A review of bacteriological profile of acute pyogenic meningitis in a tertiary care center in Southwest Nigeria

Abstract

Aim: Pyogenic meningitis remain a major cause of mortality and morbidity in lower middle income countries. There exists a wide variability in antibiogram profile of infective causes of acute pyogenic meningitis seeking for individualized management protocol. This study aim to review a five years profile of isolates from suspected cases and evaluate the antibiogram of the infective agent in a tertiary hospital in South west Nigeria.

Methods: All patients presenting to the hospital with signs and symptoms suggestive of meningitis were evaluated. Aside random plasma glucose, CSF samples were sent for biochemistry, gene expert for tuberculosis and cultured on Blood agar, Chocolate agar and MacConkey agar for neonates and read after 24hours incubation.  

Results: 393 of the 657,890 patients seen in the hospital over a five year period suspected to have meningitis were investigated, 22(7%) had a positive culture. Streptococcus pneumoniae (31.8%), Haemophilus influenzae (27.4%), other Enterobacteriaceae (18.2%), Pseudomonas aeruginosa (9.1%), Staphylococcus aureus (4.5%), Proteus mirabilis (4.5%) and Candida albicans (4.5%) were isolated. 

Conclusion: Spectrum of causative bacterial agent is not different from documented in other parts of the country. Streptococcus pneumoniae predominance was reported which is sensitive to Ampicillin, Ceftriaxone, Cefotaxime and Penicillin. Empirical treatment with Ceftriaxone or Cefotaxime can be instituted while awaiting laboratory confirmation in suspected cases.

Keywords

• Acute pyogenic meningitis,Lower middle income countries,Antibiogram,Southwest Nigeria

Güneybatı Nijerya'da bir üçüncü basamak merkezde akut piyojenik menenjitin bakteriyolojik profilinin gözden geçirilmesi

Öz

Amaç: Piyojenik menenjit, düşük orta gelirli ülkelerde önemli bir mortalite ve morbidite nedenidir. Bireyselleştirilmiş yönetim protokolü arayan akut piyojenik menenjitin enfektif nedenlerinin antibiyogram profilinde geniş bir değişkenlik vardır. Bu çalışmada, şüpheli vakalardaki izolatların beş yıllık bir profili gözden geçirilerek Güney Batı Nijerya'daki bir üçüncü basamak hastanede enfektif ajanın antibiyogramının değerlendirilmesi amaçlanmıştır.

Yöntem: Menenjit düşündüren belirti ve bulguları olan hastaneye başvuran tüm hastalar değerlendirildi. Rastgele plazma glukozunun yanı sıra, CSF örnekleri biyokimya, tüberküloz için gen uzmanı olarak gönderildi ve yenidoğanlar için Blood agar, Chocolate agar ve MacConkey agar üzerinde kültürlendi ve 24 saat inkübasyondan sonra okundu.

Bulgular: Hastanede menenjit geçirdiğinden şüphelenilen beş yıllık bir süre içinde görülen 657.890 hastanın 393'ü araştırıldı, 22'sinde (%7) pozitif kültür vardı. Streptococcus pneumoniae (%31,8), Haemophilus influenzae (%27,4), diğer Enterobacteriaceae (%18,2), Pseudomonas aeruginosa (%9,1), Staphylococcus aureus (%4,5), Proteus mirabilis (%4,5) ve Candida albicans (%4,5).

Sonuç: Nedensel bakteri ajanının spektrumu, ülkenin diğer bölgelerinde belgelenenlerden farklı değildir. Ampisilin, Ceftriaxone, Cefotaxime ve Penicillin'e duyarlı Streptococcus pneumoniae baskınlığı bildirilmiştir. Şüpheli vakalarda laboratuvar onayı beklenirken Ceftriaxone veya Cefotaxime ile ampirik tedavi uygulanabilir.

Anahtar Kelimeler

• Akut piyojenik menenjit,Düşük orta gelirli ülkeler,Antibiyogram,Güneybatı Nijerya

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