Antimicrobial Resistance Pattern of Bacterial Meningitis Among Patients in Quetta, Pakistan

Abstract

Introduction: Bacterial meningitis (BM) is a lethal infectious disease that persists as a substantial cause of morbidity and mortality. The antimicrobial drug resistance in BM pathogens poses a major threat to the community while raising challenges for clinicians. For the first time, we elucidate the incidence rate of BM and its drug resistance among the population of Quetta, Balochistan. Methods: A cross-sectional study was conducted (from January 2018 to March 2021) among meningitis patients admitted to government hospitals in Quetta. The cerebrospinal fluid (CSF) specimen was collected and processed for microbiological and cytological analysis. Bacterial isolates were identified and confirmed using phylogenetic analysis of the 16S rRNA gene. Results: We found 35.9% (321/894) confirmed cases of BM among the population of Quetta, Balochistan. The identified bacterial isolates comprised Streptococcus pneumoniae 14.7% (130/894), Staphylococcus aureus 6.9% (61/894), Neisseria meningitidis 5.7% (51/ 894), Haemophilus influenzae 2.5% (22/894), Escherichia coli 4.5% (40/894), and Klebsiella pneumoniae 1.9% (17/894). A high percentage in male patients of 20.8% (186/894) was identified as compared to female patients of 15.1% (135/894). Extreme age groups such as infants (age range: 1 month to 1 year) and adults (age range: 61 years to 99 years) with low immunity were critically affected by BM. Clinical parameters such as abnormal CSF appearance, pH, and high WBCs in BM patients with endocarditis as the underlying disease were significantly at elevated risk of fatal outcome. 16S rRNA gene phylogenetic analysis confirmed the evolutionary similarity of isolated strains with prevailing pathogenic strains in Asia. Furthermore, age was identified as a significant risk factor for clinical outcomes. Conclusion:The majority of the identified BM patients belonged to rural areas with limited health-care facilities and paramedic staff. The high case fatality rate 11% demonstrates increased antibiotic resistance among BM isolates, thereby stimulating its devastation in underdeveloped regions. Timely detection and intensive treatment of BM may improve critical outcomes in patients.

A Rare Case of Third Generation Cephalosporin-Resistant Klebsiella Meningitis

“…In a total of 1108 patients identified with meningitis in a study by van de Beek et al, Streptococcus pneumoniae and Neisseria meningitis were the most commonly found organisms [4]. Moreover, in another study, Klebsiella was the least commonly isolated organism in confirmed cases of bacterial meningitis [2]. And, only two cases of community-acquired Klebsiella meningitis have been reported in the Caribbean [5].…”

“…Meningitis is associated with very fatal outcomes; therefore, it requires urgent medical intervention for favorable outcomes. Even with the advancements in medicine, it is still a challenge to treat this condition due to the acquired resistance to various broad-spectrum antibiotics and varying clinical presentations [2].…”

“…Acute bacterial meningitis is a recurrent cause of mortality in all age groups, especially in underdeveloped countries [1,2]. Erum et al reported the highest incidence in neonates than other age groups in Pakistan [1].…”

Bacterial Isolates and their Sensitivity Profile from CSF Samples – A 5 Year Study at a Tertiary Care Hospital

“…Similarly in various reports from Pakistan reveal high resistance of Staphylococcus aures to Penicillins (98%), Cefoxitin and other antimicrobials. (26). This high resistance level is due to easy availability of antimicrobials, self mdications and taking incomplete dosage of antimicrobials.…”

Traditional and molecular methods for diagnosing bacterial meningitis in Erbil city, Iraq

“…Bosshard and his colleagues 33 Antimicrobial resistance of E. coli exacerbates the prevalence of infections, particularly in newborns and mothers. E. coli related meningitis was discovered to be amoxicillin (80%) and rifampicin (77.5%) resistant, while sensitive to meropenem 92.5% and amikacin 97.5% 34 . In a study by Assegu Fenta and his colleagues 35 , indicated that E.coli was resistant to penicillin, ceftriaxone, cefotaxime, and ciprofloxacin.…”