Clinical profile, bacterial profile and outcomes of acute bacterial meningitis in a tertiary care hospital– one year study

Abstract

Background: Bacterial meningitis is still one of the major causes of mortality and morbidity among all groups in developing countries. The mortality and prevalence of common pathogens has reduced in developing countries with implementation of successful vaccination against the pathogens. Laboratory surveillance of pathogens is crucial in formulating the empirical treatment guidelines and to identify the targets of immunization. The present study was undertaken to evaluate the clinical profile, bacterial pathogens and their antibiotic sensitivity pattern of the pathogens. The outcome of the cases was recorded and followed for six months to detect any neurological sequelae.Methods: A one year prospective cross sectional study was done and all suspected cases of acute bacterial meningitis (ABM) were screened and confirmed by diagnostic criteria. Clinical features were recorded and entered into the case sheet. CSF culture was done and biochemical analysis and cell counts were performed. All the data was entered in Microsoft excel and analysed.Results: A total of 547 cases were screened and 282 confirmed with 164 males and 116 females. 282 pathogens were isolated with 266 bacterial and 12 fungal isolates. Gram negative bacterial pathogens were predominant than gram positive. Streptococcus pneumoniae was the common isolate in the study followed by others like S. aureus, Coagulase negative staphylococci and Acinetobacter sp., Escherichia coli, Klebsiella pneumoniae and meningococci. Candida albicans and Cryptococcus sp. were fungal pathogens. Community acquired meningitis was commonest cause and seen in 51-60 years of age. Gram positive pathogens exhibited maximum sensitivity to vancomycin and linezolid whereas Gram negative pathogens to carbapenems.Conclusions: There is an overwhelming need to formulate policies in the management of cases of ABM. The rationale use of antibiotics is necessary to prevent the development of antibiotic resistance. Hence minimizing the emergence of antibiotic resistance and its spread is necessary, which can be achieved by regular prevalence and antibiotic susceptibility studies.

Etiology, clinical findings and laboratory parameters in neonates with acute bacterial meningitis

“…In this study 85 neonates (36.5%) had positive results for CSF culture, and about 1.5% of infants suspected for sepsis detected to have meningitis in our departments. In one study, positive result for CSF culture was reported in 36.88% (7). In another study, the prevalence of neonatal meningitis was 1% (22).…”

“…Knowledge about causative pathogens of meningitis helps for prompt diagnosis and treatment. In developing countries such as India, despite important advances in treatment, mortality rates of this disease is still 16-34% (6,7).…”

“…CSF parameters are especially helpful in cases where diagnosis has not been confirmed, or in cases of bacterial meningitis without bacteremia (14). Laboratory parameters of acute bacterial meningitis include neutrophilic pleocytosis with increased protein and decreased glucose in CSF (7). Therefore, when patients are suspected to be septic in this age group, they should be admitted, and CSF should be obtained.…”

Current clinical trends in the management of gram positive infections in Indian critical care settings: a survey

“…Various reports across India have documented variations in MRSA prevalence which ranges from 17.6% to 80.4% depending on the geographical area. [20][21][22][23][24] Similarly, the survey identified 34% of the delegates who observed 10-20% of MRSA prevalence; while, another 30% delegates identified 20%-40% of MRSA in their respective ICU settings. This variation in prevalence rates could be attributed to the different ICU settings, patient profiles and local antibiotic regimen that could impact the overall prevalence.…”

Guidelines for Antibiotic Prescription in Intensive Care Unit

“…415 A recent Indian study including 266 culture positive ABM patients (including 142 CAM patients) found that gram positive pathogens exhibited maximum sensitivity to vancomycin and linezolid whereas most gram-negative pathogens were sensitive to carbapenems. 416 Seven days antibiotic therapy has been recommended for N. meningitidis and H. influenzae , 10–14 days for S. pneumoniae , 14–21 days for S. agalactiae , 21 days for aerobic GNB and 21 days or more for L. monocytogenes . 417…”