Bacterial meningitis in north India: trends in antimicrobial resistance
Keywords:
Meningitis, antimicrobial resistance, MRSA, ESBL, HLAR
Abstract
Background: The mortality rate in ABM remains significant and has been reported in the range of 8-40%. It is important to know the regional bacterial etiology in semitropical countries like India along with their sensitivity profile to allow optimum management of such patients. This study was undertaken to evaluate the trends in etiology of bacterial meningitis and the antimicrobial resistance pattern of the pathogens prevalent in North India over a period of 8 years. Material and Methods: The study was performed from June 2001 to June 2009. CSF samples were collected from all patients suspected of meningitis and cultured on chocolate agar, blood agar and MacConkey agar. Antimicrobial susceptibility testing was done using Kirby Bauer disc diffusion method. Detection of MRSA, HLAR, ESBL, AmpC and MBL was also done. Results: 401 samples were positive on culture. S. aureus was the most common pathogen isolated. Among the gram positive cocci as well as the gram negative bacilli a gradual decline in the antimicrobial susceptibility was seen. The aminoglycosides were found to be most effective group of antimicrobial. Towards the end of the study an alarming rise of methicillin resistance in S. aureus to 69.4%, HLAR among the Enterococci to 60% was noticed and among the Enterobacteriaceae ESBL and AmpC production was found to be 16.67% and 42% respectively. Conclusion: The high prevalence of drug resistant pathogens should be dealt with by rational use of antimicrobials. Frequent revision in drug policy may be necessitated for optimum management of patients.References
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15. Thirumoorthi MC. Bacterial meningitis in children. Indian. J. Pediatr. 1995; 62 : 265-279.
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17. Shahid M, Singhai M, Malik A, Shukla I, Khan HM, Shujatullah F et al. In vitro efficacy of ceftriaxone-sulbactum against Esherichia coli isolates producing CTX-M-15 extended spec-trum beta-lactamase. J. Antimicrob. Chemoth. 2007; 60: 187-188.
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19. Gad GFM, El Ghaffar AAEF, El-Domany RA, Hashem ZS. Epidemiology and antimicrobial resistance of staphylococci isolated from dif-ferent infectious diseases. Braz. J. Microbiol. 2010;41:333-44.
2. Bandaru NR, Ibrahim MK, Nuri MS, Suliman MB. Etiology and occurrence of acute bacterial meningitis in children in Benghazi, Libyan Arab Jamahiriya. East. Mediterr. Health. J. 1998;4: 50-7.
3. You MD. Ampicillin in the treatment of menin-gitis due to Haemophilus influenza: an appraisal after 6 years of experience. J. Pediatr. 1969; 74: 848-51.
4. Collee JG, Fraser AG, Marmion BP, Simmons A. Laboratory Strategy In The Diagnosis Of Infective Syndromes. In:Collee JG, Duguid FP, Fraser AG, Marmion BP, Simmons A,(eds). Mackey and McCartney practical Medical Mi-crobiology.14th ed. Elsevier, NewDelhi, India, 2006 p.77.
5. Clinical and Laboratory Standards Institute 2003. Performance standards for antimicrobial susceptibility testing: eighteenth informational supplement: Approved standards M100-S18. Clinical and Laboratory Standards Institute, Baltimore, USA. 2008.
6. Rizvi M, Fatima N, Rashid M, Shukla I, Malik A, Usman A, Siddiqui S. Extended spectrum AmpC and metallo-beta-lactamases in Serratia and Citrobacter spp. in a disc approximation assay. J. Infect. Dev. Ctries. 2009; 3(suppl. 4): 285-94.
7. Collee JG, Fraser AG, Marmion BP, Simmons. Tests for the identification of Bacteria. In: Collee JG, Miles RS, Watt B,(eds). Mackey and McCartney practical Medical Microbiology.14th ed. Elsevier, NewDelhi, India, 2006 p.131-149.
8. Lee KY, Chong HB, Shin YA, Yong KD, Yum JH. Modified Hodge test and EDTA disc synergy tests to screen metallo beta lactamase producing strains of Pseudomonas and Acinetobacter species. Clin. Microbiol. Infect. 2001; 7: 88-91.
9. Murray PR, Baron EJ, Jorgenson JH. Special phenotypic methods for detecting antibacterial resistance. In, Swenson JM, Hindler JF and Jorgenson JH, editors. Manual of Clinical Mi-crobiology.8th ed. ASM Press, Washington DC, 2003 p.1179
10. Schlech WF, Ward JI, Band JD, Hightower A, Fraser AW, Broome CV. Bacterial meningitis in the United States. J. American. Med. Associat. 1985; 253: 1749-1754.
11. Schuchat A, Robinson K, Wenger JD, Harrison LH, Farley M, Reingold AL et al. Bacterial me-ningitis in the United States in 1995. Active Surveillance Team.N. Eng. J. Med. 1997; 337: 970-976.
12. Tang LM, Chen ST, Hsu WC, Lyu RK. Acute bacterial meningitis in adults: A hospital based epidemiological study. Q.J.M. 1999; 92 : 719-725.
13. Bhat BV, Verma IC, Puri RK, Srinivasan S, Nalini P. A profile of pyogenic meningitis in children. J. Indian. Med. Assoc. 1991; 89 : 224-227.
14. Kabra SK, Praveen K, Verma IC, Mukherjee D, Chowdhary BH, Sengupta S et al. Bacterial meningitis in India: An IJP survey.Indian. J. Pediatr. 1991; 58 : 505-11.
15. Thirumoorthi MC. Bacterial meningitis in children. Indian. J. Pediatr. 1995; 62 : 265-279.
16. Ensor VM, Shahid M, Evans JT and Hawkey PM. Occurrence, prevalence and genetic envi-ronment of CTX-M beta-lactamase in Entero-bacteriaceae from Indian Hospitals. J. Antimi-crob. Chemoth. 2006; 58: 1260-1263.
17. Shahid M, Singhai M, Malik A, Shukla I, Khan HM, Shujatullah F et al. In vitro efficacy of ceftriaxone-sulbactum against Esherichia coli isolates producing CTX-M-15 extended spec-trum beta-lactamase. J. Antimicrob. Chemoth. 2007; 60: 187-188.
18. De Oliveira CF, Salla A, Lara FM, Rieger A, André Horta J, Alves SH. Prevalence of ex-tended-spectrum beta-lactamases-producing microorganisms in nosocomial patients and molecular characterization of the SHV type isolates. Braz. J. Microbiol. 2010; 41:278-82.
19. Gad GFM, El Ghaffar AAEF, El-Domany RA, Hashem ZS. Epidemiology and antimicrobial resistance of staphylococci isolated from dif-ferent infectious diseases. Braz. J. Microbiol. 2010;41:333-44.
Published
2015-01-28
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