title: Emergence of ciprofloxacin-resistant Neisseria meningitidis in North America.
abstract: We report on three cases of meningococcal disease caused by ciprofloxacin-resistant Neisseria meningitidis, one in North Dakota and two in Minnesota. The cases were caused by the same serogroup B strain. To assess local carriage of resistant N. meningitidis, we conducted a pharyngeal-carriage survey and isolated the resistant strain from one asymptomatic carrier. Sequencing of the gene encoding subunit A of DNA gyrase (gyrA) revealed a mutation associated with fluoroquinolone resistance and suggests that the resistance was acquired by means of horizontal gene transfer with the commensal N. lactamica. In susceptibility testing of invasive N. meningitidis isolates from the Active Bacterial Core surveillance system between January 2007 and January 2008, an additional ciprofloxacin-resistant isolate was found, in this case from California. Ciprofloxacin-resistant N. meningitidis has emerged in North America.
authors.affiliation: Office of Workforce and Career Development, and the Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. hwu@cdc.gov
authors.forename: Henry M
authors.initials: HM
authors.lastname: Wu
authors.forename: Brian H
authors.initials: BH
authors.lastname: Harcourt
authors.forename: Cynthia P
authors.initials: CP
authors.lastname: Hatcher
authors.forename: Stanley C
authors.initials: SC
authors.lastname: Wei
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Novak
authors.forename: Xin
authors.initials: X
authors.lastname: Wang
authors.forename: Billie A
authors.initials: BA
authors.lastname: Juni
authors.forename: Anita
authors.initials: A
authors.lastname: Glennen
authors.forename: David J
authors.initials: DJ
authors.lastname: Boxrud
authors.forename: Jean
authors.initials: J
authors.lastname: Rainbow
authors.forename: Susanna
authors.initials: S
authors.lastname: Schmink
authors.forename: Raydel D
authors.initials: RD
authors.lastname: Mair
authors.forename: M Jordan
authors.initials: MJ
authors.lastname: Theodore
authors.forename: Molly A
authors.initials: MA
authors.lastname: Sander
authors.forename: Tracy K
authors.initials: TK
authors.lastname: Miller
authors.forename: Kirby
authors.initials: K
authors.lastname: Kruger
authors.forename: Amanda C
authors.initials: AC
authors.lastname: Cohn
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Clark
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Messonnier
authors.forename: Leonard W
authors.initials: LW
authors.lastname: Mayer
authors.forename: Ruth
authors.initials: R
authors.lastname: Lynfield
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001483:Base Sequence; D002353:Carrier State / Q000382:microbiology; D002939:Ciprofloxacin / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial / Q000235:genetics*; D006801:Humans; D007223:Infant; D008589:Meningococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009345:Neisseria meningitidis / Q000145:classification / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification; D010614:Pharynx / Q000382:microbiology; D017354:Point Mutation; D014481:United States; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents; D002939:Ciprofloxacin