Antimicrobial sensitivity patterns of cerebrospinal fluid (CSF) isolates in Namibia: implications for empirical antibiotic treatment of meningitis

Abstract

ObjectiveBacterial meningitis is a medical emergency associated with high mortality rates. Cerebrospinal fluid (CSF) culture is the “gold standard” for diagnosis of meningitis and it is important to establish the susceptibility of the causative microorganism to rationalize treatment. The Namibia Standard Treatment Guidelines (STGs) recommends initiation of empirical antibiotic treatment in patients with signs and symptoms of meningitis after taking a CSF sample for culture and sensitivity. The objective of this study was to assess the antimicrobial sensitivity patterns of microorganisms isolated from CSF to antibiotics commonly used in the empirical treatment of suspected bacterial meningitis in Namibia.MethodsThis was a cross-sectional descriptive study of routinely collected antibiotic susceptibility data from the Namibia Institute of Pathology (NIP) database. Results of CSF culture and sensitivity from January 1, 2009 to May 31, 2012, from 33 state hospitals throughout Namibia were analysed.ResultsThe most common pathogens isolated were Streptococcus species, Neisseria meningitidis, Haemophilus influenzae, Staphylococcus, and Escherichia coli. The common isolates from CSF showed high resistance (34.3% –73.5%) to penicillin. Over one third (34.3%) of Streptococcus were resistance to penicillin which was higher than 24.8% resistance in the United States. Meningococci were susceptible to several antimicrobial agents including penicillin. The sensitivity to cephalosporins remained high for Streptococcus, Neisseria, E. coli and Haemophilus. The highest percentage of resistance to cephalosporins was seen among ESBL K. pneumoniae (n = 7, 71%–100%), other Klebsiella species (n = 7, 28%–80%), and Staphylococcus (n = 36, 25%–40%).ConclusionsThe common organisms isolated from CSF were Streptococcus Pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Staphylococcus, and E. coli. All common organisms isolated from CSF showed high sensitivity to cephalosporins used in the empirical treatment of meningitis. The resistance of the common isolates to penicillin is high. Most ESBL K. pneumoniae were isolated from CSF samples drawn from neonates and were found to be resistant to the antibiotics recommended in the Namibia STGs. Based on the above findings, it is recommended to use a combination of aminoglycoside and third-generation cephalosporin to treat non–ESBL Klebsiella isolates. Carbapenems (e.g., meropenem) and piperacillin/tazobactam should be considered for treating severely ill patients with suspected ESBL Klebsiella infection. Namibia should have a national antimicrobial resistance surveillance system for early detection of antibiotics that may no longer be effective in treating meningitis and other life-threatening infections due to resistance.

Higher CTX-M, Tem, and SHV Extended-Spectrum Beta-Lactamase Plasmid Gene Combination Frequency in Esbl Producing Klebsiella Pneumoniae Compared With Esbl Producing Escherichia Coli

“…Wound biomaterial was the most common source of biomaterial for ESBL producing Enterobacteriaceae isolation in this study, while urine was the most commonly used biomaterial in other studies (Peralta et al, 2012;Kassakian & Mermel, 2014;Moor et al, 2008;Ruiz de Alegría et al, 2011;Kolar et al, 2006). The frequency of other biomaterial for ESBL producing bacteria detection, including abdominal cavity and abscess biomaterial, bronchoalveolar fluid, blood, and cerebrospinal fluid was approximately the same as that described in other literature sources (Peralta et al, 2012;Kassakian & Mermel, 2014;Ruiz de Alegría et al, 2011;Kolar et al, 2006;Mengistu et al, 2013). The frequency of other Enterobacteriaceae found in this study, including P. mirablis, S. marcescens, and K. oxytoca, was similar to that in other studies (Sasirekha, 2013).…”

Bacteriology of Body Fluids With an Evaluation of Enrichment Technique to Increase Culture Positivity

“…This observation corroborate with other studies reporting antimicrobial susceptibility patterns of Gram positive organisms isolated from body fluids. [11,13,15] Overall we observed a general pattern of Gram negative isolates and Enterococci being more commonly isolated from ascitic fluid, while Gram positive isolates were more frequently isolated from CSF and other fluids. This can be explained by the fact that in bacterial peritonitis, there is increased intestinal permeability, which in turn contributes to higher number of enteric pathogens being isolated because of their transmigration across the intestinal wall.…”

Prevalence of Etiological Agents and Antimicrobial Resistance Patterns of Bacterial Meningitis in Nemazee Hospital, Shiraz, Iran

“…(16). In similar studies from two African countries, Namibia and Ethiopia, reported frequencies are 9.6% and 5.6%, respectively (17,18). This may be a reflection of the different infection control policies and other factors involved in the mentioned regions or countries (19).…”