FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 339:868-874 September 24, 1998 Number 13 Next

	Full Text PDF Editorial by Shaw, W. V. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited Related Article PubMed Citation

ABSTRACT

Background Neisseria meningitidis is nearly always susceptible to the penicillins, the cephalosporins, and chloramphenicol. Between 1987 and 1996, however, chloramphenicol-resistant strains were isolated from 11 patients in Vietnam and 1 in France.

Methods The minimal inhibitory concentration of chloramphenicol was determined for the 12 isolates. The isolates were analyzed by monoclonal-antibody–based serotyping and subtyping, pulsed-field gel electrophoresis, and multilocus enzyme electrophoresis. Bacterial DNA was analyzed by hybridization, the polymerase chain reaction, and sequencing to identify the resistance gene and determine the origin of the resistance.

Results The isolates were resistant to chloramphenicol (minimal inhibitory concentration, 64 mg per liter) and produced an active chloramphenicol acetyltransferase. All 12 strains belonged to serogroup B but had a high degree of diversity, and 10 could not be typed with the use of monoclonal antibodies. The nucleotide sequence of the resistance gene and the flanking regions was identical to that of an internal portion of transposon Tn4451 that carries the catP gene in Clostridium perfringens. Moreover, this gene was located in the same genomic site in the chloramphenicol-resistant isolates.

Conclusions The high-level chloramphenicol resistance that we describe in N. meningitidis isolates is of great concern, since in developing countries, chloramphenicol given intramuscularly is the standard therapy for meningococcal meningitis. The resistance to chloramphenicol is due to the presence of the catP gene on a truncated transposon that has lost mobility because of internal deletions, and the transformation of genetic material between strains of N. meningitidis probably played an important part in the dissemination of the gene.

Source Information

From the National Reference Center for Antibiotics and the Unité des Agents Antibactériens (M. Galimand, G.G., P.C.) and the National Reference Center for Meningococci (M. Guibourdenche, J.-Y.R.), Institut Pasteur, Paris.

Address reprint requests to Dr. Galimand at the Unité des Agents Antibactériens, Institut Pasteur, 28 Rue du Dr. Roux, 75724 Paris CEDEX 15, France.

Full Text of this Article

This article has been cited by other articles:

• du Plessis, M., von Gottberg, A., Cohen, C., de Gouveia, L., Klugman, K. P., for the Group for Enteric Respiratory and Meningea, (2008). Neisseria meningitidis Intermediately Resistant to Penicillin and Causing Invasive Disease in South Africa in 2001 to 2005. J. Clin. Microbiol. 46: 3208-3214 [Abstract] [Full Text]  
• Taha, M.-K., Zarantonelli, M. L., Neri, A., Enriquez, R., Vazquez, J. A., Stefanelli, P. (2006). Interlaboratory Comparison of PCR-Based Methods for Detection of Penicillin G Susceptibility in Neisseria meningitidis. Antimicrob. Agents Chemother. 50: 887-892 [Abstract] [Full Text]  
• Harrison, L. H. (2006). Prospects for Vaccine Prevention of Meningococcal Infection. Clin. Microbiol. Rev. 19: 142-164 [Abstract] [Full Text]  
• Jorgensen, J. H., Crawford, S. A., Fiebelkorn, K. R. (2005). Susceptibility of Neisseria meningitidis to 16 Antimicrobial Agents and Characterization of Resistance Mechanisms Affecting Some Agents. J. Clin. Microbiol. 43: 3162-3171 [Abstract] [Full Text]  
• Crawford, S. A., Fiebelkorn, K. R., Patterson, J. E., Jorgensen, J. H. (2005). International Clone of Neisseria meningitidis Serogroup A with Tetracycline Resistance Due to tet(B). Antimicrob. Agents Chemother. 49: 1198-1200 [Abstract] [Full Text]  
• Shultz, T. R., Tapsall, J. W., White, P. A., Ryan, C. S., Lyras, D., Rood, J. I., Binotto, E., Richardson, C. J. L. (2003). Chloramphenicol-resistant Neisseria meningitidis containing catP isolated in Australia. J Antimicrob Chemother 52: 856-859 [Abstract] [Full Text]  
• Huovinen, P. (2002). Macrolide-Resistant Group A Streptococcus -- Now in the United States. NEJM 346: 1243-1245 [Full Text]  
• Rosenstein, N. E., Perkins, B. A., Stephens, D. S., Popovic, T., Hughes, J. M. (2001). Meningococcal Disease. NEJM 344: 1378-1388 [Full Text]  
• Galimand, M., Gerbaud, G., Courvalin, P. (2000). Spectinomycin Resistance in Neisseria spp. Due to Mutations in 16S rRNA. Antimicrob. Agents Chemother. 44: 1365-1366 [Abstract] [Full Text]  
• van Deuren, M., Brandtzaeg, P., van der Meer, J. W. M. (2000). Update on Meningococcal Disease with Emphasis on Pathogenesis and Clinical Management. Clin. Microbiol. Rev. 13: 144-166 [Abstract] [Full Text]  
• (1999). Tackling antimicrobial resistance. DTB 37: 9-16 [Abstract] [Full Text]  
• (1998). Chloramphenicol Resistance in N. meningitidis. JWatch Infect. Diseases 1998: 5-5 [Full Text]  
• Shaw, W. V. (1998). Chloramphenicol Resistance in Meningococci. NEJM 339: 917-918 [Full Text]