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Emergence of MDR invasive Neisseria meningitidis in El Salvador, 2017-19
José Eduardo Oliva Marín1, Esmeralda Villatoro2, María Jose Luna2
1Instituto Nacional de Salud, Ministerio de Salud, San Salvador, El Salvador.
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.
Insights
Antimicrobial resistance is a growing concern for invasive meningococcal disease (IMD). This study identified the first multidrug-resistant Neisseria meningitidis strains in Latin America, highlighting a significant public health threat.
Area of Science:
- Infectious Diseases
- Microbiology
- Genomics
Background:
- Invasive meningococcal disease (IMD) is a severe infection caused by Neisseria meningitidis.
- Penicillin and ciprofloxacin are standard treatments, but antimicrobial resistance is a growing challenge.
Purpose of the Study:
- To characterize six cases of penicillin- and ciprofloxacin-resistant IMD in El Salvador (2017-2019).
- To investigate the genetic basis of resistance in these Neisseria meningitidis isolates.
Main Methods:
- Clinical and epidemiological data collection for IMD cases.
- Antimicrobial susceptibility testing (broth microdilution).
- Whole Genome Sequencing (WGS) for genotyping and phylogenetic analysis.
Main Results:
- Six cases of Neisseria meningitidis serogroup Y resistant to penicillin and ciprofloxacin were identified.
- Penicillin resistance linked to ROB-1 beta-lactamase; ciprofloxacin resistance to T91I gyrase mutation.
- All isolates belonged to ST-3587 (cc23) and were genetically similar.
Conclusions:
- First report of multidrug-resistant (MDR) Neisseria meningitidis causing IMD in Latin America.
- Emergence of MDR strains poses a significant public health threat.
- Resistance impacts the effectiveness of IMD treatment and prophylaxis.
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