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Journal of Clinical Microbiology, April 2006, p. 1592-1593, Vol. 44, No. 4
0095-1137/06/$08.00+0     doi:10.1128/JCM.44.4.1592-1593.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.

LETTER TO THE EDITOR

Surveillance of Antimicrobial Resistance in Neisseria meningitidis from Patients in the Cincinnati Tristate Region (Ohio, Kentucky, and Indiana)


   LETTER
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References
 
In a recent publication, Jorgensen and colleagues presented data on the antimicrobial susceptibility of a large sample of Neisseria meningitidis isolates from the United States and other countries (7). Epidemiological data are critical to tracking the spread of less susceptible strains (1-3, 5, 6, 9) and to providing guidance in the empirical selection of antimicrobial agents. The present study was undertaken by the Cincinnati Regional Clinical Microbiology Laboratory Response Network (the Network) to describe N. meningitidis isolates from our region. The Network is a consortium of 27 hospital clinical and public health laboratories from the Cincinnati tristate region (southwestern Ohio, northern Kentucky, and southeastern Indiana).

All isolates were collected from our geographic region during the preceding 5 years by the members of the Network. Only isolates from blood, cerebrospinal fluid, or other normally sterile body sites were included. Institutional Review Board-approved data collection included age, sex, and ZIP code.

Identification of isolates was performed using Gram stain morphology, growth characteristics, and the Remel Rapid NH system (Lenexa, KA). Serotyping was performed using conventional Difco antisera (Becton Dickinson Microbiology, Cockeysville, MD).

The Etest system (AB Biodisk, Solna, Sweden) and manufacturer's instructions were used for antimicrobial susceptibility testing. The following agents (concentrations) were tested: ceftriaxone (0.002 to 32 µg/ml), ciprofloxacin (0.002 to 32 µg/ml), penicillin (0.002 to 32 µg/ml), rifampin (0.002 to 32 µg/ml), trimethoprim-sulfamethoxazole (0.002 to 32 µg/ml), and tetracycline (0.016 to 256 µg/ml). Chocolate Mueller-Hinton agar was inoculated and incubated at 37°C in 5% CO2 for 20 h (4, 8, 10). For quality control, Staphylococcus aureus ATCC 29213 was tested on plain Mueller-Hinton agar, Streptococcus pneumoniae ATCC 49619 was tested on Mueller-Hinton agar with 5% sheep blood and on chocolate Mueller-Hinton agar, and three N. meningitidis strains (source, Arkansas Children's Hospital) for which the drug MICs were well characterized were tested on chocolate Mueller-Hinton agar. Beta-lactamase production was detected by using the cefinase test.

The serotypes of the 52 isolates included in the study were the following (number of isolates, percentage): B (22, 42.3%), Y (19, 36.5%), C (8, 15.4%), untypeable (2, 3.8%), and W135 (1, 1.9%). Isolates were collected from patients in 38 different ZIP codes. No more than two isolates came from any single ZIP code. Isolates were collected from patients in the following counties (numbers of isolates in parentheses): Hamilton (17), Butler (7), Clermont (6), Montgomery (4), Greene (3), Adams (1), Warren (1), and one unknown county (1) in Ohio; one unknown county (5), Campbell (2), Kenton (2), Boone (1), and Gallantin (1) in Kentucky; and Dearborn (1) in Indiana. The ages of the patients were 2 weeks to 85 years (mean, 24.7 years; median, 15 years; mode, 1 year). Thirty-three patients were male, 18 were female, and the sex of one was unknown. Specimens were collected from the following sources (numbers of specimens in parentheses): blood (48), cerebrospinal fluid (2), joint fluid (1), and petechiae (1).

Antimicrobial susceptibility testing results are shown in Table 1. Beta-lactamase-producing isolates were not detected. The relative distribution of penicillin MICs is shown in Fig. 1.


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  		TABLE 1. MICs for isolates in this study

 

Figure 1
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  		FIG. 1. Distribution of penicillin MICs.

 
The isolate which showed a penicillin MIC of 0.75 µg/ml gave a consistent MIC when retested in triplicate using the Etest system. The isolate came from a 13-year-old male from northern Kentucky with a positive blood culture.

The data from the present study supplement the recently published data of Jorgensen et al. and also show a significant number of isolates of N. meningitidis with decreased susceptibility to penicillin (7).


   ACKNOWLEDGMENTS
 
We thank the members of the Cincinnati Regional Microbiology Laboratory Response Network and Tammy Bannerman of the Ohio Department of Health Laboratories for collaborating with us and providing isolates.


   REFERENCES
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 References
 

  1. Campos, J., G. Trujillo, T. Seuba, and A. Rodriguez. 1992. Discriminative criteria for Neisseria meningitidis isolates that are moderately susceptible to penicillin and ampicillin. Antimicrob. Agents Chemother. 36:1028-1031.[Abstract/Free Full Text]
  2. Contoyiannis, P., and D. A. Adamopoulos. 1974. Penicillin-resistant Neisseria meningitidis. Lancet i:462.
  3. Del Love, B. D., and M. Finland. 1954. In vitro susceptibility of meningococci to eleven antibiotics and sulfadiazine. Am. J. Med. Sci. 228:534-539.[Medline]
  4. Hughes, J. H., D. J. Biedenbach, M. E. Erwin, and R. N. Jones. 1993. E test as susceptibility test and epidemiologic tool for evaluation of Neisseria meningitidis isolates. J. Clin. Microbiol. 31:3255-3259.[Abstract/Free Full Text]
  5. Jackson, L. A., F. C. Tenover, C. Baker, B. D. Plikaytis, M. W. Reeves, S. A. Stocker, R. E. Weaver, and J. D. Wenger. 1994. Prevalence of Neisseria meningitidis relatively resistant to penicillin in the United States, 1991. J. Infect. Dis. 169:438-441.[Medline]
  6. Jones, D. M., and E. M. Sutcliffe. 1990. Meningococci with reduced susceptibility to penicillin. Lancet 335:863-864.[Medline]
  7. Jorgensen, J. H, S. A. Crawford, and K. R. Fiebelkorn. 2005. Susceptibility of Neisseria meningitidis to 16 antimicrobial agents and characterization of resistance mechanisms affecting some agents. J. Clin. Microbiol. 43:3162-3171.[Abstract/Free Full Text]
  8. Marshall, S. A., P. R. Rhomberg, and R. N. Jones. 1997. Comparative evaluation of Etest for susceptibility testing Neisseria meningitidis with eight antimicrobial agents, an investigation using US Food and Drug Administration regulatory criteria. Diagn. Microbial. Infect. Dis. 27:93-97.[CrossRef][Medline]
  9. Perez-Trallero, E., L. Aldamiz-Echeverria, and E. G. Perez-Yarza. 1990. Meningococci with increased resistance to penicil1in. Lancet i:1096- 1097.
  10. Richter, S. S., K. A. Gordon, P. R. Rhomberg, M. A. Pfaller, and R. N. Jones. 2001. Neisseria meningitidis with decreased susceptibility to penicillin: report from the SENTRY antimicrobial surveillance program, North America, 1989-99. Diagn. Microbiol. Infect. Dis. 41:83-88.[CrossRef][Medline]
Joel E. Mortensen*
Mary Jo Gerrety
Department of Pathology and Laboratory Medicine
Cincinnati Children's Hospital
Cincinnati, Ohio,1

Larry D. Gray
Trihealth Laboratories
Cincinnati, Ohio,2

* Phone: (513) 636-5310, Fax: (513) 636-8850, E-mail: joel.mortensen{at}chmcc.org

Journal of Clinical Microbiology, April 2006, p. 1592-1593, Vol. 44, No. 4
0095-1137/06/$08.00+0     doi:10.1128/JCM.44.4.1592-1593.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.




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