Clinical Features, Antibiotic Resistance, and Management of Bacterial Meningitis in Children Under Five at Nakuru Level 5 Hospital

Abstract

Bacterial meningitis is a severe condition contributing to high morbidity and mortality among children under five years in low-resource settings. This study assessed the clinical management of bacterial meningitis at Nakuru County Referral Hospital (NCRH) in Kenya, focusing on antimicrobial therapy appropriateness and factors influencing treatment outcomes. A cross-sectional study based on retrospective data of hospital records was conducted, including data on clinical features, laboratory results, and antimicrobial sensitivity patterns. The study aimed to evaluate the appropriateness of antimicrobial therapy and its adherence to culture and sensitivity results. The study included children with a mean age of 2.03 years and a mean weight of 1.48 kg. Streptococcus pneumoniae (42.9%) and Haemophilus influenzae (30.5%) were the most prevalent pathogens. Antimicrobial sensitivity revealed that Streptococcus pneumoniae was most responsive to Ceftriaxone (70.8%) and Vancomycin (60%). Despite this, the appropriate use of Ceftriaxone was low (16%), while Vancomycin was administered correctly in 60% of cases. Incomplete vaccination status and daycare attendance were significant risk factors for poor outcomes (p < 0.05). The findings highlight challenges in the clinical management of bacterial meningitis at NCRH, particularly in the selection and application of antimicrobial therapies. The low rate of appropriate antimicrobial use suggests gaps in following sensitivity results, potentially compromising patient outcomes. The predominance of Streptococcus pneumoniae underscores the need for improved vaccination strategies. Additionally, younger age, lower weight, and male gender were identified as key factors associated with increased risk, necessitating targeted interventions in these groups. In conclusion, enhancing adherence to antimicrobial guidelines and strengthening vaccination efforts are crucial for improving the clinical management of bacterial meningitis in children under five at NCRH. Further research should explore additional factors affecting treatment outcomes in this population.