WITHDRAWN: Antimicrobial Resistance Pattern of Bacterial Meningitis Among Patients in Quetta, Pakistan

Abstract

Bacterial meningitis (BM) is lethal infectious disease that persists as substantial cause of morbidity and mortality. The antimicrobial drug resistances in BM pathogens possess a major threat in the community, while escalating challenges for clinicians. We for the first time elucidate incidence rate of BM and its drug resistance among the population of Quetta, Balochistan. A cross-sectional study was conducted (form January 2018 to March 2021) among meningitis patients admitted at 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 16S rRNA gene. We found 35.9% (321/894) confirmed cases of BM among the population of Quetta, Balochistan. The identified bacterial isolates comprised of Streptococcus pneumonia 14.7% (130/894), Staphylococcus aureus 6.9% (61/894), Neisseria meningitidis 5.7% (51/894). Haemophilus influenza 2.5% (22/894), Escherichia coli 4.5% (40/894), and Klebsiella pneumoniae 1.9% (17/894). A surge in male patients 20.8% (186/894) was identified as compare to female patients 15.1% (135/894). Extreme age groups such as Infants (age range: 1month- 1year) and adults (age range: 61years- 99years) with low immunity were critically affected with BM. Clinical parameters such as abnormal CSF appearance, pH, high WBCs in BM patients with endocarditis as underlying disease were significantly at elevated risk of fatal outcome. 16S rRNA gene phylogenetic analysis confirmed evolutionary similarity of isolated strains with prevailing pathogenic strains in Asia. Furthermore, age was identified as significant risk factors for clinical outcomes. Majority of the identified BM patients belonged to rural areas with limited healthcare facilities and paramedics’ staff. High fatality rate demonstrates increased antibiotic resistance among BM isolates, thereby stimulating its devastation among underdeveloped region. Timely detection and intensive treatment of BM may improve critical outcomes in patients