title: Bacterial meningitis in Malawian infants <2 months of age: etiology and susceptibility to World Health Organization first-line antibiotics.
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%, χ = 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.
authors.affiliation: 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.
authors.forename: Olivia
authors.initials: O
authors.lastname: Swann
authors.forename: Dean B
authors.initials: DB
authors.lastname: Everett
authors.forename: Jeremry S
authors.initials: JS
authors.lastname: Furyk
authors.forename: Ewen M
authors.initials: EM
authors.lastname: Harrison
authors.forename: Malango T
authors.initials: MT
authors.lastname: Msukwa
authors.forename: Robert S
authors.initials: RS
authors.lastname: Heyderman
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Molyneux
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002443:Ceftriaxone / Q000494:pharmacology; D005839:Gentamicins / Q000494:pharmacology; D006801:Humans; D007231:Infant, Newborn; D008295:Malawi / Q000453:epidemiology; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid* / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D008826:Microbial Sensitivity Tests; D019779:Salmonella enterica / Q000187:drug effects / Q000302:isolation & purification; D013292:Streptococcus agalactiae / Q000187:drug effects / Q000302:isolation & purification; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D002443:Ceftriaxone