Bacteriology and sensitivity patterns of pyogenic meningitis at Kenyatta National Hospital, Nairobi, Kenya

Abstract

A descriptive cross sectional study on bacteriology and sensitivity patterns of laboratory-proven pyogenic meningitis was carried out over a six month period. A total of 92 patients (52 adults, 40 children) were studied. In 75 (82%) of the cases, the cerebrospinal fluid cultures were bacteriologically positive. Common isolates included Streptococcus pneumoniae (45%), Neisseria meningitidis (14%) and Haemophilus influenzae (12%). Other isolates included Cryptococcus neoformans from four (4.3%) adults who were also HIV-l positive. Sensitivity to antibiotics was determined using the disk diffusion method. There was no resistance to chloramphenicol among the three most common bacterial isolates. However, 7% and 15% of Streptococcus pneumoniae and N. meningitidis isolates, respectively, were resistant to crystalline penicillin. Twenty seven percent of Haemophilus influenzae was resistant to ampicillin. Sensitivity of the three organisms to the third generation cephalosporin (ceftazidime, cefotaxime, ceftriaxone) a second generation cephalosporin (cefuroxime) and augmentin was almost 100%. We recommend that chloramphenicol and crystalline penicillin or ampicillin be initial blind therapy for adults and older children with pyogenic meningitis and ampicillin and chloramphenicol for pre-school children. The above cephalosporins and augmentin are alternative therapy but their use will be limited by cost.

PIP: A total of 92 patients (52 adults and 40 children) admitted to Kenyatta National Hospital in Nairobi, Kenya, with pyogenic meningitis were enrolled in a descriptive cross-sectional analysis of the bacteriology and sensitivity factors associated with this disease. In 75 cases (82%), cerebrospinal fluid cultures were bacteriologically positive. Common isolates included Streptococcus pneumoniae (45%), Neisseria meningitidis (14%), and Haemophilus influenzae (12%). Although all 3 of these isolates were responsive to chloramphenicol, 7% of Streptococcus pneumoniae and 15% of Neisseria menigitidis isolates were resistant to crystalline penicillin and 27% of Haemophilus influenzae isolates were resistant to ampicillin. Sensitivity of these 3 organisms to the third-generation cephalosporins (ceftazidime, cefotaxime, and ceftriaxone), a second-generation cephalosporin (cefuroxime), and augmentin was almost 100%; however, their use is limited by cost. On the basis of these findings, it is recommended that chloramphenicol and crystalline penicillin or ampicillin be initial blind therapy for adults and older children with pyogenic meningitis, while ampicillin and chloramphenicol should be used in preschool children.