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Updated: Jul 2, 2026

Metagenomic Next-Generation Sequencing of Cerebrospinal Fluid for the Detection of Central Nervous System Pathogens
Published on: April 17, 2026
Antimicrobial resistance and microbiological gap analysis for central nervous system-assocaited bacterial pathogens
Jafar Ammoura1, Nouruldeen Alshamaa1, Amjad Elamin1
1Pathological Sciences Department, Division of Microbiology, College of Medicine, Ajman University, Ajman, United Arab Emirates.
Background:
Despite extensive vaccination efforts, central nervous system (CNS) infections remain a significant cause of morbidity and mortality in the African meningitis belt. This burden is increasingly complicated by the rising antimicrobial resistance (AMR) in pathogens not covered by the available vaccines. We mapped pathogen-specific AMR profiles and diagnostic gaps in CNS bacterial pathogens to inform precise microbiology-based interventions for improved surveillance and empiric therapy in Nigeria.
Methods:
We conducted a retrospective analysis of a three-year national AMR surveillance data, focusing on CNS bacterial pathogens. Data from 25 sentinel laboratories were extracted, analysed and interpreted per CLSI/GLASS standards. AMR profiles and diagnostic gaps were assessed using descriptive statistics and Chi-square tests for demographic and temporal comparisons.
Results:
Among 84,548 valid cultures from over 26,000 patients, culture positivity rate was higher in females (35.1%) compared to males (28.3%, p < 0.001) and higher among older adults (>65 years, 40.0%, p < 0.001). CSF specimens were underrepresented, while species-level ambiguity was high for CNS-associated infections. Staphylococcus aureus (31.3%), Escherichia coli (20%), and Klebsiella species (12%) were the dominant isolates, while Pseudomonas aeruginosa (3.5%) and Acinetobacter species (0.6%) showed persistent low-level presence. High levels of penicillin resistance were observed in Streptococcus pneumoniae across the study years, culminating at 100% in 2018. Other pathogens, including Klebsiella species, E. coli, and P. aeruginosa, showed high AMR across multiple drug classes. Gap analysis scored all CNS-associated bacterial pathogens at maximum clinical risk (5/5), with major deficits in detection and the laboratory capacity. A precision-targeted recommendation map proposed tailored microbiological interventions, such as neonatal antimicrobial susceptibility testing (AST) protocols for E. coli and intensive care unit infection registries for Pseudomonas species.
Conclusion:
Species-level identification gaps and high AMR in CNS bacterial pathogens demand targeted microbiological-led diagnostics, including expanded cerebrospinal fluid testing and AST-guided empiric therapy in resource-limited settings.
Insights
Central nervous system (CNS) infections in Nigeria show high antimicrobial resistance (AMR) and diagnostic gaps. Targeted microbiology interventions are crucial for effective treatment and surveillance of bacterial meningitis.
Area of Science:
- Infectious Diseases
- Microbiology
- Public Health
Background:
- Central nervous system (CNS) infections pose a significant health burden in the African meningitis belt.
- Rising antimicrobial resistance (AMR) complicates treatment for CNS infections not covered by vaccines.
- Nigeria faces challenges with AMR in CNS pathogens and diagnostic limitations.
Purpose of the Study:
- To map pathogen-specific AMR profiles and diagnostic gaps in CNS bacterial pathogens in Nigeria.
- To inform precise microbiology-based interventions for improved surveillance and empiric therapy.
- To address the growing challenge of AMR in CNS infections.
Main Methods:
- Retrospective analysis of three-year national AMR surveillance data for CNS bacterial pathogens.
- Data extracted from 25 sentinel laboratories and analyzed per CLSI/GLASS standards.
- AMR profiles and diagnostic gaps assessed using descriptive statistics and Chi-square tests.
Main Results:
- High culture positivity rates observed in females and older adults.
- Dominant isolates included *Staphylococcus aureus*, *Escherichia coli*, and *Klebsiella* species.
- High AMR levels noted for *Streptococcus pneumoniae*, *Klebsiella* species, *E. coli*, and *P. aeruginosa*.
- Significant diagnostic gaps identified across all CNS bacterial pathogens, scoring maximum clinical risk.
Conclusions:
- Species-level identification gaps and high AMR necessitate targeted microbiological diagnostics.
- Expanded cerebrospinal fluid testing and antimicrobial susceptibility testing (AST)-guided empiric therapy are crucial.
- Interventions must be tailored for resource-limited settings to combat CNS infections effectively.
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