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Cefotaxime-Resistant Neisseria meningitidis Sequence Type 4821 Causing Fulminant Meningitis
Emerging Infectious Diseases
|March 2, 2025
Abstract:
We explored the role of commensal Neisseria in the emergence of third-generation cephalosporin-resistant N. meningitidis. Cefotaxime resistance-conferring penA795 was prevalent among commensal Neisseria isolates in Shanghai, China, and was acquired by a serogroup C quinolone-resistant sequence type 4821 N. meningitidis, Nm507, causing fulminant meningitis in an unvaccinated 2-year-old child.
Insights
Commensal Neisseria bacteria carry resistance genes that can transfer to disease-causing Neisseria meningitidis. This transfer led to a severe meningitis case in a child due to cephalosporin-resistant bacteria.
Area of Science:
- Microbiology
- Genetics
- Epidemiology
Background:
- Neisseria meningitidis is a significant cause of bacterial meningitis.
- Third-generation cephalosporins are crucial antibiotics for treating N. meningitidis infections.
- The emergence of antibiotic resistance in N. meningitidis poses a public health threat.
Observation:
- Commensal Neisseria species, commonly found in the human nasopharynx, were investigated for antibiotic resistance genes.
- The penA795 allele, conferring resistance to cefotaxime (a third-generation cephalosporin), was found to be prevalent in commensal Neisseria isolates in Shanghai, China.
- A specific strain of N. meningitidis (serogroup C, sequence type 4821, designated Nm507), which was already resistant to quinolones, acquired the penA795 allele.
Findings:
- The study identified the transfer of the cefotaxime resistance gene (penA795) from commensal Neisseria to a pathogenic N. meningitidis strain.
- This acquisition resulted in a multi-drug resistant N. meningitidis strain (Nm507) capable of causing severe disease.
- Nm507 caused a case of fulminant meningitis in a young, unvaccinated child.
Implications:
- Commensal Neisseria act as a reservoir for antibiotic resistance genes that can be acquired by N. meningitidis.
- The findings highlight the potential for horizontal gene transfer to drive the emergence of resistant meningococcal strains.
- This underscores the need for continuous surveillance of antibiotic resistance in both commensal and pathogenic Neisseria species to inform treatment guidelines and public health strategies.
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