Drug-Resistant Meningitis Present in North America

Bacteria resistant to ciprofloxacin but remain susceptible to other antibiotics
By A. Agrawal, PhD
HealthDay Reporter

WEDNESDAY, Feb. 25 (HealthDay News) -- Ciprofloxacin-resistant meningitis has appeared in North America, although the bacteria remain susceptible to other antibiotics, according to a report in the Feb. 26 issue of the New England Journal of Medicine.

Henry M. Wu, M.D., from the U.S. Centers for Disease Control and Prevention in Atlanta, and colleagues describe three cases of meningococcal disease caused by ciprofloxacin-resistant Neisseria meningitidis in North Dakota and Minnesota in 2007 and 2008.

The investigators found that the N. meningitidis isolates all belonged to serogroup B and were resistant to ciprofloxacin but remained susceptible to several other antibiotics. The ciprofloxacin-resistant isolates represented 9 percent of total confirmed cases reported in these states during that period. Sequencing the gyrA gene, whose encoded protein is a target of ciprofloxacin, identified a threonine-to-isoleucine mutation associated with fluoroquinolone resistance, the researchers report. Further investigation identified an asymptomatic carrier of the resistant strain and an additional resistant isolate from California.

"Ciprofloxacin-resistant N. meningitidis has emerged in North America," Wu and colleagues write. "It is unclear whether the ciprofloxacin resistance reported here represents a sporadic phenomenon or the early stage of wider dissemination."

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