The causes and outcomes of nosocomial meningitis by pathogens for which new antibiotics are urgently needed.

BACKGROUND

In 2017, WHO published a list of bacteria for which new antibiotics are urgently needed. The main bacteria are common causes of nosocomial meningitis. The key focuses are carbapenem resistance, vancomycin resistance, methicillin resistance, and extended-spectrum beta-lactamase (ESBL) production. There are a limited number of appropriate drugs to treat nosocomial meningitis due to resistance and permeability of drugs, we aimed to discuss the urgency by analyzing the causes and related outcomes of antimicrobial resistance in the pathogens.

METHODS

We collected 333 patients in whom 854 pathogens were isolated. Poor outcome was defined as a Glasgow Outcome Scale of 1-3. The adjusted analysis of risk factors for poor outcomes was performed using a generalized linear model.

RESULTS

The main pathogens were Enterobacteriaceae (n = 186, 21.8%), A. baumannii (n = 66, 7.7%), S. aureus (n = 38, 4.4%), E. faecium (n = 27, 3.2%), and P. aeruginosa (n = 16, 1.9%). Vancomycin resistance was found in 0% (0/38) of S. aureus and 22.2% (6/27) of E. faecium. Carbapenem resistance was found in 35.5% (16/186) of Enterobacteriaceae, 80.3% (53/66) of A. baumannii and 37.5% (6/16) of P. aeruginosa. ESBL production occurred in 54.8% (102/186) of Enterobacteriaceae and methicillin resistance occurred in 39.5% (15/38) of S. aureus. Additionally, 136 (40.8%) cases had poor outcomes. Vancomycin or carbapenem resistance (relative risk 1.98, 95% confidence interval [1.72-4.12], p < 0.001) and ESBL production or methicillin resistance (relative risk 1.60, 95% confidence interval [1.10-3.07], p = 0.020) were risk factors for poor outcomes.

CONCLUSION

In nosocomial meningitis, drug-resistant A. baumannii and Enterobacteriaceae were predominant, requiring urgent development of new antimicrobials for treatment.

CLINICAL TRIAL: Not applicable.