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Antimicrobial sensitivity patterns of cerebrospinal fluid (CSF) isolates in Namibia: implications for empirical antibiotic treatment of meningitis
Article Number: SIS594136AI221222
22nd December, 2022
Author(s):
Assegid Mengistu, Johannes Gaeseb, Gottfried Uaaka, Christophine Ndjavera, Kennedy Kambyambya, Lazarus Indongo, Francis Kalemeera, Christopher Ntege, David Mabirizi, Mohan P Joshi & Evans Sagwa
Abstract:
Objective: Bacterial meningitis is a medical emergency associated with high mortality rates. Cerebrospinal fluid
(CSF) culture is the “gold standard” for diagnosis of meningitis and it is important to establish the susceptibility of
the causative microorganism to rationalize treatment. The Namibia Standard Treatment Guidelines (STGs)
recommends initiation of empirical antibiotic treatment in patients with signs and symptoms of meningitis after
taking a CSF sample for culture and sensitivity. The objective of this study was to assess the antimicrobial sensitivity
patterns of microorganisms isolated from CSF to antibiotics commonly used in the empirical treatment of
suspected bacterial meningitis in Namibia.
Methods: This was a cross-sectional descriptive study of routinely collected antibiotic susceptibility data from the
Namibia Institute of Pathology (NIP) database. Results of CSF culture and sensitivity from January 1, 2009 to May 31,
2012, from 33 state hospitals throughout Namibia were analysed.
Results: The most common pathogens isolated were Streptococcus species, Neisseria meningitidis, Haemophilus
influenzae, Staphylococcus, and Escherichia coli. The common isolates from CSF showed high resistance (34.3% –
73.5%) to penicillin. Over one third (34.3%) of Streptococcus were resistance to penicillin which was higher than
24.8% resistance in the United States. Meningococci were susceptible to several antimicrobial agents including
penicillin. The sensitivity to cephalosporins remained high for Streptococcus, Neisseria, E. coli and Haemophilus. The
highest percentage of resistance to cephalosporins was seen among ESBL K. pneumoniae (n = 7, 71%–100%), other
Klebsiella species (n = 7, 28%–80%), and Staphylococcus (n = 36, 25%–40%).
Conclusions: The common organisms isolated from CSF were Streptococcus Pneumoniae, Neisseria meningitidis,
Haemophilus influenzae, Staphylococcus, and E. coli. All common organisms isolated from CSF showed high
sensitivity to cephalosporins used in the empirical treatment of meningitis. The resistance of the common isolates
to penicillin is high. Most ESBL K. pneumoniae were isolated from CSF samples drawn from neonates and were
found to be resistant to the antibiotics recommended in the Namibia STGs. Based on the above findings, it is
recommended to use a combination of aminoglycoside and third-generation cephalosporin to treat non–ESBL
Klebsiella isolates. Carbapenems (e.g., meropenem) and piperacillin/tazobactam should be considered for treating
severely ill patients with suspected ESBL Klebsiella infection. Namibia should have a national antimicrobial resistance
surveillance system for early detection of antibiotics that may no longer be effective in treating meningitis and
other life-threatening infections due to resistance.