Thomas Glück, MD reviewing Deghmane AE et al. J Antimicrob Chemother 2016 Oct 12.

In France, 2% of meningococci harbor a modified penicillin-binding protein 2 with reduced susceptibility to third-generation cephalosporins.

Neisseria meningitidis isolates with reduced penicillin susceptibility due to a modified penA gene coding for penicillin-binding protein 2 have been known for several years. However, until recently, such isolates have been fully susceptible to third-generation cephalosporins (C3Gs; cefotaxime and ceftriaxone) that are part of the currently recommended empiric regimen for community-acquired meningitis.

Researchers from the French National Reference Centre for Meningococci — which receives 76% of the isolates from the approximately 500 annual cases of invasive meningococcal disease in France — detected reduced penicillin susceptibility in 26% of 1407 isolates collected between 2012 and 2015. In 7% of these (2% of all isolates), reduced susceptibility to C3Gs was found with a 10-fold raised minimum inhibitory concentration (MIC).

Sequence analysis showed that this increase in C3G MIC was due to a variant penA gene (penA327) that was detected only after 2012 (in 3, 6, 8, and 8 isolates during 2012–2015, respectively). The penA327 allele was found to be identical to a previously described allele in Neisseria gonorrhoeae (penAXXXIV) that was also associated with reduced susceptibility to C3Gs. PenA327 meningococci were also reported in meningococcal urethritis (Physician's First Watch Jun 3 2016), suggesting that sexual transmission not only of gonococci, but also of meningococci, is possible.

CITATION(S):

Deghmane AE et al. Emergence of meningococci with reduced susceptibility to third-generation cephalosporins. J Antimicrob Chemother 2016 Oct 12; [e-pub]. 

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