Bacterial isolates from cerebrospinal fluids and their antibiotic susceptibility patterns in Gondar University Teaching Hospital, Northwest Ethiopia

Background: Bacterial meningitis remains a common disease worldwide. Its most frequent causes are Nessieria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae. Information on the relative frequency of the isolation and antibiotic susceptibility patterns of these pathogens is scarce in Ethiopia. Objectives: To identify bacterial pathogens that cause meningitis and to assess the antibiotic susceptibility patterns of the isolates from the cerebrospinal fluids (CSF) of acute bacterial meningitis cases/specimens. Methods: A retrospective analysis of 390 cerebrospinal fluid specimens submitted for culture and antibiotic susceptibility patterns to the bacteriology laboratory of Gondar University Teaching Hospital was conducted between September 2002 and August 2003. Results: Bacterial pathogens were isolated from 22 patients showing an isolation rate of 5.6%. The most commonly isolated bacteria were Neisseria meningitidis 10(45.5%) and Streptococcus pneumoniae 7(31.8%). Among gram positive organisms S. pneumoniae showed a high level of drug resistance against chloramphenicol 4(57%), tetracycline 3 (43%), co-trimoxazole 3(43%), ampicillin 3(43%), and gentamicin 1(14%). Among gram negative bacteria, N. meningitidis was found to be resistant to co-trimoxazole 5(50%), chloramphenicol 3(30%), gentamicin 3(30%) and ampicillin 2(20%). The single isolate from Proteus species was found to be resistant to co-trimoxazole and tetracycline. E. coli was found to be resistant to all antibiotics except for gentamicin and ciprofloxacin. Multiple drug resistance was observed in 50% of the isolates. No organism was found to be resistant to ciprofloxacin. Conclusions: The isolation rate of bacterial pathogens from cerebrospinal fluids was found to be low. However, the frequency of single as well as multiple drug resistance was very high among the bacterial isolates. Ciprofloxacin may be used for the empirical treatment of bacterial meningitis when culture and sensitivity report is not available for adult patients. [Ethiop.J.Health Dev. 2005; 19(2):160-164] Introduction Meningitis is a very serious infection of the meninges that surround the brain and the spinal cord (1). It is usually caused by viral, bacterial or fungal pathogens. Bacterial meningitis can be quite severe and may result in brain damage, hearing loss, or learning disability and death if not treated early (2). Despite advances in vaccine development and chemoprophylaxis, bacterial meningitis remains a common disease worldwide. The disease is more common in developing countries (3). The relative frequency of isolation of various bacterial species as a cause of meningitis varies with age, and among geographical regions. About 80% of all cases of bacterial meningitis are caused by N. meningitidis, S. pneumoniae, and H. influenzae (3-5). Over two-thirds of all cases of bacterial meningitis occur in children less than five years old. Meningococcus affects all ages, most cases occurring in children and adolescents. More than 80% of meningitis caused by H. influenzae occurs in children less than 5 years old. Group B hemolytic streptococcus (S. agalactiae) is the commonest cause of meningitis in neonates. E. coli is a frequent cause of meningitis in neonates and is rarely a cause after infancy (5). The highest burden of meningococcal meningitis occurs in sub-Saharan Africa, in an area that is referred to as the meningitis belt, which has an estimated total population of approximately 300 million (3). Studies on the epidemiology of meningococcal meningitis in adult Ethiopians shows fatality rates for meningitis and meningococcemia to be 16% and 85% respectively (6). Antimicrobial resistance of bacteria is a worldwide problem. However, the situation in developing countries like Ethiopia is particularly serious (7-8). Because of the absence of well-equipped bacteriological laboratories in Ethiopia no organized surveillance exists on drug resistance patterns among common bacterial isolates and thus published data on drug resistance are few. However, the presence multiple antimicrobial resistances in different clinical specimens including CSF have been