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Resistant pathogens in meningococcal disease raise alarms at a time when health experts continue to grapple with the SARS-CoV-2 pandemic. The discovery of possibly the first case of resistant bacterial meningitis in a 5-month-old patient has since led to further investigations and a federal health advisory on antibiotic-resistant Neisseria meningitidis isolates.
Laboratories play a critical role in detecting these isolates, Lucy McNamara, PhD, MS, an epidemiologist with the U.S. Centers for Disease Control and Prevention (CDC), told CLN Stat. Labs should continue to culture N. meningitidis from clinical cases whenever possible and share all isolates from clinical cases of meningococcal disease with their jurisdiction’s public health laboratory for further testing and submission to CDC, advised McNamara.
N. meningitidis isolates in the United States in the past have responded to antibiotics. This changed over the past year, when a previously healthy 5-month-old presented at Children’s National Hospital in Washington, D.C., after days of congestion and fever. A 5-minute screening test for penicillin and ampicillin resistance revealed that the infant was suffering from meningitis caused by β-lactamase–producing, ciprofloxacin-resistant N. meningitidis.
“We did [the testing] again to make sure it was accurate, and the results were reproducible,” said Joseph Campos, PhD, D(ABMM), FAAM, director of the Microbiology Laboratory and the Infectious Diseases Molecular Diagnostics Laboratory at Children’s National, in a statement. He and his colleagues reported on their findings in the Journal of the Pediatric Infectious Diseases Society.
“When we were taking care of this patient, there were no known U.S. cases with this resistant strain reported in the literature,” Gillian Taormina, DO, a third year fellow in pediatric infectious diseases at Children’s National and the case study’s lead author, told CLN Stat.
She and her colleagues sent samples of the antibiotic-resistant bacteria to public health officials in the Washington, D.C., region and to CDC. The agency asked other state labs to send their own N. meningitidis samples.
The CDC’s evaluation revealed prior cases with the same resistance pattern, Taormina said. Overall, there were 33 positive β-lactamase–producing samples, 11 of which were resistant to penicillin and ciprofloxacin. The other 22 cases did not have mutations associated with ciprofloxacin resistance.
Clinical laboratories should be aware that penicillin- and ciprofloxacin-resistance has been reported among U.S. meningococcal isolates and that healthcare providers may request testing for susceptibility to these antibiotics, said McNamara, corresponding author of the CDC investigation. “Please note that rigorous protection from droplets and aerosols, including use of a biosafety cabinet, is required when microbiologic procedures are performed on N. meningitidis isolates,” she added.
CDC has since issued a health advisory on the discovery of antibiotic-resistant N. meningitidis isolates. The agency called for antimicrobial susceptibility testing to better inform treatment decisions on antibiotics, and increased surveillance on the part of state and territorial health departments of meningococcal isolates. “Further research would require national coordination of data collection/analysis to gather enough information in a reasonable time frame. We hope that clinicians will be in touch with their health departments and CDC about patients with meningococcemia so that the resistance pattern can be further characterized,” said Taormina and Campos.
Compounding the superbug threat is the SARS-CoV-2 virus, which has been causing secondary bacterial infections that require antibiotics. “As a result, most hospitals are prescribing antibiotics preemptively to hospitalized COVID-19 patients, heightening the likelihood that more bacteria are adapting and developing resistance to these antibiotics,” according to one news report. Experts are warning that unless scientists get a jump-start on more antimicrobial innovation, antibiotic-resistant bugs could become an even bigger health emergency than SARS-CoV-2.
“We must encourage doctors to prescribe antibiotics as smartly and sparingly as possible so patients take these drugs only when truly necessary,” Kevin Outterson and John Rex wrote in an opinion piece. “Second, we need a large-scale effort to create newer, more effective antimicrobials.”