Invasive disease caused by Neisseria meningitidis relatively resistant to penicillin in North Carolina

J Infect Dis. 1994 Aug;170(2):453-6. doi: 10.1093/infdis/170.2.453.


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 have been reported in Spain, elsewhere in Europe, in South Africa, and in Canada, but invasive disease caused by meningococcal isolates relatively resistant to penicillin was not recognized in the United States before a preliminary report of this case in October 1992. The Centers for 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 past. Increases in prevalence and magnitude of penicillin resistance among strains of N. meningitidis would require reconsideration of current clinical practice with regard to treatment of meningococcal disease.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Amoxicillin / therapeutic use
  • Bacteremia / drug therapy
  • Bacteremia / microbiology*
  • Bacterial Proteins*
  • Carrier Proteins*
  • Ceftriaxone / therapeutic use
  • Drug Therapy, Combination
  • Female
  • Hexosyltransferases / metabolism
  • Humans
  • Infant
  • Meningitis, Meningococcal / drug therapy
  • Meningitis, Meningococcal / microbiology*
  • Meningococcal Infections / drug therapy
  • Meningococcal Infections / microbiology*
  • Multienzyme Complexes / metabolism
  • Muramoylpentapeptide Carboxypeptidase*
  • Neisseria meningitidis / drug effects*
  • North Carolina
  • Otitis Media / drug therapy
  • Penicillin G / metabolism
  • Penicillin Resistance*
  • Penicillin-Binding Proteins
  • Peptidyl Transferases / metabolism
  • Rifampin / therapeutic use


  • Bacterial Proteins
  • Carrier Proteins
  • Multienzyme Complexes
  • Penicillin-Binding Proteins
  • Ceftriaxone
  • Amoxicillin
  • Peptidyl Transferases
  • Hexosyltransferases
  • Muramoylpentapeptide Carboxypeptidase
  • Penicillin G
  • Rifampin