Frontiers in cellular and infection microbiology · 2026
Bacterial spectrum and antimicrobial resistance of cerebrospinal fluid pathogens in pediatric bacterial meningitis: a 7-year study in Southwest China with emphasis on post-neurosurgical cases.
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Wang Yanjun, Dong Fangling, Li Cuifen, Lv Qiyan, Wu Xiong, Kong Zhuo, Liu Honglin
Аннотация
BACKGROUND: The etiological profile and antimicrobial resistance (AMR) patterns of pediatric bacterial meningitis (PBM) are region-specific and dynamic. With limited data from Southwest China, this 7-year study aimed to characterize the pathogens and their AMR profiles to guide empirical therapy and infection control strategies.
METHODS: We retrospectively analyzed children diagnosed with PBM who had positive cerebrospinal fluid (CSF) cultures at Kunming Children's hospital from September 2018 to September 2025. Clinical characteristics, laboratory findings, pathogen distribution, and antibiotic susceptibility were assessed. Risk factors for refractory meningitis and ICU admission were analyzed.
RESULTS: A total of 258 children (58.1% male; median age 17.0 months) were included. Gram-negative bacteria (GNB) accounted for 26.7% of cases. A significant portion (43.0%) had prior neurosurgery. Overall, 281 non-duplicate pathogens were isolated, with Gram-positive bacteria predominating (203/281, 72.2%) and Gram-negative accounting for the remaining 78 (27.8%). Overall, the three most common pathogens were coagulase-negative Staphylococci (CoNS) (37.0%, 104/281), Streptococcus pneumoniae (S. pneumoniae) (16.7%, 47/281), and Escherichia coli (E. coli) (12.5%, 35/281). Notably, pathogen distribution varied significantly with age: E. coli was predominant in infants (<12 months), while S. pneumoniae was more common in preschool children. Antimicrobial resistance was highly prevalent: The methicillin-resistant rate in CoNS was alarmingly high at 88.2%. Among GNB, fluoroquinolone resistance was the most dominant phenotype, detected in 74.3% of E. coli isolates. The detection rate of ESBL-producing E. coli fluctuated widely (0%-83.3%) during the study period. Difficult-to-treat resistance was less common, observed in 5.7% (2/35) of E. coli isolates. Complications including hydrocephalus (26.4%) and subdural effusion (24.4%) were frequent.
CONCLUSION: In this cohort with a high proportion of post-neurosurgical cases (43.0%), CoNS was the most common pathogen (37.0%), with a methicillin resistance rate of 88.2%. Continuous and dynamic monitoring of the epidemic trends of pathogens and the resistance rates of antibacterial drugs is of vital importance for the treatment of PBM.
METHODS: We retrospectively analyzed children diagnosed with PBM who had positive cerebrospinal fluid (CSF) cultures at Kunming Children's hospital from September 2018 to September 2025. Clinical characteristics, laboratory findings, pathogen distribution, and antibiotic susceptibility were assessed. Risk factors for refractory meningitis and ICU admission were analyzed.
RESULTS: A total of 258 children (58.1% male; median age 17.0 months) were included. Gram-negative bacteria (GNB) accounted for 26.7% of cases. A significant portion (43.0%) had prior neurosurgery. Overall, 281 non-duplicate pathogens were isolated, with Gram-positive bacteria predominating (203/281, 72.2%) and Gram-negative accounting for the remaining 78 (27.8%). Overall, the three most common pathogens were coagulase-negative Staphylococci (CoNS) (37.0%, 104/281), Streptococcus pneumoniae (S. pneumoniae) (16.7%, 47/281), and Escherichia coli (E. coli) (12.5%, 35/281). Notably, pathogen distribution varied significantly with age: E. coli was predominant in infants (<12 months), while S. pneumoniae was more common in preschool children. Antimicrobial resistance was highly prevalent: The methicillin-resistant rate in CoNS was alarmingly high at 88.2%. Among GNB, fluoroquinolone resistance was the most dominant phenotype, detected in 74.3% of E. coli isolates. The detection rate of ESBL-producing E. coli fluctuated widely (0%-83.3%) during the study period. Difficult-to-treat resistance was less common, observed in 5.7% (2/35) of E. coli isolates. Complications including hydrocephalus (26.4%) and subdural effusion (24.4%) were frequent.
CONCLUSION: In this cohort with a high proportion of post-neurosurgical cases (43.0%), CoNS was the most common pathogen (37.0%), with a methicillin resistance rate of 88.2%. Continuous and dynamic monitoring of the epidemic trends of pathogens and the resistance rates of antibacterial drugs is of vital importance for the treatment of PBM.