Emergence of Ciprofloxacin-Resistant<i>Neisseria meningitidis</i>in North America

Wu, Henry M.; Harcourt, Brian H.; Hatcher, Cynthia; Wei, Stanley C.; Novak, Ryan T.; Wang, Xin; Juni, Billie A.; Glennen, Anita; Boxrud, David; Rainbow, Jean; Schmink, Susanna; Mair, Raydel; Theodore, M. Jordan; Sander, Molly A.; Miller, Tracy K.; Kruger, Kirby; Cohn, Amanda C.; Clark, Thomas A.; Messonnier, Nancy E.; Mayer, Leonard W.; Lynfield, Ruth

doi:10.1056/nejmoa0806414

Cited by 124 publications

(90 citation statements)

References 25 publications

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“…Despite this limitation, the use of ceftriaxone as empirical therapy in our institution is recommended until penicillin susceptibility has been determined [25,26]. In our series, resistance to fluoroquinolones was not described; however, resistance to this antimicrobial group has been documented in recent publications in North America [10].…”

Section: Discussionmentioning

confidence: 95%

“…A vaccine against serogroup B is not available, however, two possible candidates obtained from meningococcal recombinant proteins are under development. The emergence of N. meningitidis strains resistant to different antimicrobial agents has been recorded, with resistance to penicillin found in multiple countries [10] and resistance to quinolones reported in North America in recent years [11,12,13].…”

Section: Introductionmentioning

confidence: 99%

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Epidemiology of meningococcal disease in the Panamanian pediatric population, 1998-2008

Guevara

Luciani

Montesdeoca-Melían

et al. 2010

J Infect Dev Ctries

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Introduction: Worldwide public health authorities report 500,000 cases of invasive meningococcal disease with 50,000 deaths per year and 10-15% of sequelae in people affected. This study describes the epidemiology, microbiology, and clinical presentation of this disease in the Panamanian pediatric population. Methodology: The discharge of patients with a meningococcal invasive disease diagnosis was reviewed in the statistical database and archives of the Hospital del Niño. Results: A total of 32 discharges with a meningococcal disease diagnosis were reported during the study period (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008). Ninety-one percent (n/N = 29/32) were confirmed as meningitis. The mean age of patients was 4.1 ± 4.6 years. The incidence in the period of the study was 0.25/100,000. Infants younger than one year old presented the highest incidence rate and number of cases. Four deaths were reported, three of which occurred in the group of 10-14 years and one in the group of 1-4 years. The overall fatality rate was 12.5%. The serogroup of the causative agent, Neisseria meningitidis, was documented in 30 of the 32 cases, with serogroup B the most frequent (66.7%). Ninetypercent (18/20) of serogroup B were isolated in the first five years of study. Serogroup C was identified in 8 of the 12 cases during the period

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Epidemiology of meningococcal disease in the Panamanian pediatric population, 1998-2008

Guevara

Luciani

Montesdeoca-Melían

et al. 2010

J Infect Dev Ctries

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“…On the other hand, resistant N. meningitidis has not spread widely, possibly because the acquisition of rifampicin resistance appears to confer a biological disadvantage [71]. Ciprofloxacin-resistant N. meningitidis was isolated in the USA in 2009 from three IMD cases and two carriers, one after contact with one of the patients and after receipt of ciprofloxacin [78] ; no further cases have been described after recommendations to use other antibiotics for prophylaxis in the affected regions. Another theoretical negative effect of chemoprophylaxis is the eradication of N. lactamica from the nasopharynx.…”

Section: Discussionmentioning

confidence: 99%

What is the evidence for giving chemoprophylaxis to children or students attending the same preschool, school or college as a case of meningococcal disease?

Hellenbrand

Hanquet²,

Heuberger

et al. 2011

Epidemiol. Infect.

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SUMMARYWe performed a systematic literature review to assess the effectiveness of chemoprophylaxis for contacts of sporadic cases of invasive meningococcal disease (IMD) in educational settings. No studies directly compared IMD risk in contacts with/without chemoprophylaxis. However, compared to the background incidence, an elevated IMD risk was identified in settings without a general recommendation for chemoprophylaxis in pre-schools [pooled risk difference (RD) 58 . 2/10 5 , 95 % confidence interval (CI) 27 . 3-89 . 0] and primary schools (pooled RD 4 . 9/10 5 , 95% CI 2 . 9-6 . 9) in the y30 days after contact with a sporadic IMD case, but not in other educational settings. Thus, limited but consistent evidence suggests the risk of IMD in pre-school contacts of sporadic IMD cases is significantly increased above the background risk, but lower than in household contacts (pooled RD for household contacts with no chemoprophylaxis vs. background incidence : 480 . 1/10 5 , 95 % CI 321 . 5-639 . 9). We recommend chemoprophylaxis for pre-school contacts depending on an assessment of duration and closeness of contact.

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“…Commensals are reservoirs of antibiotic resistance determinants, and HGT likely plays an important role in their spread among the pathogens. Supporting this notion are the observations that a N. meningitidis strain responsible for an outbreak in the Midwest appears to have acquired its ciprofloxacin-resistant gyrA allele from commensal N. lactamica carried in the community (27); and that the cephalosporin resistance of some N. gonorrhoeae strains is because of mosaic penA alleles of commensal origin (28)(29)(30).…”

Section: Discussionmentioning

confidence: 99%

Neisseria infection of rhesus macaques as a model to study colonization, transmission, persistence, and horizontal gene transfer

Weyand

Wertheimer

Hobbs

et al. 2013

Proc. Natl. Acad. Sci. U.S.A.

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The strict tropism of many pathogens for man hampers the development of animal models that recapitulate important microbehost interactions. We developed a rhesus macaque model for studying Neisseria-host interactions using Neisseria species indigenous to the animal. We report that Neisseria are common inhabitants of the rhesus macaque. Neisseria isolated from the rhesus macaque recolonize animals after laboratory passage, persist in the animals for at least 72 d, and are transmitted between animals. Neisseria are naturally competent and acquire genetic markers from each other in vivo, in the absence of selection, within 44 d after colonization. Neisseria macacae encodes orthologs of known or presumed virulence factors of human-adapted Neisseria, as well as current or candidate vaccine antigens. We conclude that the rhesus macaque model will allow studies of the molecular mechanisms of Neisseria colonization, transmission, persistence, and horizontal gene transfer. The model can potentially be developed further for preclinical testing of vaccine candidates.commensal Neisseria | nonhuman primate model | type IV pili M icrobe-host interactions are often refractory to investigation because of the exquisite tropism of many bacteria for the human host. Host-restriction has prevented the development of animal models that recapitulate colonization, transmission, and persistence; hampered studies of horizontal gene transfer (HGT); and prevented preclinical testing of vaccine candidates. One means to circumvent host restrictions is to develop an animal model of infection using a related species indigenous to that animal. For example, infections by human pathogens, such as Bordetella pertussis and Chlamydia trachomatis, have been effectively modeled in animals with Bordetella bronchiseptica and Chlamydia muridarum, respectively (1, 2).The genus Neisseria and the rhesus macaque provide us with this opportunity. Neisseria are Gram-negative, diplococcal β-Proteobacteria. This genus includes >10 human-adapted species, two of which are pathogens, and an unknown number of species that naturally colonize animals. These species are highly related: >40% of the genes in pathogenic species are also present in commensals, and many of these encode virulence genes and antibiotic resistance alleles. The species are naturally competent and transfer genetic information to each other in vitro (3, 4). HGT is widely assumed to play an important role in the spread of antibiotic resistance among pathogenic Neisseria; however, there is little information on the extent to which HGT occurs in vivo.Pathogens Neisseria meningitidis and Neisseria gonorrhoeae have an exquisite tropism for man. These pathogens do not naturally infect animals; inoculated into nonhuman hosts, the pathogens will colonize only for brief periods (5, 6). Neisseria species have been isolated from a number of animals (7-10), suggesting it may be possible to develop a model for studying Neisseria-host interactions in which there are no host-restriction barriers to overcome.The ...

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Emergence of Ciprofloxacin-ResistantNeisseria meningitidisin North America

Cited by 124 publications

References 25 publications

Epidemiology of meningococcal disease in the Panamanian pediatric population, 1998-2008

Epidemiology of meningococcal disease in the Panamanian pediatric population, 1998-2008

What is the evidence for giving chemoprophylaxis to children or students attending the same preschool, school or college as a case of meningococcal disease?

Neisseria infection of rhesus macaques as a model to study colonization, transmission, persistence, and horizontal gene transfer

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