Prevalence and antibiotic resistance of bacteria isolated from cerebrospinal fluid among children with bacterial meningitis in China from 2016 to 2018: A multicenter retrospective study

Abstract

Background: Bacterial meningitis (BM) remains a devastating disease in children, and it causes substantial neurological morbidity and mortality worldwide. However, there are few large-scale studies on the pathogens causing pediatric bacterial meningitis (PBM) and their antimicrobial resistance (AMR) patterns in China. The present multicenter survey summarized the features of the etiologies of BM in children and characterized their AMR patterns.Methods: Data from 1193 cerebrospinal fluid bacterial isolates from children with BM who were admitted to 13 children’s hospitals in China from 2016 to 2018 were analyzed retrospectively.Results: Of the 1142 patients with PBM, 65.9% (753) were less than 1 year old, and more than two-fifths (513, 44.9%) were younger than 3 months. The three leading pathogens causing PBM were Staphylococcus epidermidis (S. epidermidis) (16.5%), Escherichia coli (E. coli) (12.4%) and Streptococcus pneumoniae (S. pneumoniae) (10.6%). Infants under 3 months of age were at a relatively high risk of infection by E. coli (116/523; 22.2%), Enterococcus faecium (75/523; 14.3%), S. epidermidis (57/523; 10.9%), and Group B Streptococcus (55/523, 10.5%). However, Children more than 3 months of age were at a relatively high risk of infection by S. epidermidis (140/670; 20.9%), S. pneumoniae (117/670; 17.5%), and Staphylococcus hominis (57/670; 8.5%). Greater than 93.0% of E. coli isolates were sensitive to cefoxitin, piperacillin/tazobactam, cefoperazone/sulbactam, amikacin and carbapenems, and the resistance rates to ceftriaxone, cefotaxime and ceftazidime were 49.4%, 49.2% and 26.4%, respectively. From 2016 to 2018, the proportion of methicillin-resistant coagulase-negative Staphylococcus (MRCoNS) isolates declined from 80.5% to 72.3%, and the frequency of penicillin-resistant Streptococcus pneumoniae (PRSP) isolates increased from 75.0% to 87.5%. The proportion of extended-spectrum β-lactamase (ESBL)-producing E. coli fluctuated between 44.4% and 49.2%, and the detection rate of ESBL production in Klebsiella pneumoniae (K. pneumoniae) ranged from 55.6% to 88.9%. The resistance of E. coli strains to carbapenems was 5.0%, but the overall prevalence of carbapenem-resistant (CR) K. pneumoniae was high (54.5%).Conclusions: The resistance of CoNS to methicillin and the high incidence of ESBL production in Gram-negative Enterobacteriaceae pose a critical challenge to infection control. Carbapenem-resistant K. pneumoniae isolates are a serious issue for the treatment of children with PBM.