Abstract
The aim of this study was identifying bacterial pathogens involved in meningitis, studying their antibiotic resistance profiles, investigating the antibiotic resistance genes as well as evaluating the use of various antibiotic combinations. Antibiotic susceptibility tests were evaluated according to CLSI guidelines. Antibiotic combinations were evaluated by calculating the Fractional Inhibitory Concentration (FIC) index. A total of 71 bacterial isolates were recovered from 68 culture positive CSF specimens. Sixty five of these isolates (91.5%) were recovered from single infection specimens, while 6 isolates (8.4%) were recovered from mixed infection specimens. Out of the 71 recovered isolates, 48 (67.6%) were Gram-positive, and 23 (32.4%) were Gram-negative. Thirty one of the Gram positive isolates were S. pneumoniae (64.6%, n = 48). Out of the recovered 71 isolates; 26 (36.6%) were multidrug-resistant (MDR) isolates of which, 18 (69.2%) were Gram-negative and 8 (30.8%) were Gram-positive. All MDR isolates (100%) showed resistance to penicillin and ampicillin, however, they showed lower resistance to meropenem (50%), levofloxacin (50%), amikacin (48%), pipercillin-tazobactam (45.8%). Most common antibiotic resistance genes were investigated including: tem (21.1%), shv (15.8%), ctx-m (15.8%) coding for TEM-, SHV, CTX-M extended-spectrum beta-lactamases (ESBLs), respectively; aac(6')-I b(26.3%) coding for aminoglycoside 6’-N-acetyltransferase type Ib ciprofloxacin resistant variant; and qnrA (5.3%) gene coding for quinolone resistance. The DNA sequences of the respective resistance genes of some selected isolates were PCR amplified, analyzed and submitted to the GenBank database under the accession numbers, KX214665, KX214664, KX214663, KX214662, respectively. The FIC values for ampicillin/sulbactam plus cefepime showed either additive or synergistic effect against ten tested Gram-negative MDR isolates, while doxycycline plus levofloxacin combination revealed synergism against two MDR Gram-positive isolates. The results indicate high prevalence of antibiotic resistance among MDR isolates. Therefore, new guidelines should be implemented in Egypt to rationalize the use and avoid the misuse and abuse of antimicrobial agents.
Highlights
Bacterial meningitis is a life threatening disease that is associated with significant mortality and morbidity [1]
Depending on PMNLs/Lymphocytes ratios(obtained from cell count of conducted microscopically using Hemocytometer; (Assistent, Germany),WBC count, protein leveland glucose levels, the specimens have been divided in to 4 categories: a) viral; b) zero; c) turbid no growth (PMNLs exceeds lymphocytes and negative culture, glucose50mg\dl); and d) bacterial (PMNLs exceed lymphocytes, glucose 50mg\dl and positive culture growth)
Piperacillin/tazobactam, levofloxacin, meropenem and ampicillin/sulbactam had a favorable sensitivity pattern among Gram-positive and Gram-negative pathogens; they are Prevalence of MDR pathogens of bacterial meningitis and new synergistic antibiotic combinations recommended for treatment of bacterial meningitis
Summary
Bacterial meningitis is a life threatening disease that is associated with significant mortality and morbidity [1]. Three major pathogens account for most cases of bacterial meningitis, which includes: Neisseria (N.) meningitidis, Streptococcus (S.) pneumoniae, and Haemophilus (H.) influenzae, they accounted for about 75–80% of cases globally, while the majority of other cases accounted by Escherichia (E.) coli, Listeria (L.) monocytogenes, and Staphylococcus (S.) aureus [2], bacterial pathogens causing meningitis are evolving constantly, as evidenced by the change in relative occurrence of pneumococcal meningitis in sub-Saharan [3] The mortality from these bacterial varies from 3 to 21%, according to type of organism [4].
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