Acquisition of Ciprofloxacin Resistance Among an Expanding Clade of β-Lactamase–Positive, Serogroup Y <i>Neisseria meningitidis</i> in the United States
Caelin Cubeñas-Potts, Adam C. Retchless, Lucy A. McNamara, Daya Marasini, Natashia Reese, Stephanie Swint, Fang Hu, Shalabh Sharma, Amy Blain, David Lonsway, Maria Karlsson, Susan Hariri, LeAnne M. Fox, Xin Wang, Antimicrobial-Resistant Neisseria meningitidis Team, Nirmala Dhungana, Ryan Gabrio-Brannon, Jennifer L. Kyle, Brittany Martin, Joseph M. Campos, Benjamin Hanisch, Gillian Taormina, Meghan Barnes, Ashley Moore, Catherine Dominguez, Kristy Lunquest, Ami A Patel, David Torpey, Susan Hannagan, P Keating, Sandy Li, Justin Albertson, Wayne Fleming, Christina Russell, Kelsey Sanders, Chas DeBolt, Nicholas Graff, Esther Lam
Abstract
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.