CDC issues health alert over antibiotic resistant Neisseria meningitidis

The Centers for Disease Control and Prevention (CDC) issued a health alert last week after reporting a number of antibiotic resistant cases of Neisseria meningitidis serogroup Y. According to officials, 11 meningococcal disease cases reported in the United States during 2019–2020 (from 9 states) had isolates containing a blaROB-1 β-lactamase gene associated with penicillin resistance, as well as mutations associated with ciprofloxacin resistance.

This is unusual as Neisseria meningitidis isolates in the United States have been largely susceptible to the antibiotics recommended for treatment and prophylaxis and represents a significant increase in penicillin- and ciprofloxacin-resistant meningococci in the United States.

CDC also notes that from 2013-2020, an additional 22 cases reported contained a blaROB-1 β-lactamasegene but did not have mutations associated with ciprofloxacin resistance. The 33 cases were reported from 12 geographically disparate states.

CDC recommends healthcare providers should perform antimicrobial susceptibility testing (AST) to determine susceptibility of all meningococcal isolates to penicillin before changing from empirical treatment with cefotaxime or ceftriaxone to penicillin or ampicillin.

In states that have experienced meningococcal disease cases caused by ciprofloxacin-resistant strains within the past 1–2 years, clinicians and public health staff should consider AST on meningococcal isolates to inform prophylaxis decisions. AST should not delay the initiation of prophylaxis with ciprofloxacin, rifampin, or ceftriaxone.