Microbial Profile, Antimicrobial Resistance, and Outcome of Presumptive Meningitis Patients at the University of Gondar Comprehensive Specialized Hospital, Gondar, Northwest Ethiopia
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Date
2025
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Addis Ababa Universtity
Abstract
Background: Meningitis is a life-threatening disease characterized by inflammation of the meninges. It remains a significant public health challenge, particularly in resource-limited settings where delayed presentation to healthcare facilities and comorbidities are more common. In Ethiopia, the etiology of meningitis is rarely identified, and treatment is often empirical, primarily targeting bacterial pathogens. However, this approach poses challenges due to the
dynamic nature of pathogen prevalence and the increasing threat of antimicrobial resistance.
Objectives: The study was conducted to assess the microbial profile, antimicrobial resistance, and outcome of presumptive meningitis patients at the University of Gondar Comprehensive Specialized Hospital, Gondar, Northwest Ethiopia, 2023.
Methods: A prospective cross-sectional study was conducted from August 01 to December 31, 2023, on 195 presumptive meningitis patients at the University of Gondar Comprehensive Specialized Hospital. A cerebrospinal fluid sample was collected from each study participant and analyzed using culture and PCR techniques for the detection of bacterial and viral etiologies. The antimicrobial susceptibility of isolates was determined using the disc diffusion method. Patient outcomes were assessed using the Glasgow Outcome Scale. Descriptive statistics were employed. Bivariate and multivariable analyses were also done to identify factors associated with unfavorable patient outcomes. In all the cases, a p-value <0.05 at 95% confidence level was considered statistically significant.
Results: The overall prevalence of meningitis among the 195 patients with presumptive meningitis was 114 (58.5%). Bacterial pathogens were detected in 55 (28.2%) of the study participants, which constituted 55/114 (48.2%) of the PCR-confirmed cases. E. coli was the most commonly detected pathogen 25 (21.9%), followed by H. influenzae 9 (7.9%), S. pneumoniae 6 (5.3%), N. meningitidis 4 (3.5%), S. aureus 3 (2.6%), K. pneumoniae 1 (0.9%), L. monocytogene 1 (0.9) and mixed infections involving both E. coli and K. pneumoniae 3 (2.6%). Viral pathogens were detected in 59 (30.3%) of the study participants, which constitute 59/114 (51.8%) of the PCR-identified etiologies. The most frequently detected virus was enterovirus 53 (46.5%), followed by herpes simplex virus-1 5 (4.4%), and Epstein-Barr virus 1 (0.9%). A total of 14 (7.2%) CSF samples were found positive for bacterial growth in culture. The most frequently isolated pathogens were S. pneumoniae and K. pneumoniae for 4 each, followed by E. coli and S. aureus 2 each, and H. influenzae and N. meningitidis 1 each. With regard to drug resistance, 3/4 (75%) of K. pneumoniae exhibited resistance to both trimethoprim-sulfamethoxazole and ampicillin and 2/4 (50%) to meropenem, cefotaxime, and ciprofloxacin. E. coli isolates showed 1/2 (50%) resistance to ceftazidime, tetracycline, ciprofloxacin, chloramphenicol, trimethoprim sulfamethoxazole, and ampicillin. 1/4 (25%) of S. pneumoniae isolates were resistant to erythromycin, trimethoprim-sulfamethoxazole, ciprofloxacin, and rifampin. 2/2 (100%) of the S.
aureus isolates were resistant to both chloramphenicol and rifampin. Unfavorable outcomes on leaving the hospital were documented in 27/195 (13.8%) of the study participants. Glasgow Coma Scale (GCS) (AOR = 0.658, 95% CI = 0.524–0.827), the presence of comorbidity (AOR = 9.221, 95% CI = 1.580–53.815), and duration of disease onset to hospital visit (AOR = 1.604, 95% CI = 1.146–2.242) were factors independently associated with the unfavorable outcome; however, dexamethasone use does not confer benefit or harm in multivariate analysis.
Conclusion: A considerably high prevalence of meningitis was detected. Viral meningitis was more prevalent than bacterial, but most presumptive meningitis patients were empirically treated for bacterial infections. High rates of antibiotic resistance among gram-negative bacterial isolates were observed. Most of the study participants experienced favorable outcomes; however, unfavorable outcomes were associated with low GCS, the presence of comorbidity, and delayed presentation to healthcare facilities. The use of dexamethasone as adjunctive treatment in presumptive meningitis patients does not confer benefit or harm
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Keywords
Meningitis PCR Antimicrobial resistance Patient outcome