March 1, 2008

Fluoroquinolone-resistant Meningococcus Reported

nmenThe first cases of ciprofloxacin-resistant Neisseria meningitidis in North America have been reported along the border of North Dakota and Minnesota.

Three cases of ciprofloxacin-resistant serogroup B N. meningitidis infection including one fatality occurred this January, according to the Centers for Disease Control and Prevention (CDC). All three were indistinguishable by several assays including pulsed-field electrophoresis and multilocus sequence typing, and all had identical gyrA gene sequences conferring  resistance. The first case was epidemiologically linked to an August 2006 fatality. Isolates from the 2006 patient were sensitive to ciprofloxacin, however.

CDC is advising practitioners in the region not to use ciprofloxacin for prophylaxis of close contacts. Ceftriaxone, rifampin, and azithromycin are recommended instead.

The cases are reported in the Feb. 22 issue of Morbidity and Mortality Weekly Report, which lists the counties where ciprofloxacin prophylaxis is not recommended.

North Dakota and Minnesota public health officials and CDC are conducting a survey to determine how common fluoroquinolone-resistant meningococcus is among area residents. CDC is also testing existing isolates for resistance and conducting surveillance for additional cases.

CDC is encouraging laboratories to check isolates for fluoroquinolone resistance, particularly among serotype B isolates. Resistant isolates, as well as cases of meningococcal disease that fail ciprofloxacin treatment, should be reported to local health officials, and to CDC’S Meningitis and Vaccine Preventable Diseases Branch at (404) 639-3158.

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