Bacterial Meningitis in Malawian Infants <2 Months of Age: Etiology and Susceptibility to World Health Organization First-Line Antibiotics

Swann, Olivia MB ChB*†; Everett, Dean B. PhD‡§; Furyk, Jeremry S. MB BS; Harrison, Ewen M. PhD; Msukwa, Malango T. BSc; Heyderman, Robert S. PhD‡**; Molyneux, Elizabeth M. FRCPCH*

Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0000000000000210
Original Studies
Abstract

Background: Neonatal meningitis is an important cause of morbidity in sub-Saharan Africa and requires urgent empiric treatment with parenteral administered antibiotics. Here we describe the etiology, antimicrobial susceptibility and suitability of the World Health Organization first-line recommended antibiotics (penicillin and gentamicin) for bacterial meningitis in young infants in Malawi.

Methods: We reviewed all cerebrospinal fluid samples received from infants ≤2 months of age with clinically suspected meningitis between January 1, 2002, and December 31, 2008, at the Queen Elizabeth Central Hospital in Blantyre, Malawi.

Results: We identified 259 culture-positive isolates from 259 infants ≤2 months of age. Sixty isolates were from neonates ≤7 days old, in whom the most common pathogens were Group B Streptococcus (27/60; 45.0%), Streptococcus pneumoniae (13/60; 21.7%) and nontyphoidal Salmonella enterica (7/60; 11.7%). One hundred and ninety one isolates were from young infants who were >7 days and ≤2 months of age. In this group, the most common isolates were S. pneumoniae (80/191; 41.9%), Group B Streptococcus (38/191; 19.9%) and nontyphoidal Salmonella enterica (34/191; 17.8%). More isolates were susceptible to ceftriaxone than to the combination of penicillin and gentamicin (218/220; 99.1% vs. 202/220; 91.8%, Fisher’s exact test P = 0.006). In particular, Gram-negative isolates were significantly more susceptible to ceftriaxone than to gentamicin (72/74; 97.3% vs. 63/74; 85.1%, Fisher’s exact test P = 0.020). Penicillin and gentamicin provided less coverage for Gram-negative than Gram-positive isolates (74/86; 86.0% vs. 155/163; 95.1%, χ2 = 6.24, P = 0.012).

Conclusions: In view of these results, the World Health Organization recommendations for empiric penicillin and gentamicin for suspected neonatal meningitis should be reevaluated.

Author Information

From the *Department of Paediatrics, University of Malawi College of Medicine, Blantyre, Malawi; Centre for Immunity, Infection and Evolution, Edinburgh, United Kingdom; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi; §Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom; Emergency Department, Townsville Hospital, Douglas, Queensland, Australia; Centre for Inflammation Research, University of Edinburgh, Edinburgh; and **Liverpool School of Tropical Medicine, Liverpool, United Kingdom.

Accepted for publication November 7, 2013.

The study was performed at Department of Paediatrics, University of Malawi College of Medicine, Blantyre, Malawi.

The microbiology surveillance service at QECH is provided by the Malawi-Liverpool-Wellcome Clinical Research Programme which is funded by a core grant from the Wellcome Trust. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the article.

The authors have no funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.pidj.com).

Address for correspondence: Olivia Swann, MB ChB, Centre for Immunity, Infection and Evolution, 4.61 Ashworth Laboratories, Kings Buildings, Edinburgh, EH9 3JT. E-mail: Olivia.Swann@ed.ac.uk.

This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

© 2014 by Lippincott Williams & Wilkins, Inc.