Emerging ciprofloxacin-resistant Neisseria meningitidis serogroup W135 in Southern Thailand
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Abstract
BACKGROUND: Neisseria meningitidis is a cause of endemic and epidemic disease in developed and developing countries including Thailand. Close contacts of case patients are at increased risk for disease, and chemoprophylaxis is an urgent intervention for prevention of disease. Rifampicin and Ciprofloxacin are acceptable antimicrobial agents. Ciprofloxacin is more commonly used than Rifampicin because of convenience. However, the emergence of ciprofloxacin-resistant N. meningitidis has been reported in many countries but has never been previously reported in Thailand.
OBJECTIVE: To evaluate ciprofloxacin susceptibility of N. meningitidis from September 2009 to September 2018
METHODS: A retrospective descriptive study was done in Songkhla Hospital. All available medical records of all clinical specimens with culture-confirmed N. meningitidis were reviewed to explore the clinical manifestation and susceptibility pattern.
RESULTS: Eleven patients were confirmed as meningococcal diseases and one case of nasopharyngeal colonization. Four patients were children under one year of age and all presented with acute meningitis, while one patient developed meningococcal septicemia. Seven adult patients presented with meningococcemia and only one patient had meningococcal meningitis. There were no case fatalities. Before 2017 only serogroup B was identified and all were susceptible to ciprofloxacin. In 2018, three patients were identified as serogroup W135 and 100% were resistant to Ciprofloxacin. All isolates had 100% susceptible to Ceftriaxone.
CONCLUSIONS: Emerging ciprofloxacin-resistant N. meningitidis serogroup W135 in southern Thailand is raising public concern about the spread of colonization, infection, and outbreak in the community. Drug recommendation for post-exposure chemoprophylaxis is another concern. Rifampicin or Ceftriaxone may be appropriate drugs for chemoprophylaxis at this time.
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References
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