Emergence of MDR invasive Neisseria meningitidis in El Salvador, 2017-19.

BACKGROUND: Invasive meningococcal disease (IMD) is an acute, highly transmissible and potentially fatal disease caused by Neisseria meningitidis. Prompt antimicrobial therapy and prophylaxis are recommended, where penicillin or ciprofloxacin are the available choices. However, the emergence of resistant isolates of N. meningitidis poses a challenge for antimicrobial therapy. OBJECTIVES: To describe the clinical, epidemiological and biological characteristics of six penicillin- and ciprofloxacin-resistant, culture-confirmed IMD cases reported in El Salvador, Central America, between 2017 and 2019. METHODS: Following the detection of six patients presenting with IMD in El Salvador, clinical data were collected and epidemiological action plans conducted. Isolates were subjected to antimicrobial susceptibility testing by broth microdilution and WGS for genotyping and molecular characterization analysis, including phylogeny comparison with global sequences available from public databases. RESULTS: A total of six IMD cases caused by N. meningitidis serogroup Y, resistant to both penicillin (MIC >8.0 mg/L) and ciprofloxacin (MIC 0.125 mg/L), were detected from 2017 to 2019. Genomic analysis showed that penicillin resistance was mediated by the production of ß-lactamase ROB-1. Ciprofloxacin resistance was attributed to an amino acid substitution in DNA gyrase (T91I). All isolates were classified as ST3587, clonal complex 23, and were genetically highly similar, based on core-genome SNP analysis. CONCLUSIONS: To the best of our knowledge, we report the first cases of MDR N. meningitidis causing IMD in Latin America. Our findings highlight the emergence of this potential public health threat, with a profound impact on the efficacy of IMD treatment and prophylaxis protocols.

Susceptibilidad a la ciprofloxacina en Salmonella enterica serotipo Typhi, no multidrogorresistente, 2017 a 2020 / Susceptibility to ciprofloxacin in Salmonella enterica serotype Typhi, no multidrug resistant, 2017 to 2020

Introducción. Los patrones de susceptibilidad antimicrobiana de Salmonella enterica serotipo Typhi se han modificado globalmente durante las últimas tres décadas. Objetivo. Describir los patrones de susceptibilidad antimicrobiana de las cepas de Salmonella enterica Typhi, aisladas en El Salvador de enero 2017 a junio 2020. Metodología. Evaluación secundaria de las bases de datos del Laboratorio Nacional de Salud Pública, de los aislamientos de Salmonella enterica Typhi con sus respectivos antibiogramas, de muestras de pacientes que adolecieron de fiebre tifoidea en El Salvador, de enero 2017 a junio 2020. Resultados. 1406 aislamientos de Salmonella enterica Typhi fueron reportados. El 100 % de los aislamientos analizados presentó susceptibilidad a la ceftriaxona y a la azitromicina. El 99,9 % de los aislamientos analizados presentó susceptibilidad a la ampicilina, al cloranfenicol, a la tetraciclina y al trimetoprim-sulfametoxazol. Para ciprofloxacina, se detectó susceptibilidad en el 8,5% de las cepas analizadas, susceptibilidad intermedia en el 91,5% y resistencia en el 0,08 %. Conclusión. Los hallazgos son compatibles con lo reportado a nivel mundial: el desarrollo rápido de susceptibilidad intermedia o resistencia a la ciprofloxacina, una vez esta es adoptada como el tratamiento de elección para la fiebre tifoidea. En El Salvador, los antibióticos antes considerados como de primera línea contra Salmonella enterica Typhi, deben ser reciclados

Introduction. The antimicrobial susceptibility patterns of Salmonella enterica serotype Typhi have been modified globally for the past three decades. Target. Describe the antimicrobial susceptibility patterns of Salmonella enterica Typhi strains, isolated in El Salvador from January 2017 to June 2020. Methodology. Secondary assessment from the databases of the National Public Health Laboratory, of the isolates of Salmonella enterica Typhi with their respective antibiograms, of samples of patients who suffered from typhoid fever in El Salvador, from January 2017 to June 2020. Results. 1406 isolates of Salmonella enterica Typhi were reported. 100% of the isolations analyzed showed susceptibility to ceftriaxone and azithromycin. 99.9% of the isolates analyzed presented susceptibility to ampicillin, chloramphenicol, tetracycline, and trimethoprim-sulfamethoxazole. For ciprofloxacin, detected susceptibility in 8.5% of the strains analyzed, intermediate susceptibility in 91.5% and resistance in the 0.08%. Conclution. The findings are consistent with what has been reported worldwide: the rapid development of susceptibility intermediate or resistance to ciprofloxacin, once it is adopted as the treatment of choice for typhoid fever. In El Salvador, antibiotics previously considered first-line against Salmonella enterica Typhi, must be recycled