title: Etiology, antimicrobial susceptibility profiles, and mortality associated with bacterial meningitis among children in Egypt.
abstract: OBJECTIVE
  Surveillance for patients with meningitis is a high priority in order to determine the etiology of disease and design prevention strategies. This study presents data on the causes of bacterial meningitis among children <6 years of age treated in a network of hospitals throughout Egypt.
  
  
  METHODS
  Training was provided to standardize the collection of clinical information and optimize recovery of bacterial pathogens. Bacterial isolates were tested for antimicrobial resistance patterns using Kirby Bauer disk diffusion, E-test and/or Beta-lactamase (BL) testing methods.
  
  
  RESULTS
  Patients with culture-confirmed bacterial meningitis (228 children<6 years) were identified including 89 (39%) patients with H. influenzae (HI), 68 (30%) with Streptococcus pneumoniae (SP), 30 (13%) with N. meningitidis (NM), 18 (8%) with Mycobacterium tuberculosis (MTB) and 23 (10%) with other bacteria. The overall case fatality ratio was high (24%) and increased among children with TB meningitis (56%). The susceptibility for HI to ampicillin (AMP), chloramphenicol (C) and ceftriaxone (CRO) was 21%, 13%, and 100% respectively. The susceptibility for SP to C and CRO was 79% and 100%, respectively.
  
  
  CONCLUSIONS
  HI and SP are the leading causes of bacterial meningitis among children in Egypt. The majority of HI strains tested were resistant to AMP or C suggesting the need for routine use of CRO as first line therapy. Among older children TB emerges as a significant cause of bacterial meningitis in Egypt.
authors.affiliation: US Naval Medical Research Unit No. 3, Cairo, Egypt. yousseff@namru3.med.navy.mil
authors.forename: Fouad G
authors.initials: FG
authors.lastname: Youssef
authors.forename: Hammam
authors.initials: H
authors.lastname: El-Sakka
authors.forename: Adel
authors.initials: A
authors.lastname: Azab
authors.forename: Saed
authors.initials: S
authors.lastname: Eloun
authors.forename: Gail D
authors.initials: GD
authors.lastname: Chapman
authors.forename: Tharwat
authors.initials: T
authors.lastname: Ismail
authors.forename: Hoda
authors.initials: H
authors.lastname: Mansour
authors.forename: Z
authors.initials: Z
authors.lastname: Hallaj
authors.forename: Frank
authors.initials: F
authors.lastname: Mahoney
mesh_terms: D000367:Age Factors; D002675:Child, Preschool; D003906:Developing Countries; D024881:Drug Resistance, Bacterial; D004534:Egypt / Q000453:epidemiology; D005260:Female; D006193:Haemophilus influenzae / Q000187:drug effects / Q000302:isolation & purification / Q000472:pathogenicity; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D016920:Meningitis, Bacterial / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification / Q000472:pathogenicity; D009345:Neisseria meningitidis / Q000187:drug effects / Q000302:isolation & purification / Q000472:pathogenicity; D011159:Population Surveillance; D012621:Seasons; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000302:isolation & purification / Q000472:pathogenicity