The Causative Organisms of Bacterial Meningitis and their Antimicrobial Resistance Profiles in Iranian Children in 2011-2016

Author(s): Sepideh Keshavarz Valian, Shima Mahmoudi, Babak Pourakbari, Maryam Banar, Mohammad Taghi Haghi Ashtiani, Setareh Mamishi*

Journal Name: Infectious Disorders - Drug Targets
(Formerly Current Drug Targets - Infectious Disorders)

Volume 20 , Issue 2 , 2020

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Graphical Abstract:


Abstract:

Objectives: The study aimed to describe the identity and antimicrobial resistance patterns of the causative agents of bacterial meningitis in children referred to Children’s Medical Center (CMC) Hospital, Tehran, Iran.

Methods: This retrospective study was performed at CMC Hospital during a six-year period from 2011 to 2016. The microbiological information of the patients with a diagnosis of bacterial meningitis was collected and the following data were obtained: patients’ age, sex, hospital ward, the results of CSF and blood cultures, and antibiotic susceptibility profiles of isolated organisms.

Results: A total of 118 patients with bacterial meningitis were admitted to CMC hospital. Sixty-two percent (n=73) of the patients were male. The median age of the patients was ten months (interquartile range [IQR]: 2 months-2 years) and the majority of them (n=92, 80%) were younger than two years of age. The highest number of patients (n=47, 40%) were admitted to the surgery department. Streptococcus epidermidis was the most frequent isolated bacterium (n=27/127, 21%), followed by Klebsiella pneumoniae (n=20/127, 16%), and Staphylococcus aureus (n=16/127, 12.5%). Blood culture was positive in 28% (n=33/118) of patients. Ampicillin-sulbactam and imipenem were the most effective antibiotics against Gram-negative bacteria isolated from CSF cultures. In the case of Gram-positive organisms, ampicillinsulbactam, vancomycin, and linezolid were the best choices. Imipenem was the most active drug against Gram-negative blood pathogens. Also, ampicillin and vancomycin had the best effect on Gram-positive bacteria isolated from blood cultures.

Conclusion: Results of this study provide valuable information about the antibiotic resistance profiles of the etiologic agents of childhood meningitis, which can be used for prescription of more effective empirical therapies.

Keywords: Antimicrobial, bacterial meningitis, antibiotic resistance, CSF, causative organisms, ampicillin-sulbactam.

[1]
Kim, K.S. Acute bacterial meningitis in infants and children. Lancet Infect. Dis., 2010, 10(1), 32-42.
[http://dx.doi.org/10.1016/S1473-3099(09)70306-8] [PMID: 20129147]
[2]
Sadeq, H.; Husain, E.H.; Alkoot, A.; Atyani, S.; Al-Fraij, A.; Al-Daithan, A.; AlSaleem, T.; Taher, A.; Alenezi, M. Childhood meningitis in Kuwait in the era of post pneumococcal conjugate vaccination: A multicenter study. J. Infect. Public Health, 2017, 10(6), 766-769.
[http://dx.doi.org/10.1016/j.jiph.2016.11.009] [PMID: 28196635]
[3]
Agrawal, S.; Nadel, S. Acute bacterial meningitis in infants and children: epidemiology and management. Paediatr. Drugs, 2011, 13(6), 385-400.
[http://dx.doi.org/10.2165/11593340-000000000-00000] [PMID: 21999651]
[4]
Mahmoudi, S.; Zandi, H.; Pourakbari, B.; Ashtiani, M.T.H.; Mamishi, S. Acute bacterial meningitis among children admitted into an Iranian referral children’s hospital. Jpn. J. Infect. Dis., 2013, 66(6), 503-506.
[http://dx.doi.org/10.7883/yoken.66.503] [PMID: 24270138]
[5]
Hudson, L.D.; Viner, R.M.; Christie, D. Long-term sequelae of childhood bacterial meningitis. Curr. Infect. Dis. Rep., 2013, 15(3), 236-241.
[http://dx.doi.org/10.1007/s11908-013-0332-6] [PMID: 23539430]
[6]
Ghotaslou, R.; Farajnia, S.; Yeganeh, F.; Abdoli-Oskouei, S.; Ahangarzadeh Rezaee, M.; Barzegar, M. Detection of acute childhood meningitis by PCR, culture and agglutination tests in Tabriz, Iran. Acta Med. Iran., 2012, 50(3), 192-196.
[PMID: 22418988]
[7]
Sadarangani, M.; Scheifele, D.W.; Halperin, S.A.; Vaudry, W.; Le Saux, N.; Tsang, R.; Bettinger, J.A. investigators of the Canadian Immunization Monitoring Program, ACTive (IMPACT).Outcomes of invasive meningococcal disease in adults and children in Canada between 2002 and 2011: a prospective cohort study. Clin. Infect. Dis., 2015, 60(8), e27-e35.
[http://dx.doi.org/10.1093/cid/civ028] [PMID: 25605282]
[8]
Sáez-Llorens, X.; McCracken, G.H., Jr Bacterial meningitis in children. Lancet, 2003, 361(9375), 2139-2148.
[http://dx.doi.org/10.1016/S0140-6736(03)13693-8] [PMID: 12826449]
[9]
Chávez-Bueno, S.; McCracken, G.H., Jr Bacterial meningitis in children. Pediatr. Clin. North Am., 2005, 52(3), 795-810, vii.
[http://dx.doi.org/10.1016/j.pcl.2005.02.011] [PMID: 15925663]
[10]
Abdinia, B.; Ahangarzadeh Rezaee, M.; Abdoli Oskouie, S. Etiology and antimicrobial resistance patterns of acute bacterial meningitis in children: a 10-year referral hospital-based study in northwest iran. Iran. Red Crescent Med. J., 2014, 16(7)e17616
[http://dx.doi.org/10.5812/ircmj.17616] [PMID: 25237583]
[11]
Moradi-Lakeh, M.; Esteghamati, A. National Immunization Program in Iran: whys and why nots. Human vaccines & immunotherapeutics., 2013, 9(1), 112-114.
[http://dx.doi.org/10.4161/hv.22521]
[12]
Bari, A.; Zeeshan, F.; Zafar, A.; Ejaz, H.; Jabeen, U.; Rathore, A.W. Acute bacterial meningitis in children presenting to The Children’s Hospital Lahore before and after pneumococcal vaccine in Pakistan National Immunization Program; A comparison. Pak. J. Med. Sci., 2017, 33(2), 447-451.
[http://dx.doi.org/10.12669/pjms.332.11891] [PMID: 28523054]
[13]
Mahon, CR; Lehman, DC; Manuselis, G Textbook of Diagnostic Microbiology-E-Book: Elsevier Health Sciences, 2014.
[14]
Gomroki, F; Mohammed, HB Malla, S Amplification of Methicillin Resistant Gene (mecA) gene from the MRSA strains. International journal of pharmaceutical and clinical research.,, 2015.
[15]
Rezaeizadeh, G.; Pourakbari, B.; Ashtiani, M.H.; Asgari, F.; Mahmoudi, S.; Mamishi, S. Antimicrobial susceptibility of bacteria isolated from cerebrospinal fluids in an Iranian referral pediatric center, 1998-2008. Maedica (Buchar.), 2012, 7(2), 131-137.
[PMID: 23399784]
[16]
Aletayeb, M.H.; Ahmad, F.S.; Masood, D. Eleven-year study of causes of neonatal bacterial meningitis in Ahvaz, Iran. Pediatr. Int., 2010, 52(3), 463-466.
[http://dx.doi.org/10.1111/j.1442-200X.2010.03107.x] [PMID: 20202151]
[17]
Cho, H.K.; Lee, H.; Kang, J.H.; Kim, K.N.; Kim, D.S.; Kim, Y.K.; Kim, J.S.; Kim, J.H.; Kim, C.H.; Kim, H.M.; Park, S.E.; Oh, S.H.; Chung, E.H.; Cha, S.H.; Choi, Y.Y.; Hur, J.K.; Hong, Y.J.; Lee, H.J.; Kim, K.H. The causative organisms of bacterial meningitis in Korean children in 1996-2005. J. Korean Med. Sci., 2010, 25(6), 895-899.
[http://dx.doi.org/10.3346/jkms.2010.25.6.895] [PMID: 20514311]
[18]
Lin, M-C.; Chiu, N-C.; Chi, H.; Ho, C-S.; Huang, F-Y. Evolving trends of neonatal and childhood bacterial meningitis in northern Taiwan. J. Microbiol. Immunol. Infect., 2015, 48(3), 296-301.
[http://dx.doi.org/10.1016/j.jmii.2013.08.012] [PMID: 24184002]
[19]
Motamedifar, M.; Ebrahim-Saraie, H.S.; Mansury, D.; Nikokar, I.; Hashemizadeh, Z. Prevalence of Etiological Agents and Antimicrobial Resistance Patterns of Bacterial Meningitis in Nemazee Hospital, Shiraz, Iran. Arch. Clin. Infect. Dis, 2015, 10(2)
[http://dx.doi.org/10.5812/archcid.10(2), 2015.22703]
[20]
Iregbu, KC; Abdullahi, N Profiles of acute bacterial meningitis isolates in children in National Hospital, Abuja. Nigerian medical journal: journal of the Nigeria Medical Association, 2015, 56(4), 297.
[21]
Shayanfar, N.; Mohammadpour, M.; Haghi-Ashtiani, M.T.; Nejat, F.; Farahani, N.N.; Abedini, M.; Rezaei, N. Invasive bacteria isolates from children with cerebral shunt and pattern of antimicrobial drug susceptibility in an Iranian referral pediatrics center. Braz. J. Infect. Dis., 2011, 15(4), 401-403.
[http://dx.doi.org/10.1016/S1413-8670(11)70215-X] [PMID: 21861017]
[22]
Laving, A.M.; Musoke, R.N.; Wasunna, A.O.; Revathi, G. Neonatal bacterial meningitis at the newborn unit of Kenyatta National Hospital. East Afr. Med. J., 2003, 80(9), 456-462.
[PMID: 14640166]
[23]
Garges, H.P.; Moody, M.A.; Cotten, C.M.; Smith, P.B.; Tiffany, K.F.; Lenfestey, R.; Li, J.S.; Fowler, V.G., Jr; Benjamin, D.K., Jr Neonatal meningitis: what is the correlation among cerebrospinal fluid cultures, blood cultures, and cerebrospinal fluid parameters? Pediatrics, 2006, 117(4), 1094-1100.
[http://dx.doi.org/10.1542/peds.2005-1132] [PMID: 16585303]
[24]
Kessler, A.T.; Kourtis, A.P. Treatment of meningitis caused by methicillin-resistant Staphylococcus aureus with linezolid. Infection, 2007, 35(4), 271-274.
[http://dx.doi.org/10.1007/s15010-007-6211-z] [PMID: 17646913]
[25]
Haghi-Ashtiani, M.T.; Mamishi, S.; Shayanfar, N.; Mohammadpour, M.; Yaghmaei, B.; Abedini, M.; Farahani, N.N.; Rezaei, N. Antimicrobial susceptibility profiles associated with bacterial meningitis among children: a referral hospital-based study in Iran. Acta Microbiol. Immunol. Hung., 2011, 58(4), 273-278.
[http://dx.doi.org/10.1556/AMicr.58.2011.4.3] [PMID: 22207285]
[26]
Pourakbari, B.; Aghdam, M.K.; Mahmoudi, S.; Ashtiani, M.T.H.; Sabouni, F.; Movahedi, Z.; Alyari, A.E.; Sadeghi, R.H.; Mamishi, S. High frequency of vancomycin-resistant enterococcus faecalis in an Iranian referral children medical hospital. Maedica (Buchar.), 2012, 7(3), 201-204.
[PMID: 23400108]
[27]
Pourakbari, B.; Mahmoudi, S.; Aghdam, M.K.; Sabouni, F.; Eshaghi, H.; Alizadeh, S.; Mamishi, S. Clonal spread of vancomycin resistance Enterococcus faecalis in an Iranian referral pediatrics center. J. Prev. Med. Hyg., 2013, 54(2), 87-89.
[PMID: 24396988]
[28]
Haghi Ashtiani, M.T.; Sadeghian, M.; Nikmanesh, B.; Pourakbari, B.; Mahmoudi, S.; Mamishi, S. Antimicrobial susceptibility trends among Streptococcus pneumoniae over an 11-year period in an Iranian referral children Hospital. Iran. J. Microbiol., 2014, 6(6), 382-386.
[PMID: 25926954]
[29]
Mamishi, S.; Moradkhani, S.; Mahmoudi, S.; Hosseinpour-Sadeghi, R.; Pourakbari, B. Penicillin-Resistant trend of Streptococcus pneumoniae in Asia: A systematic review. Iran. J. Microbiol., 2014, 6(4), 198-210.
[PMID: 25802701]


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VOLUME: 20
ISSUE: 2
Year: 2020
Page: [229 - 236]
Pages: 8
DOI: 10.2174/1871526519666181123130101
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