美国产β-内酰胺酶阳性、血清群 Y 脑膜炎奈瑟菌中不断扩大的分支中对环丙沙星耐药性的获得。
Acquisition of Ciprofloxacin Resistance Among an Expanding Clade of β-Lactamase-Positive, Serogroup Y Neisseria meningitidis in the United States.
机构信息
Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Weems Design Studio, Inc, Contractor to Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
出版信息
Clin Infect Dis. 2021 Oct 5;73(7):1185-1193. doi: 10.1093/cid/ciab358.
BACKGROUND
Penicillin and ciprofloxacin are important for invasive meningococcal disease (IMD) management and prevention. IMD cases caused by penicillin- and ciprofloxacin-resistant Neisseria meningitidis containing a ROB-1 β-lactamase gene (blaROB-1) and a mutated DNA gyrase gene (gyrA) have been recently reported in the United States.
METHODS
We examined 2097 meningococcal genomes collected through US population-based surveillance from January 2011 to February 2020 to identify IMD cases caused by strains with blaROB-1- or gyrA-mediated resistance. Antimicrobial resistance was confirmed phenotypically. The US isolate genomes were compared to non-US isolate genomes containing blaROB-1. Interspecies transfer of ciprofloxacin resistance was assessed by comparing gyrA among Neisseria species.
RESULTS
Eleven penicillin- and ciprofloxacin-resistant isolates were identified after December 2018; all were serogroup Y, sequence type 3587, clonal complex (CC) 23, and contained blaROB-1 and a T91I-containing gyrA allele. An additional 22 penicillin-resistant, blaROB-1- containing US isolates with wild-type gyrA were identified from 2013 to 2020. All 33 blaROB-1-containing isolates formed a single clade, along with 12 blaROB-1-containing isolates from 6 other countries. Two-thirds of blaROB-1-containing US isolates were from Hispanic individuals. Twelve additional ciprofloxacin-resistant isolates with gyrA T91 mutations were identified. Ciprofloxacin-resistant isolates belonged to 6 CCs and contained 10 unique gyrA alleles; 7 were similar or identical to alleles from Neisseria lactamica or Neisseria gonorrhoeae.
CONCLUSIONS
Recent IMD cases caused by a dual resistant serogroup Y suggest changing antimicrobial resistance patterns in the United States. The emerging dual resistance is due to acquisition of ciprofloxacin resistance by β-lactamase-containing N. meningitidis. Routine antimicrobial resistance surveillance will effectively monitor resistance changes and spread.
背景
青霉素和环丙沙星对于侵袭性脑膜炎奈瑟菌病（IMD）的治疗和预防至关重要。最近在美国报道了一些由携带 blaROB-1 型β-内酰胺酶基因（blaROB-1）和突变型 DNA 回旋酶基因（gyrA）的耐青霉素和环丙沙星的脑膜炎奈瑟菌引起的 IMD 病例。
方法
我们对 2097 株从 2011 年 1 月至 2020 年 2 月通过美国基于人群的监测收集的脑膜炎奈瑟菌基因组进行了检测，以鉴定由 blaROB-1 或 gyrA 介导的耐药菌株引起的 IMD 病例。通过表型方法确认了抗生素耐药性。将美国分离株基因组与含有 blaROB-1 的非美国分离株基因组进行了比较。通过比较奈瑟菌属种之间的 gyrA 评估了环丙沙星耐药性的种间转移。
结果
在 2018 年 12 月之后鉴定出了 11 株耐青霉素和环丙沙星的分离株；所有分离株均为血清群 Y、序列型 3587、克隆复合体（CC）23，且均含有 blaROB-1 和含有 T91I 的 gyrA 等位基因。从 2013 年至 2020 年还鉴定出了 22 株青霉素耐药、含有 blaROB-1 但 gyrA 为野生型的美国分离株。所有 33 株 blaROB-1 分离株与其他 6 个国家的 12 株 blaROB-1 分离株一起形成了一个单独的分支。三分之二的 blaROB-1 分离株来自西班牙裔个体。另外还鉴定出了 12 株含有 gyrA T91 突变的环丙沙星耐药分离株。环丙沙星耐药分离株属于 6 个 CC，含有 10 个独特的 gyrA 等位基因；其中 7 个与淋病奈瑟菌或淋病奈瑟菌的等位基因相似或相同。
结论
最近由血清群 Y 引起的双重耐药性 IMD 病例表明，美国的抗生素耐药模式正在发生变化。新出现的双重耐药性是由于含有β-内酰胺酶的脑膜炎奈瑟菌获得了环丙沙星耐药性。常规的抗生素耐药性监测将有效地监测耐药性的变化和传播。
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