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Chaomin Wan
Sichuan University West China Second University Hospital
Corresponding Author
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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.
Keywords
Bacterial meningitis, pediatric, bacterial pathogens, antimicrobial resistance
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This is a list of supplementary files associated with this preprint. Click to download.
- Additionalfile1.jpg
Additional file 1: Figure S1 Distribution of major PBM pathogens according to clinical wards in China, 2016-2018 PBM: pediatric bacterial meningitis; Sep, Staphylococcus epidermidis; Eco, Escherichia coli; Spn, Streptococcus pneumoniae; Efa, Enterococcus faecium; Sho, Staphylococcus hominis; GBS, group B Streptococcus; Sha, Staphylococcus haemolyticus; Kpn, Klebsiella pneumoniae; SA, Staphylococcus aureus
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CURRENT STATUS: Published
View the published article at Antimicrobial Resistance & Infection Control.
Version 3
Posted 08 Jan, 2021
No community comments so far
Editorial decision: Accept
On 17 Jan, 2021
Editor assigned
On 21 Dec, 2020
Submission checks complete
On 21 Dec, 2020
Editor invited
On 21 Dec, 2020
No comments provided
Editorial decision: Major revision
On 06 Dec, 2020
Editor assigned
On 03 Nov, 2020
Submission checks complete
On 03 Nov, 2020
Editor invited
On 03 Nov, 2020
No comments provided
Editorial decision: Major revision
On 27 Sep, 2020
Review #2 received
Received 15 Sep, 2020
Reviewer #2 agreed
On 01 Sep, 2020
Review #1 received
Received 22 Jul, 2020
Reviewer #1 agreed
On 09 Jul, 2020
Reviewers invited
Invitations sent on 24 Jun, 2020
Editor assigned
On 20 May, 2020
Submission checks complete
On 19 May, 2020
Editor invited
On 19 May, 2020
First submitted
On 15 May, 2020
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See the published version of this preprint at Antimicrobial Resistance & Infection Control.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Chaomin Wan
Sichuan University West China Second University Hospital
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at Antimicrobial Resistance & Infection Control.
Version 3
Posted 08 Jan, 2021
No community comments so far
Editorial decision: Accept
On 17 Jan, 2021
Editor assigned
On 21 Dec, 2020
Submission checks complete
On 21 Dec, 2020
Editor invited
On 21 Dec, 2020
No comments provided
Editorial decision: Major revision
On 06 Dec, 2020
Editor assigned
On 03 Nov, 2020
Submission checks complete
On 03 Nov, 2020
Editor invited
On 03 Nov, 2020
No comments provided
Editorial decision: Major revision
On 27 Sep, 2020
Review #2 received
Received 15 Sep, 2020
Reviewer #2 agreed
On 01 Sep, 2020
Review #1 received
Received 22 Jul, 2020
Reviewer #1 agreed
On 09 Jul, 2020
Reviewers invited
Invitations sent on 24 Jun, 2020
Editor assigned
On 20 May, 2020
Submission checks complete
On 19 May, 2020
Editor invited
On 19 May, 2020
First submitted
On 15 May, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at Antimicrobial Resistance & Infection Control.
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.
Figure 1
Figure 2
Figure 3
This is a list of supplementary files associated with this preprint. Click to download.
- Additionalfile1.jpg
Additional file 1: Figure S1 Distribution of major PBM pathogens according to clinical wards in China, 2016-2018 PBM: pediatric bacterial meningitis; Sep, Staphylococcus epidermidis; Eco, Escherichia coli; Spn, Streptococcus pneumoniae; Efa, Enterococcus faecium; Sho, Staphylococcus hominis; GBS, group B Streptococcus; Sha, Staphylococcus haemolyticus; Kpn, Klebsiella pneumoniae; SA, Staphylococcus aureus
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