Causative pathogens of bacterial meningitis in children and their susceptibility to antibiotics

摘要

Bacterial meningitis is an emergent disease that is characterized by a high mortality rate and is associated with neurological complications, even when treated early. The aim of this study was to analyze how the outcome of bacterial meningitis in children is influenced by the identity and antibiotic susceptibility of the causative pathogens. Methodology: We have retrospectively analyzed the outcome of 124 culture-proven cases of bacterial meningitis in children treated during a six-year period (1997-2002). Results: Out of 124 culture-proven cases of bacterial meningitis, neurological complications occurred in 36 cases (29.03%), and the overall mortality rate was 2.41% (three cases of death). The most common pathogens associated with bacterial meningitis in children were N.meningitidis (n=71, 57.25%), H. influenzae type B (n=22, 17.74%), S. pneumoniae (n=17, 13.70%) and gram-negative bacilli (n=11, 8.87%). The highest incidence of neurological complications occurred in cases caused by H. influenzae (relative risk 2.44, CI 95%). Out of 124 isolated pathogens, 95.16% of strains were susceptible to antibiotics, while only 4.83% were multiresistant to antibiotics. Conclusion: Although the incidence of neurological complications in culture-proven cases of bacterial meningitis was high, the antimicrobial resistance of causative pathogens was very low in children. Introduction Even when patients are treated with highly effective antibiotic therapies, death and long-term disabilities are common outcomes of acute bacterial meningitis (BM). Suspected BM is considered a medical emergency, and therapy should be initiated immediately after the results of a lumbar puncture procedure are obtained, or even immediately after the lumbar puncture itself if the clinical suspicion is very high 1,2. Empiric treatment of BM involves applying an antibacterial agent(s), such as a third-generation cephalosporin with vancomycin, to the cerebro-spinal fluid (CSF) in substantial levels 3,4. The chosen antibiotic should have bactericidal activity in the CSF. In most cases, the initial treatment must be empirical, but nonetheless based on epidemiological knowledge of the most common organisms for each age group and the local antibiotic resistance patterns 5,6,7,8. The identification of BM pathogens, and their sensitivity to antibiotics, may help transition empirical therapies into pathogen-specific therapies 9. The aim of this study was to analyze how the outcome of bacterial meningitis in children is influenced by the identity and antibiotic susceptibility of the causative pathogens. Patients and Methods Our study was observational and retrospective. We analyzed 124 culture-confirmed cases (44.76%) out of 277 cases of BM in children under 16 years of age treated during a six-year period (1997-2002) in the Clinic of Infectious Diseases in Prishtina at the University Clinical Center of Kosovo. We have analyzed the relationship between the outcome of the disease and the identity and antibiotic susceptibility of the causative pathogens. The antimicrobial susceptibility was determined using the disk diffusion method according to the recommendations of the Clinical Laboratory Standard Institute (formerly the NCCLS).Statistical analysisData were analyzed using the Stata 9.0 program. Statistical significance was evaluated using the relative risk (RR) test with confidence interval of 95%. Results During a six-year study period, the causative pathogens of 124 culture-proven cases of pediatric bacterial meningitis cases were as follows: N.meningitidis, 71 cases (57.25%); H.influenzae type B (Hib), 22 cases (17.74%); S.pneumoniae, 17 cases (13.70%); gram-negative bacilli, 11 cases (8.87%); S. aureus, 2 cases (1.61%) and S. pyogenes, 1 case (0.80%)(Table 1).