Etiology of Neonatal Bacterial Meningitis and Their Antibiotic Susceptibility Pattern at the University of Gondar Comprehensive Specialized Hospital, Ethiopia: A Seven-Year Retrospective Study

Abstract

Background

Meningitis, which is mostly caused by infectious agents, occurs more commonly during the first month of life. Bacterial meningitis is an important source of mortality and morbidity, especially in neonates of resource-limited countries. We aimed to determine the prevalence and etiological agents of bacterial meningitis and their antibiotic susceptibility pattern in neonates at the University of Gondar Comprehensive Specialized Hospital.

Methods

We collected retrospective data from bacteriological results of cerebrospinal fluid of meningitis suspected neonates from 2013 to 2019. Sample collection, culture preparation, bacterial identification, and susceptibility testing were performed using standard microbiological techniques. We extracted data on socio-demographic characteristics and culture and antibiotic susceptibility testing results. We inputted the data using Epi-info version 7 and exported it to SPSS version 20 for analysis.

Results

In this study, 1101 cerebrospinal fluid samples, 595 (54%) male and 506 (46%) female neonates, were cultured to look for meningitis-causing bacteria. Of 1101 cerebrospinal fluid, 19 (1.73%) were culture positive for meningitis-causing bacteria. The common etiological agents were Klebsiella pneumoniae 36.8% (7), non-lactose-fermenter Gram-negative rods 21% (4), and Group B streptococcus 15.8% (3). The overall resistance rate among cephalosporin, cotrimoxazole, penicillin, and aminoglycosides classes were 90%, 88.9%, 77.3%, and 54.54%, respectively. Of all isolates, 58% (11) were multidrug-resistant, including all the non-lactose-fermenter Gram-negative rods and 71.4% of the Klebsiella pneumonia isolates.

Conclusion

The prevalence of neonatal bacterial meningitis was 1.73%. Klebsiella pneumonia and other Gram-negative rods, with a high multidrug-resistant rate, were the leading cause of neonatal bacterial meningitis. Further studies are needed to explore the source of infection, incidence, and risk factors of neonatal bacterial meningitis.

Keywords:

• bacterial meningitis
• etiology
• antibiotic susceptibility
• Ethiopia

Acknowledgments

We thank all the Medical Microbiology staff working at the University of Gondar, School of Biomedical and Laboratory Science, College of Medicine and Health Sciences for their unreserved support. We like to thank the UoGCSH and its bacteriology laboratory staff for their support during the data collection period.

Abbreviations

BM, Bacterial Meningitis; CSF, Cerebrospinal Fluid; GBS, Group B streptococcus; LF-GNR, Lactose-fermenter Gram-negative rods; MDR, multidrug resistant; NBM, Neonatal Bacterial Meningitis; NICU, Neonatal Intensive Care Unit; NLF-GNR, Non-lactose-fermenter Gram-negative rods; UoGCSH, University of Gondar Comprehensive Specialized Hospital; WHO, World Health Organization.

Data Sharing Statement

All data generated or analyzed during this study were included in this article. Data that support the findings of this study are also available from the corresponding author upon reasonable request.

Ethical Approval and Consent to Participate

Before the commencement of the study, we obtained ethical clearance from the University of Gondar, School of Biomedical and Laboratory Sciences ethical review committee, and an official letter of co-operations was provided to UoGCSH. Before data collection, we explained the study objectives to the heads of the hospital director and laboratory personnel who worked in the hospital. Since we used secondary data for this study and didn’t require the patient’s informed consent. We conducted the study following the Declaration of Helsinki.⁴⁸ To ensure confidentiality of information from participant’s record, we didn’t record any personal identifiers on the data collection sheet, and secured data from participant records were not available to anyone except for the investigators.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests in this work.