Prevalence and antimicrobial resistance patterns of bacteria isolated from cerebrospinal fluid among children with bacterial meningitis in China from 2016 to 2018: A multicenter retrospective study
Authors: Peng Xiaoshan , Zhu Qingxiong , Liu Jing , Zeng Mei , Qiu Yue , Zhu Chunhui , Cheng Yibing , Zhou Yibo , Xu Yi , Chen Minxia , Wen Zhengwang , Chen Yiping , Li Rui , Tong Jianning , Shan Qingwen , Lin Daojiong , Wu Shouye , Zhuo Zhiqiang , Wang Caihong , Zhao Shiyong , Qi Zhenghong , Sun Xiaofeng , Maihebuba Bieerding , Jia Chunmei , Gao Huiling , Li Shuangjie , Zhu Yu , Wan Chaomin 
Published: January 2021

Abstract
Background: Pediatric bacterial meningitis (PBM) remains a devastating disease that causes substantial neurological morbidity and mortality worldwide. However, there are few large-scale studies on the pathogens causing PBM and their antimicrobial resistance (AMR) patterns in China. The present multicenter survey summarized the features of the etiological agents of PBM and characterized their AMR patterns.Methods: Patients diagnosed with PBM were enrolled retrospectively at 13 children’s hospitals in China from 2016 to 2018 and were screened based on a review of cerebrospinal ﬂuid (CSF) microbiology results. Demographic characteristics, the causative organisms and their AMR patterns were systematically analyzed.Results: Overall, 1193 CSF bacterial isolates from 1142 patients with PBM were obtained. The three leading pathogens causing PBM were Staphylococcus epidermidis (16.5%), Escherichia coli (12.4%) and Streptococcus pneumoniae (10.6%). In infants under 3 months of age, the top 3 pathogens were Escherichia coli (116/523; 22.2%), Enterococcus faecium (75/523; 14.3%), and Staphylococcus epidermidis (57/523; 10.9%). However, in children more than 3 months of age, the top 3 pathogens were Staphylococcus epidermidis (140/670; 20.9%), Streptococcus pneumoniae (117/670; 17.5%), and Staphylococcus hominis (57/670; 8.5%). More than 93.0% of Escherichia 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 isolates (MRCoNS) 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 Escherichia coli fluctuated between 44.4% and 49.2%, and the detection rate of ESBL production in Klebsiella pneumoniae ranged from 55.6% to 88.9%. The resistance of Escherichia coli strains to carbapenems was 5.0%, but the overall prevalence of carbapenem-resistant Klebsiella pneumoniae (CRKP) was high (54.5%).Conclusions: Staphylococcus epidermidis, Escherichia coli and Streptococcus pneumoniae were the predominant pathogens causing PBM in Chinese patients. The distribution of PBM causative organisms varied by age. The resistance of CoNS to methicillin and the high incidence of ESBL production among Escherichia coli and Klebsiella pneumoniae isolates were concerning. CRKP poses a critical challenge for the treatment of PBM.