Aetiological spectrum and antibiotic susceptibility pattern of bacterial meningitis in infants and children in Hangzhou, China

Sir, Despite the availability of effective antimicrobial therapy, morbidity, mortality and neurological sequelae of infants and children with bacterial meningitis are still unacceptably high throughout the world, particularly in the developing countries. Clinical prognosis of bacterial meningitis is associated with early diagnosis and early effective treatment, so ample knowledge of its aetiological spectrum and antibiotic susceptibility pattern in the particular locality is required. In this paper, the retrospective analysis of the aetiological spectrum and antibiotic susceptibility pattern of bacterial meningitis between January 1997 and December 2003 is reported for the first time from the Children’s Hospital of Zhejiang University which, as a teaching hospital, is the only tertiary children’s health institution which serves as the common referral centre for all health establishments in Zhejiang Province. Patients (0–14 y) presented with symptoms and physical signs that suggested bacterial meningitis. A total of 639 patient samples of cerebrospinal fluid (CSF) and blood were cultured in VITA-200 cultures (Biomérieux, France). The identification of Meningococcus, Haemophilus influenza and Streptococcus pneumoniae was determined by API-NH strip (Biomérieux, France), and antimicrobial susceptibility tests were performed by the agar diffusion technique on Hinton’s agar (Biomérieux, France). The identification of other bacterial cultures and the determination of antimicrobial resistance were detected by VITEK60 automicroscan (Biomérieux, France). The results were interpreted according to the guidelines of the National Committee for Clinical Laboratory Standards. One hundred and fifty-two (23.8%) of 639 samples yielded bacteria from cultures. The most frequently occurring organism was Staphylococcus (29.0%), including coagulase-negative staphylococci (CNS; 20.4%) and Staphylococcus aureus (8.6%). The majority (89%) of the bacterial meningitis cases occurred among individuals aged 0–9 y (Table I). The predominant pathogens occurring in newborn (0–4 wk) bacterial meningitis were Staphylococcus and coliform bacilli. Bacterial meningitis, in general, was genderrelated (w=16.93, p50.05), and males were afflicted more frequently (68%) than females (32%). The drug susceptibilities of CNS against penicillin and erythromycin were 6% and 48%, respectively. Half (52%) of the CNS isolates showed susceptibility to oxacillin. Thirteen of the isolates (10 CNS and three S. aureus) were simultaneously resistant to penicillin G, oxacillin, cefazolin and erythromycin. Two of the isolates of CNS were simultaneously resistant to both vancomycin and teicoplanin, and three isolates resistant to teicoplanin. The resistance rates of vancomycin and teicoplanin among the CNS isolates are higher than those of Hong Kong and Japan [1]. Isolates from 50% of patients with S. pneumoniae were susceptible to penicillin, and those from 89% of patients susceptible to cefotaxime. No isolate of S. pneumoniae resistant to vancomycin was found. In recent years, it has been noted that Pediococci—Gram-positive