Retrospective analysis of bacterial agents in central nervous system infections: A nine-years evaluation in a university hospital

Abstract

The follow-up of bacterial agents and antibiotic resistance profiles that cause central nervous system (CNS) infections has guided the choice of life-saving empirical treatment against these infections. In this study, it was aimed to evaluate the bacterial agents isolated from cerebrospinal fluid (CSF) samples and their antibiotic susceptibility for nine years with the suspicion of CNS infection. The results of the patients who were sent CSF samples for bacteriological diagnosis with the suspicion of CNS infection between August 2012 and April 2021 were analyzed retrospectively. The isolated bacterial species were identified using conventional methods, biochemical tests and various commercial identification systems. Microorganisms were isolated in 121 (14.85%) of 815 CSF samples examined. The most commonly isolated agents are methicillin-resistant coagulase negative Staphylococci (n:59; 48.76%) among Gram-positive and Klebsiella spp. (n:12; 9.92%) among Gram-negative. The follow-up of bacteria isolated from CNS infections, which can progress rapidly and cause serious complications, and the changes in antibiotic susceptibility over the years is known as a guide in the regulation of appropriate treatment. We think that our results may contribute to the selection of antibiotics that can be used especially in cases where urgent empirical treatment is required.

Keywords

• Antimicrobial resistance
• bacterial agents
• central nervous system
• infection
• cerebrospinal fluid

References

1. 1. Archibald LK, Quisling RG. Central Nervous System Infections. In: Layon A, Gabrielli A, Friedman W, editors. Textbook of Neurointensive Care. London: Springer; 2013, p. 427-517.
2. 2. Akhvlediani T, Bautista CT, Shakarishvili R, Tsertsvadze T, Imnadze P, Tatishvili N, et al. Etiologic agents of central nervous system infections among febrile hospitalized patients in the country of Georgia. PLoS One. 2014; 9(11): e111393.
3. 3. Lim AKH, Paramaswaran S, Jellie LJ, Junckerstorff RK. A Cross-Sectional Study of Hyponatremia Associated with Acute Central Nervous System Infections. J Clin Med. 2019; 8(11): 1801.
4. 4. Duman Y, Yakupoğulları Y, Tekerekoğlu MS, Güçlüer N, Otlu B. A Three Years Retrospective Analysis of Agents Isolated from Cerebrospinal Fluid in a University Hospital. Dicle Med J. 2012; 39(1): 70-74.
5. 5. Traore Y, Tameklo TA, Njanpop-Lafourcade BM, Lourd M, Yaro S, Niamba D, et al. Incidence, seasonality, age distribution, and mortality of pneumococcal meningitis in Burkina Faso and Togo. Clin Infect Dis. 2009; 48 Suppl 2: S181-S189.
6. 6. Wright C, Blake N, Glennie L, Smith V, Bender R, Kyu H, Wunrow HY, Liu L, Yeung D, Knoll MD, Wahl B, Stuart JM, Trotter C. The Global Burden of Meningitis in Children: Challenges with Interpreting Global Health Estimates. Microorganisms. 2021;9(2):377.
7. 7. Clinical and Laboratory Standards Institute: Performance Standards for Antimicrobial Susceptibility Testing; Twenty First Informational Supplement, M100-S25 [Internet]. [updated 2015 Feb 10; cited 2022 Dec 06]. Available from: https://clsi.org/standards/products/microbiology.
8. 8. The European Committee on Antimicrobial Susceptibility Testing. Breakpoint Tables for Interpretation of MICs and Zone Diameters, version 10.0 [Internet]. [updated 2022 Jan 1; cited 2022 Dec 06]. Available from: http://www.eucast.org/clinical_breakpoints/.

9. 9. Zimmer AJ, Burke VE, Bloch KC. Central Nervous System Infections. Microbiol Spectr. 2016; 4(3).
10. 10. Cunha BA. The Clinical and Laboratory Diagnosis of Acute Meningitis and Acute Encephalitis. Expert Opin Med Diagn. 2013; 7(4): 343-364.
11. 11. Hong NTT, Nghia HDT, Thanh TT, Lan NPH, Ny NTH, Ngoc NM, et al. Cerebrospinal Fluid MinION Sequencing of 16S rRNA Gene for Rapid and Accurate Diagnosis of Bacterial Meningitis. J Infect. 2020; 80(4): 469-496.
12. 12. Furyk JS, Swann O, Molyneux E. Systematic review: neonatal meningitis in the developing world. Trop Med Int Health. 2011; 16(6): 672-679.
13. 13. Durand ML, Calderwood SB, Weber DJ, Miller SI, Southwick FS, Caviness VS Jr, Swartz MN. Acute bacterial meningitis in adults. A review of 493 episodes. N Engl J Med. 1993; 328(1): 21-28.
14. 14. Mengistu A, Gaeseb J, Uaaka G, Ndjavera C, Kambyambya K, Indongo L, et al. Antimicrobial sensitivity patterns of cerebrospinal fluid (CSF) isolates in Namibia: implications for empirical antibiotic treatment of meningitis. J Pharm Policy Pract. 2013; 6: 4.
15. 15. Centers for Disease Control and Prevention. Immunization Schedules [Internet]. [updated 2022 Feb 17; cited 2022 Dec 06]. Available from: https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html.
16. 16. World Health Organization. Immunization, Vaccines and Biologicals. [Internet]. [updated 2022 Nov 01; cited 2022 Dec 06]. Available from: https://www.who.int/teams/immunization-vaccines-and-biologicals/policies/who-recommendations-for-routine-immunization---summary-tables.
17. 17. Harrison LH. Prospects for vaccine prevention of meningococcal infection. Clin Microbiol Rev. 2006; 19(1): 142-164.
18. 18. Saez-LIorens X, McCracken GH Jr. Bacterial meningitis in children. Lancet. 2003; 361(9375): 2139-2148.
19. 19. Elenga N, Sicard S, Cuadro-Alvarez E, Long L, Njuieyon F, Martin E, et al. et al. Pediatric bacterial meningitis in French Guiana. Med Mal Infect. 2015; 45(11-12): 441-445.
20. 20. Jiang H, Su M, Kui L, Huang H, Qiu L, Li L, et al. Prevalence and antibiotic resistance profiles of cerebrospinal fluid pathogens in children with acute bacterial meningitis in Yunnan province, China, 2012-2015. PLoS One. 2017; 12(6): e0180161.
21. 21. Duman Y, Yakupoğulları Y, Tekerekoğlu MS, Güçlüer N, Otlu B. Bir Üniversite Hastanesi Laboratuvarında Beyin Omurilik Sıvısı’nda İzole Edilen Mikroorganizmaların Üç Yıllık Geriye Dönük Analizi. Dicle Tıp Derg. 2012; 39(1): 70-74.
22. 22. Sümer Z, Bakıcı Z, Özüm Ü. Menenjit Ön Tanılı Hastaların BOS Örneklerinin Bir Yıllık Bakteriyolojik İnceleme Sonuçlarının Değerlendirilmesi. C. Ü. Tıp Fakültesi Derg. 2000; 22(3): 127-130.
23. 23. Üsküdar Güçlü A, Kılıç A, Küçükkaraaslan A, Baysallar M, Doğancı L. Beyin Omurilik Sıvılarından İzole Edilen Mikroorganizmalar ve Antibiyotik Duyarlılıkları. Gülhane Tıp Derg. 2005; 47: 204-208.