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

Background: Bacterial meningitis (BM) remains a devastating disease among children and can cause substantial neurological morbidity and mortality worldwide. However, there are limited large-scale data concerning the pathogens responsible for pediatric bacterial meningitis (PBM) and their antimicrobial resistance (AMR) patterns in China. The objective of this multi-centre survey was tosummarize the features of etiologies causing BM among children and to characterize their AMR patterns.Methods: Data of 1193 cerebrospinal fluid bacterial isolates from children with BM admitted to thirteen children’s hospitals in China from 2016 to 2018 wereanalyzed retrospectively.Results:Of the 1142 patients with PBM,65.9% (753) were less than 1yearold, among which more than two-thirds (513, 68.1%) were younger than 3 months. The three leading pathogens causing PBM were Staphylococcus epidermidis (16.5%), Escherichia coli (12.4%) and Streptococcus pneumoniae (10.6%). The age group of under 3 months was at a relatively high risk of infection by Escherichia coli(116/523; 22.2%), Enterococcus faecium (75/523; 14.3%), Staphylococcus epidermidis (57/523; 10.9%), and Group B Streptococcus(55/523,10.5%). However, the age group of more than 3 months was at a relatively high risk of infection by Staphylococcus epidermidis (140/670; 20.9%), Streptococcus pneumoniae (117/670; 17.5%), and Staphylococcus hominis (57/670;8.5%). More than 93.0% of E. coli isolates were sensitive to cefoxitin, piperacillin/tazobactam, cefoperazone/sulbactam,amikacin, carbapenems, while 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%, while the frequency of penicillin-resistant S. 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 ESBLproduction among 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 among gram-negative Enterobacteriaceae posed a critical challenge to infection control. Carbapenem-resistant K. pneumoniae isolates are a large issue for the treatment of children with PBM.