Acute Bacterial Meningitis at the 'Complexe Pediatrique' of Bangui, Central African Republic

Abstract

To precis the aetiologies of children meningitis and the susceptibility to antibiotics of bacteria responsible for meningitis in Bangui, we conducted a prospective study between October 2004 and September 2005, at the 'Complexe Pédiatrique de Bangui', Central African Republic (CAR). Children from 1 day to 16 years with suspected meningitis and who underwent a lumbar puncture were enrolled. Gram staining, culture on chocolate blood medium, cell count, biochemistry (protein level, glucose ratio), capsular antigen detection were performed for each cerebrospinal fluid. MICs were determined by the E-test method. Four hundred and seventeen patients were enrolled during the study period; 130 were proven acute bacterial meningitis and 37 probable bacterial meningitis. Among proven bacterial meningitis, Streptococcus pneumoniae was the most common organism responsible for meningitis (62 cases, 48%) followed by Haemophilus influenzae (46 cases, 35%) and by Neisseria meningitidis and Salmonella sp. (8 cases, 6% each). Ninety-four percent and 96% of S. pneumoniae strains tested remain susceptible to benzylpenicilline and chloramphenicol, respectively. A beta-lactamase was detected in 92% of H. influenzae strains tested. However, MICs 50% and 90% for amoxicillin were found to be 1 and 4 mg/l, respectively and 33% of these strains were resistant to chloramphenicol. The global mortality rate was 35% (59/167). This mortality rate was 47% for S. pneumoniae, 33% for H. influenzae, 62% for Salmonella sp. and 13% for N. meningitidis. The probabilistic treatment with ampicillin and chloramphenicol usually administered for children meningitis in Bangui must be reconsidered particularly in cases of H. influenzae meningitis. It is of importance to reduce the presentation delays of children with suspected meningitis in Bangui. The H. influenzae b immunization would allow a dramatic reduction of meningitis cases and deaths in Central African children.

Antibiotic resistance among bacterial pathogens in Central Africa: a review of the published literature between 1955 and 2008

“…In a paediatric bacteraemia study in the DRC, Kariuki et al [60] found resistance to five or more first-line antibiotics in >95% of the isolates. [23,24,28,45,49,54,59,[61][62][63][64][65][66] (Table 4) The general study characteristics were similar to those reporting on S. Typhi, with five studies also addressing nosocomial infections. High mean resistance rates were noted for ampicillin (63.0%), chloramphenicol (42.9%) and the fluoroquinolones (16.8%).…”

“…Use of control stains and participation in external quality programmes were mentioned in only 14 and 3 studies, respectively. Only 5 [10,17,[22][23][24][25][26][27][28] Resistance data for S. aureus were reported in nine studies, including three surveillance studies and six clinical studies from urban hospitals. Although a wide range of samples (pus, wounds, urine and CSF) was addressed from mixed origins (community, nosocomial), only one study considered blood cultures [24].…”

“…Kesah et al [10] A c c e p t e d M a n u s c r i p t 8 (Table 2) [14,15,22,[28][29][30][31][32][33][34][35] Data were found in 11 studies conducted between 1990 and 2008, mainly in urban children. Clinical samples were predominantly from CSF (8/11; 72.7%); one study described blood cultures isolates [15].…”

“…Multidrug resistance to at least four antibiotics was as frequent as 41.2%. [14,28,29,34,[90][91][92] Data between 1968 and 2008 were found, mainly from countries near to the meningitis belt (i.e. Chad, Cameroon).…”

Impact of Antibiotic MIC on Infection Outcome in Patients with Susceptible Gram-Negative Bacteria: a Systematic Review and Meta-Analysis

“…and especially Neisseria gonorrhoeae, we could not find any article that provided data for increasing treatment failures with increasing MICs within the susceptible range. However, articles that reported only treatment success or treatment failure for patients with susceptible isolates have been published (2,12).…”