Meningitis: Etiologic Agents and Antibiotic Susceptibility Pattern in Tikur Anbessa University Hospital, Addis Ababa, Ethiopia

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Addis Ababa University


Bacterial meningitis remains a common disease worldwide. Its most frequent causes are Nessieria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae. In Ethiopia there are a number of previous published reports concerning meningitis. However most of the studies have been conducted during epidemic seasons. Meningitis is a serious emergency, which requires the early identification of the causative bacterium and its antibiogram. However, it is a usual practice to start empirical therapy before the complete laboratory result is available. Such practice requires knowledge of the most frequent etiological agents of meningitis and their antibiotic sensitivity patterns in the local population. This will help to influence the choice of initial therapy before a sensitivity result is available and in areas where laboratory facilities may not be available. To readdress this situation, this study was undertaken to isolate and identify the bacterial etiologic agents, including their antibiotic susceptibility pattern and serogroup/serotype isolated from patients with meningitis (n=340) visiting Tikur Anbessa University Hospital, Addis Ababa, Ethiopia, between November 2007 and June 2008. Of the patients investigated, 53.5% were males and 46.5% were females resulting in an overall male to female ratio of 1.2:1. Over half of the patients, 51.2% were children and the rest 32.6% and 16.2% were neonates and adults respectively. A total of 26 bacterial and fungal pathogens were isolated in all age groups. Of which, in neonates (n=2), children (n=16) and adults (n=8). Bacterial isolates accounted for 22 (84.6%) of the total isolates and the others 4 (15.4%) were fungal. In general, Streptococcus pneumoniae accounted for (36.4%) followed by Haemophilus influenzae type b and Nessieria meningitidis (Serogroup A and C)(13.6%) each. Cryptococcus neoformans was the only fungal isolate, which accounted for half of the isolates in adults. All gram positive bacteria were sensitive to Ceftriaxone, Ciprofloxacin, Chloramphenicol, Erythromycin and Rifampicin and Low level of resistance (<60%) were observed to Penicillin, Tetracycline and Trimethoprim sulphamethoxazole. exceptionally, all isolates of S.pneumoniae showed high level of resistance (>80%) to Gentamicin. Whereas, the gramnegatives showed high level of resistance (>80%) to Tetracycline and Trimethoprim sulphamethoxazole, intermediate level of resistance (60-80%) to Ampicilin and low level ofresistance (<60 %) to Ceftriaxone, Ciprofloxacin, Gentamycin, Chloramphenicol and Rifampicin. Most of the tested drugs were effective against gram-positive bacteria where as Gramnegative bacteria showed high level of resistance. Overall ceftriaxone and ciprofloxacin were the most effective drugs when compared to other drugs tested against the gram-positive and gram-negative bacteria. Multiple resistance (resistance to two or more drugs) was observed in 2/11(18.2%) and 11/11(100%) gram positive and gram-negative bacteria respectively. In conclusion, in the present study, S. pneumoniae was the predominant isolate followed by H. influenzae type b and N. meningitidis. The susceptibility pattern of isolates from the study showed that ceftriaxone and ciprofloxacin were the most effective drugs. Therefore, efforts should be directed towards early diagnosis and treatment of meningitis and continued reevaluation of the resistant patterns of organisms to optimize treatments and reduce complications. In addition, vaccination policies should reflect the primary etiologic agents, including pneumococcus and meningococcal serogroups A and C and H. influenzae type b.



Meningitis, Bacterial etiologic agents, Antibiotic susceptibility pattern, Serogroup/serotype, Neonates/children and adults, Ethiopia.