Occurrences of self-administered antibiotics, culture diagnostic challenges and multi-drug resistant S. aureus among Ethiopian pyogenic/bacterial meningitis patients: 2020-2021

Abstract Introduction: Bacterial meningitis (BM) is a serious life-threatening disease affecting the central nervous system. Less focus is given to uncommon causes of BM etiologic agents such as Staphylococcus aureus (S. aureus) and their magnitude of antimicrobial resistance (AMR). The disease burden caused by S. aureus is also poorly understood in developing countries such as Ethiopia. Culture based diagnosis of BM is the gold standard method for detection of the etiologic agents of the disease. Use of self-administered antibiotics results in development of AMR of bacterial agents and in culture based diagnostic challenges.Purpose: This study is exploring the status of uncommon cause of BM, the magnitude of antimicrobial resistance and challenges in culture based diagnosis.Patient and Methods:One hundred thirty-seven patients clinically diagnosed with pyogenic meningitis were recruited from the year 2020 to 2021 from four referral level hospitals located in Ethiopia. Cerebrospinal fluid samples transported in Trans-isolate media (T-IM) was inoculated into blood and culture media plates. Colony morphology and biochemical tests were used for identifying the grown bacterial agents. Patient clinical, socio-demographic and laboratory data were entered into SPSS version 20. Analysis was done using Pearson chi-square test and Graph data set chart builder. Non-parametric test was used to analyze statistical significance of P value < 0.05. Results obtained:A total of seven out of 137 culture media plates have shown growths of colonies on chocolate and blood culture media. Five out of the seven isolates were drug resistant S. aureus while two isolates were Neisseria species which are not drug resistant. Conclusion: Use of self-administered antibiotics prior to hospital visitation may be the reason for culture negative results which are challenges for culture based diagnosis. Wider scope of such studies using sensitive diagnostic approaches such as PCR is recommended to analyze the magnitude of uncommon causes of BM. AMR is occurring even in uncommon BM etiologic agents. Further analysis should be made using PCR amplification of drug resistant genes to bring the issue to public health attention.