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Emergence of meningococci with reduced susceptibility to third-generation cephalosporins
Ala-Eddine Deghmane1, Eva Hong1, Muhamed-Kheir Taha2
1Institut Pasteur, Invasive Bacterial Infection and National Reference Centre for Meningococci, Paris, France.
Objectives:
Reduced susceptibility to penicillin G in Neisseria meningitidis is mainly due to alterations in PBP2 encoded by the penA gene. However, this phenotype was not associated with reduced susceptibility to third-generation cephalosporins (C3Gs). We aimed to study the emergence of meningococci with reduced susceptibility to C3Gs (MIC >0.06 mg/L) in France since 2012.
Methods:
Invasive meningococcal isolates were typed by MLST and penA sequencing and their antibiotic susceptibility was tested.
Results:
Isolates with reduced susceptibility to C3Gs represented 2% of all invasive isolates from 2012-15, but were absent before. They harboured a new penA allele, penA327, that was also detected in isolates from urethritis cases and in gonococci.
Conclusions:
Surveillance of these isolates should be enhanced as they may jeopardize the use of C3Gs in the management of invasive meningococcal disease.
Insights
Emergence of Neisseria meningitidis with reduced susceptibility to third-generation cephalosporins (C3Gs) was observed in France. This was linked to a new penA allele, penA327, potentially impacting C3G treatment efficacy.
Area of Science:
- Microbiology
- Genetics
- Epidemiology
Background:
- Penicillin G resistance in Neisseria meningitidis is primarily linked to PBP2 alterations via the penA gene.
- Historically, this resistance did not extend to third-generation cephalosporins (C3Gs).
Purpose of the Study:
- To investigate the emergence of Neisseria meningitidis strains exhibiting reduced susceptibility to C3Gs (Minimum Inhibitory Concentration >0.06 mg/L) in France starting from 2012.
Main Methods:
- Multilocus Sequence Typing (MLST) was performed on invasive meningococcal isolates.
- penA gene sequencing was utilized to identify specific alleles.
- Antibiotic susceptibility testing was conducted for all isolates.
Main Results:
- Isolates with reduced C3G susceptibility accounted for 2% of invasive isolates between 2012 and 2015.
- These resistant strains were absent in earlier periods.
- A novel penA allele, designated penA327, was identified in these isolates and also found in strains causing urethritis and in Neisseria gonorrhoeae.
Conclusions:
- Enhanced surveillance of Neisseria meningitidis isolates with reduced C3G susceptibility is crucial.
- The emergence of these strains may pose a significant threat to the effectiveness of C3Gs in treating invasive meningococcal disease.
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