5 To date, this is the first report of an invasive N. meningitidis isolate with a benzylpenicillin MIC > 0.5 mg/L from Australia (personal communication, John Tapsall, National Neisseria Network Reference Laboratory). In 2008, 108 of 149 (72%) invasive N. meningitidis isolates submitted to the Australian National Neisseria Network demonstrated reduced susceptibility to benzylpenicillin (MICs 0.06–0.5 mg/L). 4 Reduced susceptibility in these isolates is due to decreased binding of benzylpencillin due to altered penicillin- binding proteins (PBP2 and PBP3). These relatively resistant N. meningitidis isolates have penicillin MICs ranging from 0.01 mg/L to 1 mg/L. meningitidis strains with increased benzylpenicillin MICs of > 0.06 mg/L have been isolated more commonly from the United Kingdom, Europe, Greece, South America, South Africa, Asia and the United States of America (USA). meningitidis isolates have been sporadically reported from Canada, South Africa, and Spain. Highly resistant (benzylpenicillin MIC > 256 mg/L), beta-lactamase producing N. meningitidis isolates strains (including 7 from the Kimberley) collected from 2000–2006 3 this genosubtype had not previously been identified. When compared to a Western Australian database of 81 N. meningitidis porA VR database (), there were only partial matches to VR1 peptides 5–29 (56%) and 21–14 (60%) and VR2 peptides 2–39 (67%) and 16–107 (46%). 2 When the deduced amino acid sequences of VR1 and VR2 were submitted to the N. meningitidis isolate was performed by porA gene variable region (VR) 1 and 2 DNA sequencing as previously described. There was no zone to the Pen0.5u disc by the CDS method, indicating resistance, which was confirmed by the MIC method and demonstrated a benzylpenicillin MIC of 1.0 µg/mL (resistant). The identification of the organism was confirmed and susceptibility testing for benzylpenicillin was performed using two alternative methods (Calibrated Dichotomous Susceptibility (CDS) disc testing and MIC determination using agar dilution and CLSI breakpoints). The isolate was referred to the National Neisseria Network Reference Laboratory, Prince of Wales Hospital, New South Wales for confirmatory susceptibility testing. The isolate was beta-lactamase negative by nitrocefin testing. 1 Etest® minimum inhibitory concentration (MIC) results were as follows: benzylpenicillin, 0.5 mg/L (resistant) ceftriaxone, 0.004 mg/L (susceptible) ciprofloxacin, 0.006 mg/L (susceptible) rifampicin 0.012 mg/L (susceptible) and chloramphenicol, 1 mg/L (susceptible). A lumbar puncture performed 72 hours after commencing ceftriaxone was negative for N. meningitidis on culture and by polymerase chain reaction.Īntimicrobial susceptibility testing was performed in the routine microbiology laboratory by Etest® (AB Biodisk, Solna, Sweden) and results interpreted according to Clinical Laboratory Standards Institute (CLSI) breakpoints. The patient was treated with intravenous ceftriaxone 900 mg for 5 days and made a complete recovery. Blood cultures yielded serogroup B Neisseria meningitidis. On examination, he was febrile (T = 39.4☌), tachycardic (pulse rate 160 bpm) and tachypnoeic (respiratory rate 26 per minute), however there was no rash or signs of meningism. Commun Dis Intell 2010 34(3):324–326.Ī 4-year-old fully immunised malepresented to a regional hospital in the West Kimberley with fever and lethargy. meningitidis disease is of concern and emphasises the importance of ongoing surveillance for antimicrobial resistance.
As benzylpenicillin is currently recommended as first line empiric and definitive therapy for invasive meningococcal disease, the emergence of penicillin-resistant N.
meningitidis isolates with reduced penicillin susceptibility are not uncommon in Australia, this is the first report of a benzylpenicillin-resistant isolate (MIC > 0.5 mg/L) causing invasive disease. The patient was treated with intravenous ceftriaxone and made a complete recovery. Blood cultures yielded serogroup B Neisseria meningitidis, resistant to benzylpenicillin (minimum inhibitory concentration (MIC) 1.0 mg/L). Shivanti D Abeysuriya, David J Speers, Jackie Gardiner, Ronan J MurrayĪ 4-year-old fully immunised malepresented to a regional hospital in the West Kimberley with fever and lethargy.
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