Retrospective Study Of Bacterial Isolates And Susceptibility Patterns From Paediatric CSF Samples At Federal Teaching Hospital, Gombe

摘要

Between the years 2009 and 2014, one thousand two hundred and eighty five (1,285) CSF samples were collected at paediatric wards of federal teaching hospital Gombe. Using standard laboratory procedures the samples were processed for microscopy, culture and sensitivity of bacterial isolates at medical microbiology department of the same institution. The results were retrospectively analyzed. Generally, 54 (4.2%) bacterial pathogens were isolated from the patients in the years under study. Of the seven hundred and sixty seven (767) male samples processed 34 (4.4%) were culture positive while of the five hundred and eighteen (518) female samples processed, 20 (3.9%) were also culture positive. The highest number of positive samples was 29 (53.7%) from age group 0-2 years while the least positive sample was 1(1.9%) from age group 13-15years. Nine bacterial species were isolated, among which Neisseria meningitidis was the most frequent isolate with 31(57.4%) isolates. The least were Salmonella species and Citrobacter species with 1 (1.9%) isolate each. Using Oxoid sensitivity discs for the susceptibility testing, Gentamicin was the most effective drug as 6 of the 9 species isolated were excellently sensitive to it while the least was Cotrimoxazole where 8 of the isolated species were completely resistance to it. The results of this study therefore, re-establish the high vulnerability of children to bacterial meningitis, the importance of laboratory analysis of the CSF and recommends that Gentamicin and Augmentin should be included in syndromic treatment of CSM where laboratory investigations of CSF are not readily available. INTRODUCTION Meningitis is the inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges (1).The inflammation may be caused by infection with viruses, bacteria or other microorganisms, and less commonly by certain drugs (2,3).Meningitis can be life- threatening because of the inflammation’s proximity to the brain and spinal cord; therefore, the condition is classified as a medical emergency (1, 4). Meningitis being a medical emergency requires urgent rational antibiotic therapy, especially among the neonates and young infants (5).Statement of the ProblemBacterial meningitis is one of the most feared infectious diseases of children and epidemic meningitis can have a devastating impact on entire populations. It can be quite severe and may result in brain damage, loss of hearing, learning disability and death if not treated (6). It accounted for 2.7% of infant deaths among hospitalized children in Ilorin, Nigeria and 3.4% of post-neonatal deaths in Sokoto, Nigeria (7). Bacterial meningitis has a global incidence of about 20 -100 cases per 100,000 live births during the newborn period (8). It is common in the so-called meningitis belt area between 10°-15°N of the equator, in which Nigeria lies.Bacterial meningitis is characterized by acute onset of fever (usually >38.5°C rectal or >38.0°C axilliary), headache, neck stiffness, altered consciousness, vomiting, and inability to tolerate light (photophobia) or loud noise (phonophobia). Children only exhibit nonspecific symptoms such as irritability and drowsiness. If a rash is present, it may indicate a particular cause of meningitis; for instance, meningitis caused by meningococcal bacteria may be accompanied by a characteristic rash (5, 9).The types of bacteria that cause meningitis normally vary with age group. In premature babies and newborns up to three months old, common causes are group B Streptococci (subtypes III which normally inhabit the vagina and are mainly a cause during the first week of life) and those that normally inhabit the digestive tracts such as Escherichia coli (carrying K1 antigen). Listeria monocytogenes (serotype IV b) may affect the newborn and occurs in epidemics. While those under five are affected by Heamophilus influenzae type b (in countries that do not offer vaccination), older chil