Tuula Pelkonen1, Suvi Urtti2, Elizabete Dos Anjos3, Ondina Cardoso4, Linda de Gouveia5, Irmeli Roine6, Heikki Peltola7, Anne von Gottberg8, Moe H Kyaw9. 1. Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland; Hospital Pediátrico David Bernardino (HPDB), Luanda, Angola. Electronic address: tuulapelkonen@hotmail.com. 2. Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland. Electronic address: suvi.urtti@fimnet.fi. 3. Hospital Pediátrico David Bernardino (HPDB), Luanda, Angola. Electronic address: elizabeteanjos@icloud.com. 4. Hospital Pediátrico David Bernardino (HPDB), Luanda, Angola. Electronic address: ondinacardoso@hotmail.com. 5. Centre for Respiratory Disease and Meningitis (CRDM), National Institute for Communicable Diseases (NICD), Division of the National Health Laboratory Service (NHLS), Johannesburg, South Africa. Electronic address: lindad@nicd.ac.za. 6. Faculty of Medicine, University Diego Portales, Santiago, Chile. Electronic address: irmeli.roine@gmail.com. 7. Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland. Electronic address: heiheikkipeltola@gmail.com. 8. Centre for Respiratory Disease and Meningitis (CRDM), National Institute for Communicable Diseases (NICD), Division of the National Health Laboratory Service (NHLS), Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. Electronic address: annev@nicd.ac.za. 9. Sanofi Pasteur, Epidemiology, Swiftwater, PA, USA. Electronic address: MKyaw11@gmail.com.
Abstract
BACKGROUND: Despite effective antibiotics and vaccines, bacterial meningitis (BM) remains one of the leading causes of morbidity and mortality in young infants worldwide. Data from Africa on the aetiology and antibiotic susceptibility are scarce. OBJECTIVE: To describe the aetiology of BM in Angolan infants <90 days of age. METHODS: A prospective, observational, single-site study was conducted from February 2016 to October 2017 in the Paediatric Hospital of Luanda. All cerebrospinal fluid samples (CSF) from infants aged <90 days with suspected BM or neonatal sepsis were assessed. The local laboratory performed microscopy, chemistry, culture, and susceptibility testing. PCR for vaccine-preventable pathogens was performed in Johannesburg, South Africa. RESULTS: Of the 1287 infants, 299 (23%) had confirmed or probable BM. Of the 212 (16%) identified bacterial isolates from CSF, the most common were Klebsiella spp (30 cases), Streptococcus pneumoniae (29 cases), Streptococcus agalactiae (20 cases), Escherichia coli (17 cases), and Staphylococcus aureus (11 cases). A fifth of pneumococci (3/14; 21%) showed decreased susceptibility to penicillin, whereas methicillin-resistant S. aureus (MRSA) was encountered in 4/11 cases (36%). Of the gram-negative isolates, 6/45 (13%) were resistant to gentamicin and 20/58 (34%) were resistant to third-generation cephalosporins. Twenty-four percent (33/135) of the BM cases were fatal, but this is likely an underestimation. CONCLUSIONS: BM was common among infants <90 days of age in Luanda. Gram-negative bacteria were predominant and were often resistant to commonly used antibiotics. Continued surveillance of the antibiogram is pivotal to detect potential changes without delay.
BACKGROUND: Despite effective antibiotics and vaccines, bacterial meningitis (BM) remains one of the leading causes of morbidity and mortality in young infants worldwide. Data from Africa on the aetiology and antibiotic susceptibility are scarce. OBJECTIVE: To describe the aetiology of BM in Angolan infants <90 days of age. METHODS: A prospective, observational, single-site study was conducted from February 2016 to October 2017 in the Paediatric Hospital of Luanda. All cerebrospinal fluid samples (CSF) from infants aged <90 days with suspected BM or neonatal sepsis were assessed. The local laboratory performed microscopy, chemistry, culture, and susceptibility testing. PCR for vaccine-preventable pathogens was performed in Johannesburg, South Africa. RESULTS: Of the 1287 infants, 299 (23%) had confirmed or probable BM. Of the 212 (16%) identified bacterial isolates from CSF, the most common were Klebsiella spp (30 cases), Streptococcus pneumoniae (29 cases), Streptococcus agalactiae (20 cases), Escherichia coli (17 cases), and Staphylococcus aureus (11 cases). A fifth of pneumococci (3/14; 21%) showed decreased susceptibility to penicillin, whereas methicillin-resistant S. aureus (MRSA) was encountered in 4/11 cases (36%). Of the gram-negative isolates, 6/45 (13%) were resistant to gentamicin and 20/58 (34%) were resistant to third-generation cephalosporins. Twenty-four percent (33/135) of the BM cases were fatal, but this is likely an underestimation. CONCLUSIONS: BM was common among infants <90 days of age in Luanda. Gram-negative bacteria were predominant and were often resistant to commonly used antibiotics. Continued surveillance of the antibiogram is pivotal to detect potential changes without delay.
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