Title: Assessment of Clinical Profile, Bacterial Profile and Outcome of Acute Bacterial Meningitis in A Tertiary Care Hospital
Authors: Dr C.J.Selvakumar, Dr P.Balamurugan, Dr Shadiya.C
DOI: https://dx.doi.org/10.18535/jmscr/v5i9.39
Abstract
Background: Bacterial meningitis is still one of the major causes of mortality and morbidity among all groups in developing countries. The mortality and prevalence of common pathogens has reduced in developing countries with implementation of successful vaccination against the pathogens. Laboratory surveillance of pathogens is crucial in formulating the empirical treatment guidelines and to identify the targets of immunization. The present study was undertaken to evaluate the clinical profile, bacterial pathogens and their antibiotic sensitivity pattern of the pathogens. The outcome of the cases was recorded and followed for six months to detect any neurological sequelae.
Methods: A prospective and cross-sectional study was done and all suspected cases of acute bacterial meningitis (ABM) were screened and confirmed by diagnostic criteria. Clinical features were recorded and entered into the case sheet. CSF culture was done and biochemical analysis and cell counts were performed. All the data was entered in Microsoft excel and analysed.
Results: A total of 400 cases were screened and 272 confirmed with 154 males and 118 females. 268 pathogens were isolated with 256 bacterial and 12 fungal isolates. Gram negative bacterial pathogens were predominant than gram positive. Streptococcus pneumoniae was the common isolate in the study followed by others like S. aureus, Coagulase negative staphylococci and Acinetobacter sp., Escherichia coli, Klebsiella pneumoniae and meningococci. Candida albicans and Cryptococcus sp. were fungal pathogens. Community acquired meningitis was commonest cause and seen in 51-60 years of age. Gram positive pathogens exhibited maximum sensitivity to vancomycin and linezolid whereas Gram negative pathogens to carbapenems.
Conclusions: There is an overwhelming need to formulate policies in the management of cases of ABM. The rationale use of antibiotics is necessary to prevent the development of antibiotic resistance. Hence minimizing the emergence of antibiotic resistance and its spread is necessary, which can be achieved by regular prevalence and antibiotic susceptibility studies.
Keywords: Acinetobacter sp., Acute bacterial meningitis, Antibiotic resistance, Cerebro spinal fluid, Streptococcus pneumonia.
References
- Kabra SK, Kumar P, Verma IC, Mukherjee D, Chowdhary BH, Sengupta S, et al. Bacterial meningitis in India: An IJP survey. Indian J Pediatr 1991;58:505-11.
- Chinchankar N, Mane M, Bhave S, Bapat S, Bavdekar A, Pandit A, et al. Diagnosis and outcome of acute bacterial meningitis in early childhood. Indian Pediatr. 2002;39:914-21.
- Mani R, Pradhan S, Nagarathna S, Wasiulla R, Chandramuki A. Bacteriological profile of community acquired acute bacterial meningitis a ten-year retrospective study in a tertiary neuro care centre in south India. Indian J Med Microbiol. 2007;25(2):108-14.
- Nabi G, Kahn TA, Raj AB. Bacterial meningitis in children. Saudi Med J. 1992;13:348-51.
- Clinical Laboratory Standard Institute. 2014. Performance standard for antimic-robial disk susceptibility tests. Approved standard-20th Ed. Supplement/ M2-A9 2006:26(1)
- Antimicrobial chemotherapy. In: Jawetz, Melnick, Adelberg’s Medical Microbio-logy. 21st Ed. International Edition, Stanford, Connecticut, Prentice-Hall International Inc:
- Elmore JG, Horwitz RI, Quagliarello VJ. Acute meningitis with a negative Gram’s stain: Clinical and management outcomes in 171 episodes. Am J Med. 1996;100:78-84.
- Durand ML, Calderwood SB, Weber DJ, Miller SI, Southwick FS, Caviness VS Jr, et al. Acute bacterial meningitis in adults. A review of 493 episodes. N Engl J Med. 1993;328:21-
- Modi S, Anand AK. Phenotypic Characterization and antibiogram of CSF isolates in acute bacterial meningitis. J Clin Diagost Res. 2013;7(12):2704-8.