diseases Unit, Hospital de Dona Estefânia, Lisboa, Portugal
| | - Eugénia Ferreira
- Antibiotic Resistance Unit, Centre of Bacteriology1 and National Observatory for Health2, National Institute of Health Dr Ricardo Jorge, Lisboa, Portugal 3Paediatric Infectious Diseases Unit, Hospital de Dona Estefânia, Lisboa, Portugal
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Arreaza L, Salcedo C, Alcalá B, Uría MJ, Abad R, Enríquez R, Vázquez JA. Sequencing of Neisseria meningitidis penA gene: the key to success in defining penicillin G breakpoints. Antimicrob Agents Chemother 2004; 48:358-9. [PMID: 14693567 PMCID: PMC310191 DOI: 10.1128/aac.48.1.358-359.2004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Testing of susceptibility to penicillin G by E-test and sequencing of an internal fragment of the penA gene were done for 43 meningococcal strains. Those strains for which the MIC was >/=0.094 micro g/ml showed mosaic alleles, so 0.094 micro g/ml is suggested as the penicillin G intermediate breakpoint when E-test is used.
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Affiliation(s)
- Luisa Arreaza
- Reference Laboratory for Meningococci, National Center of Microbiology, Institute of Health Carlos III, Madrid, Spain
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20
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Vázquez JA, Arreaza L, Block C, Ehrhard I, Gray SJ, Heuberger S, Hoffmann S, Kriz P, Nicolas P, Olcen P, Skoczynska A, Spanjaard L, Stefanelli P, Taha MK, Tzanakaki G. Interlaboratory comparison of agar dilution and Etest methods for determining the MICs of antibiotics used in management of Neisseria meningitidis infections. Antimicrob Agents Chemother 2003; 47:3430-4. [PMID: 14576098 PMCID: PMC253763 DOI: 10.1128/aac.47.11.3430-3434.2003] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2003] [Revised: 06/09/2003] [Accepted: 07/15/2003] [Indexed: 11/20/2022] Open
Abstract
Previous studies have shown that there is considerable variation in the methods and media used to determine the susceptibility of Neisseria meningitidis to antimicrobial agents in different countries. In this study, national and regional reference laboratories used a standardized methodology to determine the MICs of antibiotics used in the management of meningococcal infection. Fourteen laboratories participated in the study, determining the susceptibility to penicillin G, rifampin, cefotaxime, ceftriaxone, ciprofloxacin, and ofloxacin of a collection of 17 meningococci, of which 11 strains were previously defined as having intermediate resistance to penicillin (Pen(I)) by sequencing and restriction fragment length polymorphism analysis of the penA gene. The MIC was determined by agar dilution and Etest with Mueller-Hinton agar (MH), MH supplemented with sheep blood (MH+B), and MH supplemented with heated (chocolated) blood. Several laboratories encountered problems obtaining confluent growth with unsupplemented MH. MH+B was considered to give the most congruent and reproducible results among the study laboratories. The modal MIC for MH+B for each antibiotic and method was calculated to define the MIC consensus, allowing assessment of each individual laboratory's data in relation to the others. The agreement in each antibiotic/method/medium combination was defined as the percentage of laboratories with a result within one dilution of the modal result. For the whole study, an agreement of 90.6% was observed between agar dilution and Etest methods. The agreement in each laboratory/antibiotic/method combination ranged from 98.2% to 69.7%, with six laboratories demonstrating agreement higher than 90% and 11 more than 80%. The ability of the laboratories to detect the Pen(I) isolates ranged from 18.2% to 100%. The apparent difficulty in interpreting susceptibility to rifampin, particularly with the Etest method, is very interesting.
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Affiliation(s)
- Julio A Vázquez
- National Institute of Health Carlos III, Majadahonda, Madrid, Spain.
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21
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Antignac A, Ducos-Galand M, Guiyoule A, Pirès R, Alonso JM, Taha MK. Neisseria meningitidis strains isolated from invasive infections in France (1999-2002): phenotypes and antibiotic susceptibility patterns. Clin Infect Dis 2003; 37:912-20. [PMID: 13130402 DOI: 10.1086/377739] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2003] [Accepted: 05/31/2003] [Indexed: 11/03/2022] Open
Abstract
Infections due to Neisseria meningitidis are a major public health concern. In France, during 1999-2002, a total of 2167 clinical isolates of N. meningitidis from invasive infections were studied at the National Reference Center for Meningococci (Paris). Serogroup B strains were the most common (58%), followed by serogroup C strains (29%) and serogroup W135 strains (8%). Various phenotypes were observed, reflecting heterogeneity in the meningococcal population. Strains were susceptible to antibiotics currently used for treatment and chemoprophylaxis of meningococcal infections. However, the prevalence of meningococci with reduced susceptibility to penicillin is increasing. Such strains were heterogeneous and accounted for approximately 30% of isolates during this period, warranting continued surveillance of this phenomenon.
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Affiliation(s)
- Aude Antignac
- Unité des Neisseria and Centre National de Référence des Méningocoques, Institut Pasteur, Paris, France
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22
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Ellis-Pegler R, Galler L, Roberts S, Thomas M, Woodhouse A. Three days of intravenous benzyl penicillin treatment of meningococcal disease in adults. Clin Infect Dis 2003; 37:658-62. [PMID: 12942396 DOI: 10.1086/377203] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2003] [Accepted: 04/18/2003] [Indexed: 11/03/2022] Open
Abstract
New Zealand has experienced an epidemic of predominantly serogroup B meningococcal disease during the past decade. In a prospective study, we treated adults (age, >15 years) with meningococcal disease with intravenous benzyl penicillin (12 MU [7.2 g] per day) for 3 days. Sixty-one adults with suspected meningococcal disease were consecutively admitted during the 33-month period; 3 patients were excluded. The 58 patients had a mean age (+/- standard deviation [SD]) of 27.9+/-14.5 years (median, 21 years; range, 15-70 years). Forty-four patients had confirmed and 14 patients had probable meningococcal disease. Fifty-seven patients received 12 MU (7.2 g) and 1 received 8 MU (4.8 g) of benzyl penicillin per day. Thirteen patients received additional antibiotics within the first 24 h because of diagnostic uncertainties. Patients received a mean (+/-SD) of 3.0+/-0.5 days of treatment. No patients relapsed. Five patients died. All but 1 death occurred during benzyl penicillin treatment, and the only posttreatment death was not due to meningococcal disease. Three days of intravenous benzyl penicillin is sufficient treatment for adults with meningococcal disease. The usual recommendations for duration of treatment are excessive.
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Affiliation(s)
- Rod Ellis-Pegler
- Department of Infectious Diseases, Auckland Hospital, Auckland, New Zealand.
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Richter SS, Gordon KA, Rhomberg PR, Pfaller MA, Jones RN. Neisseria meningitidis with decreased susceptibility to penicillin: report from the SENTRY antimicrobial surveillance program, North America, 1998-99. Diagn Microbiol Infect Dis 2001; 41:83-8. [PMID: 11687319 DOI: 10.1016/s0732-8893(01)00289-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to estimate the prevalence of Neisseria meningitidis with decreased susceptibility to penicillin (MIC, >0.06 microg/mL) in North America (NA). Antimicrobial susceptibility testing by Etest (AB BIODISK, Solna, Sweden) was performed on 53 invasive clinical isolates obtained from 11 SENTRY Antimicrobial Surveillance Program participants in NA (9 states, 2 provinces) during 1998-99. All strains were markedly susceptible to ciprofloxacin (MIC(90), 0.008 microg/mL) and cefotaxime (MIC(90), < or = 0.002 microg/mL). Only 54.7% were susceptible to trimethoprim-sulfamethoxazole (TMP/SMX) at < or = 0.5/9.5 microg/mL. One strain was resistant to rifampin (MIC, > 32 microg/mL) and 16 isolates (30.2%) were relatively resistant to penicillin with MICs ranging from 0.094 to 0.25 microg/mL. No beta-lactamase production was detected. The serogroup distribution was 40% Y, 28% B, 24% C, 2% W-135, and 6% of strains were nongroupable. The prevalence of N. meningitidis with decreased susceptibility to penicillin in NA appears higher than previous reports.
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Affiliation(s)
- S S Richter
- Medical Microbiology Division, Department of Pathology, University of Iowa College of Medicine, Iowa City, Iowa, USA.
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