Phenotypic Characterization and Antibiogram of CSF Isolates in Acute Bacterial Meningitis
Context: Acute bacterial meningitis (ABM) is a medical emergency, which warrants an early diagnosis and an aggressive therapy. Despite the availability of potent newer antibiotics, the mortality rate caused by acute bacterial meningitis remains significantly high in India and in other developing...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2013-12-01
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| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://jcdr.net/articles/PDF/3737/16-%206081_E(C)_F(DK)_PF1(PP)_PFA(P_Pr_SP)_PF2(PR).pdf |
| Summary: | Context: Acute bacterial meningitis (ABM) is a medical
emergency, which warrants an early diagnosis and an aggressive
therapy. Despite the availability of potent newer antibiotics, the
mortality rate caused by acute bacterial meningitis remains
significantly high in India and in other developing countries,
which ranges from 16 - 32%. There is a need of a periodic
review of bacterial meningitis worldwide, since the pathogens
which are responsible for the infection may vary with time,
geography and the age of the patient.
Aim: To study the bacterial profiles and antimicrobial susceptibility
patterns of the CSF isolates which were obtained from patients
of acute bacterial meningitis in our area.
Settings and Design: Two hundred and fifty two clinically
diagnosed cases of acute bacterial meningitis, who were
admitted to the wards of a tertiary medical centre in Patna, during
the period from August 2011 to December 2012, were included
in this study.
Material and Methods: Two hundred and fifty two CSF samples
from many patients of ABM were processed for cell counts,
biochemical analysis, gram staining, culture, antigen detection
by latex agglutination test (LAT) and antibiotic susceptibility tests,
as per the standard techniques.
Results: In this study, 62.3% patients were males and 37.7%
were females The most common age group of presentation
was 12-60 years (80.2%). Gram stained smears were positive
in 162 (64.3%) samples, while culture yielded positive growth
in 200 (79.4%) patients. Streptococcus pneumoniae was the
most common pathogen which was isolated in 120 (60%)
culture positive cases. Cell counts showed the predominance of
neutrophils in all cases with ABM. High protein and low sugar
levels correlated well with the features of ABM. All gram positive
isolates were sensitive to vancomycin. All the gram negative
isolates were sensitive to imipenem. Twenty two (8.7%) patients
expired during the course of study. Deaths were caused by
N.meningitidis in 9 (40.9%) cases, by S.pneumoniae in 3 (13.6%)
cases and by H.influenzea in 1 (4.5%) case. In the remaining 9
(40.9%) mortality cases, the organism could not be identified.
Conclusion: Simple, rapid, inexpensive tests like gram staining
remain significant means for diagnosis of ABM in developing
countries. LAT for pneumococcal antigen should be performed
first, since Streptococcus pneumoniae remains the major
aetiological agent of ABM, both in adults and children. The final
diagnosis of ABM depends upon a comprehensive analysis of
CSF smears, cultures, LAT, cytological, biochemical and clinical
findings of the cases, and a single test or parameter cannot
be used to decide the course of management in the patients.
However, empirical therapy is advocated, considering the
potentially high rate of mortality in these patients. |
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| ISSN: | 2249-782X 0973-709X |