Health officials in Minnesota say they are seeing increasing evidence of antibiotic resistance in disease-causing bacteria in the state, prompting a reminder to health care providers and patients about the importance of using antibiotics carefully and appropriately.

A report in this week's New England Journal of Medicine details the finding by health officials in Minnesota, North Dakota and the Centers for Disease Control in Atlanta of an antibiotic-resistant strain of bacterium, Neisseria meningitidis, that causes meningococcal disease. In a related occurrence, the Minnesota Department of Health (MDH) on Tuesday sent an alert to infection control professionals and health care providers regarding a very resistant strain of Klebsiella pneumoniae bacteria.

The bacteria N. meningitidis can cause meningitis, sepsis, pneumonia and joint infections. These infections can be life-threatening. The resistant strain of N. meningitidis was discovered during an investigation and follow-up of three cases of the disease in 2007 (Jan. '07-Jan. '08). The cases, two in western Minnesota and one in North Dakota, were not related or linked, (except that the first case attended a daycare where an adult worker died of probable meningococcal disease in 2006). All three had the same strain of the bacterium and all proved to be resistant to ciprofloxacin, the antibiotic most often recommended for preventing infections in adult close contacts of infected persons. These were the first strains of N. meningititidis in North America found to be resistant to ciprofloxacin, a commonly used antibiotic.

"This is extremely concerning because ciprofloxacin-resistance in a related bacteria, Neisseria gonorrhoeae, rose very quickly over a few years, and ciprofloxacin is no longer recommended to treat gonococcal infections" said Ruth Lynfield, state epidemiologist with MDH. "This finding further stresses the importance of using antibiotics judiciously. We've lost an important tool here for fighting disease causing bacteria and we need to preserve the effectiveness of the tools we have. That's why we need to be extremely careful how we use antibiotics."

Scientists contend that overuse and misuse of antibiotics contributes to bacteria's ability to adapt and mutate to resistant strains in order to survive. Details of the investigation and a discussion of how the bacteria may have become resistant can be found in the report at The New England Journal of Medicine..

After discovery of the resistant strain, the state health departments in North Dakota and Minnesota advised health care providers in eastern North Dakota and western Minnesota to use alternative antibiotics as preventive treatment for people who had close contact with someone diagnosed with meningococcal disease. In addition, the CDC recommended increased nationwide surveillance for antibiotic-resistant meningococcal bacteria.

In another instance, a highly resistant strain of Klebsiella pneumoniae, a disease-causing bacterium, was recently identified in Minnesota, health officials reported. This strain, called carbapenemase- producing Klebsiella pneumoniae (KPC) is resistant to almost all classes of antibiotics. This type of resistance is especially concerning because it can spread to other similar bacteria making them also resistant. "This is the first time we've identified KPC in Minnesota," said Lynfield. "However, KPC has been responsible for hospital outbreaks in other parts of the country where infections caused by this strain were associated with increased severity of illness and death. In addition, these bacteria have been shown to spread readily between patients."

While resistant N. meningitidis and KPC are very different pathogens, their emergence demonstrates the problem presented by increasing antibiotic resistance, health officials said. Preserving the effectiveness of antibiotics is essential – and everyone (not just clinicians) has a responsibility to use them appropriately.

Minnesota health officials recommend the following:

• Patients should not insist on antibiotics. Let health care providers decide if an antibiotic is needed to treat an illness.
• Many respiratory infections such as influenza or acute bronchitis are caused by viruses. Antibiotics treat bacterial infections - not infections caused by viruses.
• Clinicians should increase efforts to diagnose the cause of infections and tailor treatment to the specific illness.
• Infection prevention and control measures in health care, including acute care and long-term care facilities, are very important.
• Practice basic infection prevention measures such as good hand washing, covering your cough, staying home and away from others when you're sick, and getting recommended vaccines.