Antibiotic resistant meningococci in Europe: any need to act?

Meningococcal disease is a serious and rapidly progressing illness. It is therefore very important to monitor changes in the level of antibiotic susceptibility among clinical isolates. Different aspects such as interpretation of laboratory results, determination of breakpoints predicting treatment failure as well as definition of susceptibility levels in clinical samples using molecular methods are critical points for the surveillance of antibiotic resistance in Neisseria meningitidis. Within the strategic framework outlined by the EU.MenNet project, several objectives were identified to analyze 'The spread of antibiotic resistant meningococci in Europe', including the extent of antimicrobial resistance, its association with particular meningococcal lineages and geographical areas, as well as molecular characterization of the mechanisms involved, particularly in penicillin resistance. A heterogeneous figure for the frequency of intermediate resistance to penicillin appears across Europe. This heterogeneity may reflect different clonal lineages and/or uneven access to antibiotics in each country. In addition, the use of different criteria for the methodology used for definition cannot be avoided. The description of five specific changes associated with intermediate resistance to penicillin also allows the design of PCR-based tools to objectify results and for application in clinical samples.