Epidemiology and drug resistance profile of acute bacterial meningitis in children in Northern India: A university hospital perspective

Objective: To assess epidemiology, trends in etiology and the antimicrobial sensitivity pattern of the pathogens. Methods: Cerebrospinal fluid was collected from 150 patients who were suspected of meningitis and processed according to standard microbiological techniques. Cerebrospinal fluid samples were tested for antigen detection by latex agglutination test (LAT). Antimicrobial sensitivity test was done by Kirby-Bauer disc diffusion method. Results: Fever, abnormal movements and altered sensorium were the most common presenting features. Etiological agents were identified in 79 (53%) cases. A total of 33 (42%) samples were cultured positive while 59 (75%) were positive by LAT. Pneumococcus followed by Gram-negative organisms were the most common pathogens. Mortality was 28 (19%). The aminoglycosides had the best spectrum of antimicrobial activity. An alarming rise of methicillin-resistant Staphylococcus aureus (75%) and extended-spectrum beta-lactamase (59%) was seen. No high-level aminoglycoside resistance, AmpC or mannose-binding lectin production was observed. Conclusions: Pneumococcus and Gram-negative pathogens were the most common organisms. High prevalence of drug resistant pathogens is seen. Inclusion of LAT for antigen detection in routine diagnosis adds a valuable adjunct in the rapid and accurate diagnosis of pyogenic meningitis especially in partially treated cases.