INVASIVE DISEASE CAUSED BY NEISSERIA-MENINGITIDIS RELATIVELY RESISTANT TO PENICILLIN IN NORTH-CAROLINA

A case of sepsis and meningitis caused by Neisseria meningitidis with relative resistance to penicillin occurred in North Carolina in August 1992. This isolate was relatively resistant due to decreased affinity of its penicillin-binding protein 2 for penicillin. Such isolates hav e been reported in Spain, elsewhere in Europe, in South Africa, and in Canada, but invasive disease caused by meningococcal isolates relativ ely resistant to penicillin was not recognized in the United States be fore a preliminary report of this case in October 1992. The Centers fo r Disease Control and Prevention recently retrospectively identified 3 additional cases from 1991. A fifth case occurred in Kentucky in 1993 . Surveillance studies of penicillin susceptibility of N. meningitidis isolates suggest such meningococci have existed sporadically in the p ast. Increases in prevalence and magnitude of penicillin resistance am ong strains of N. meningitidis would require reconsideration of curren t clinical practice with regard to treatment of meningococcal disease.