Nosocomial Postsurgical Meningitis in Children:A 12-Year Survey Comparing Data From 1993-1998 With Data From 1999-2004 TO T H E EDITOR-The incidence of nosocomial meningitis after neurosurgery is increasing. 12 In a previous study, a survey of all 8 pediatric and neonatal neurosurgery departments in Slovakia revealed that 101 cases of pediatric bacterial meningitis were recorded during 1993-1998, with an attributable mortality of 15% and sequelae detected in 18% of cases. 1 We conducted a similar survey during 1999-2004, which revealed an additional 57 cases of disease. Here, cases of pediatric nosocomial meningitis during [1999][2000][2001][2002][2003][2004] are compared with those during 1993-1998 with respect to etiology, risk factors, and outcome. A prospective protocol was used to assess each case of meningitis that occurred during hospitalization in persons aged 18 years or less at any of the 8 pediatric and neonatal neurosurgery departments in Slovakia; the number of such departments has not changed during the past 10 years. Nosocomial meningitis was clinically defined as onset of meningitis after neurosurgery in patients with a positive result of a cerobrospinal fluid culture. Risk factors were assessed, including the etiology of meningitis, the type of neurosurgery, and the presence of underlying disease(s), trauma, abnormal central nervous system findings, central nervous system disease, positive results of blood cultures, malignancy, and hemorrhage. Mortality rates associated with infection and/or to central nervous system sequelae and treatment (ie, surgery and antibiotics therapy) were assessed, and antimicrobial resistance was measured for the pathogens most commonly isolated from the cerebrospinal fluid of study subjects (coagulase- (66) 13 (11) , whereas no cases of meningitis were caused by these pathogens during the first study period ( P < .01). All 10 non-S. epidermis CoNS strains were resistant to methicillin (minimum inhibitory concentration, >8 /xg/mL), and 6 were also resistant to teicoplanin (minimum inhibitory concentration, >16 /xg/mL); 20 cases of meningitis (35%) in the second study period had a polymicrobial etiology (CoNS and P. aeruginosa or CoNS and A. baumannii)The following gram-negative bacteria were isolated more frequently during the second study period: A. baumannii (10 isolates [13%] vs 10 isolates [8.7%]) and P. aeruginosa (7 isolates [9.3%] vs 6 isolates [5.2%]). Three of 10 Enterobacteriaceae organisms were resistant to cefepime, and 2 of 7 P. aeruginosa isolates were resistant to meropenem (Table 2). DNA fingerprinting was not performed, but clusters of resistance patterns were not detected in resistance phenotypes.There was no significant difference in mortality between the 2 study periods. However, there was a significant decrease in the frequency of neurologic complications (eg, hydrocephalus, palsy, and epilepsy) during 1999-2004, compared with 1999-2004 ; P< .002) were more common during the first study period. The incidence of meningitis per 100 neurosurge...