Antimicrobial Resistance Pattern of Bacterial Meningitis Among Patients in Quetta, Pakistan

Abstract

Introduction

Bacterial meningitis (BM) is a lethal infectious disease that persists as a substantial cause of morbidity and mortality. The antimicrobial drug resistance in BM pathogens poses a major threat to the community while raising challenges for clinicians. For the first time, we elucidate the incidence rate of BM and its drug resistance among the population of Quetta, Balochistan.

Methods

A cross-sectional study was conducted (from January 2018 to March 2021) among meningitis patients admitted to government hospitals in Quetta. The cerebrospinal fluid (CSF) specimen was collected and processed for microbiological and cytological analysis. Bacterial isolates were identified and confirmed using phylogenetic analysis of the 16S rRNA gene.

Results

We found 35.9% (321/894) confirmed cases of BM among the population of Quetta, Balochistan. The identified bacterial isolates comprised Streptococcus pneumoniae 14.7% (130/894), Staphylococcus aureus 6.9% (61/894), Neisseria meningitidis 5.7% (51/894), Haemophilus influenzae 2.5% (22/894), Escherichia coli 4.5% (40/894), and Klebsiella pneumoniae 1.9% (17/894). A high percentage in male patients of 20.8% (186/894) was identified as compared to female patients of 15.1% (135/894). Extreme age groups such as infants (age range: 1 month to 1 year) and adults (age range: 61 years to 99 years) with low immunity were critically affected by BM. Clinical parameters such as abnormal CSF appearance, pH, and high WBCs in BM patients with endocarditis as the underlying disease were significantly at elevated risk of fatal outcome. 16S rRNA gene phylogenetic analysis confirmed the evolutionary similarity of isolated strains with prevailing pathogenic strains in Asia. Furthermore, age was identified as a significant risk factor for clinical outcomes.

Conclusion

The majority of the identified BM patients belonged to rural areas with limited health-care facilities and paramedic staff. The high case fatality rate 11% demonstrates increased antibiotic resistance among BM isolates, thereby stimulating its devastation in underdeveloped regions. Timely detection and intensive treatment of BM may improve critical outcomes in patients.

Keywords:

• bacterial meningitis
• cerebrospinal fluid
• 16S rRNA
• incidence rate
• drug resistance

Acknowledgments

The authors gratefully acknowledge all the participants of this research. We would also like to express gratitude all doctors, physicians, and paramedic’s staff for their contribution and support. In the end, we forward our gratitude to the director of CASVAB, University of Balochistan, Quetta; for funding and supporting this study.

Institutional Review Board Statement

The research protocol was approved by the institutional research ethics committee of hospitals and institutions. This research was conducted according to Helsinki declaration, University of Balochistan (CAS/45/15-20) and hospital ethical committee’s permission (E.C 18-12/2017).

Data Sharing Statement

Data of this study are available from corresponding author on reasonable request.

Informed Consent Statement

A written consent form was taken from patients and from parents/guardians in case of children to publish this paper. For illiterate participants, the verbal consent was obtained.

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

All authors declared that they have no competing interests in this work.