Xiaoshan Peng1, Qingxiong Zhu2, Jing Liu3, Mei Zeng4, Yue Qiu4, Chunhui Zhu2, Yibing Cheng5, Yibo Zhou6, Yi Xu7, Minxia Chen7, Zhengwang Wen8, Yiping Chen8, Rui Li9, Jianning Tong9, Qingwen Shan10, Daojiong Lin11, Shouye Wu11, Zhiqiang Zhuo12, Caihong Wang12, Shiyong Zhao13, Zhenghong Qi13, Xiaofeng Sun14, Bieerding Maihebuba14, Chunmei Jia15, Huiling Gao16, Shuangjie Li17, Yu Zhu18, Chaomin Wan19. 1. Department of Pediatrics, West China Second Hospital, Sichuan University and Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, No 20, 3rd Section of Renmin South Road, Chengdu, 610041, People's Republic of China. 2. Department of Infectious Diseases, Children's Hospital of Jiangxi Province, Nanchang, People's Republic of China. 3. Department of Infectious Diseases, Hunan Children's Hospital, Changsha, People's Republic of China. 4. Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai, People's Republic of China. 5. Department of Emergency, Children's Hospital Affiliated to Zhengzhou University (Henan Children's Hospital), Zhengzhou, People's Republic of China. 6. Department of General Pediatrics, Children's Hospital Affiliated to Zhengzhou University (Henan Children's Hospital), Zhengzhou, People's Republic of China. 7. Department of Infectious Diseases, Guangzhou Women and Children's Medical Center, Guangzhou, People's Republic of China. 8. Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China. 9. Department of Pediatrics, Gastroenterology and Infectious Diseases, Qingdao Women and Children's Hospital, Qingdao, People's Republic of China. 10. Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China. 11. Department of Infectious Diseases, Hainan Women and Children's Medical Center, Haikou, People's Republic of China. 12. Department of Infectious Diseases, Xiamen Children's Hospital, Xiamen, People's Republic of China. 13. Department of Infectious Diseases, Hangzhou Children's Hospital, Hangzhou, People's Republic of China. 14. Department of Infectious Diseases, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, People's Republic of China. 15. Department of Pediatrics, The Fourth Hospital of Baotou, Baotou, People's Republic of China. 16. Department of Pharmacy, The Fourth Hospital of Baotou, Baotou, People's Republic of China. 17. Department of Hepatology, Hunan Children's Hospital, No 86 Ziyuan Road, Changsha, 410000, People's Republic of China. 2273858951@qq.com. 18. Department of Pediatrics, West China Second Hospital, Sichuan University and Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, No 20, 3rd Section of Renmin South Road, Chengdu, 610041, People's Republic of China. zhuyu_wj@163.com. 19. Department of Pediatrics, West China Second Hospital, Sichuan University and Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, No 20, 3rd Section of Renmin South Road, Chengdu, 610041, People's Republic of China. wcm0220@126.com.
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 E. coli (116/523; 22.2%), Enterococcus faecium (75/523; 14.3%), and S. epidermidis (57/523; 10.9%). However, in children more than 3 months of age, the top 3 pathogens were S. epidermidis (140/670; 20.9%), S. pneumoniae (117/670; 17.5%), and Staphylococcus hominis (57/670; 8.5%). More than 93.0% of E. 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 S. pneumoniae isolates increased from 75.0 to 87.5%. The proportion of extended-spectrum β-lactamase (ESBL)-producing E. 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 E. coli strains to carbapenems was 5.0%, but the overall prevalence of carbapenem-resistant K. pneumoniae (CRKP) was high (54.5%). CONCLUSIONS: S. epidermidis, E. coli and S. 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 E. coli and K. pneumoniae isolates were concerning. CRKP poses a critical challenge for the treatment of PBM.
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 E. coli (116/523; 22.2%), Enterococcus faecium (75/523; 14.3%), and S. epidermidis (57/523; 10.9%). However, in children more than 3 months of age, the top 3 pathogens were S. epidermidis (140/670; 20.9%), S. pneumoniae (117/670; 17.5%), and Staphylococcus hominis (57/670; 8.5%). More than 93.0% of E. 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 S. pneumoniae isolates increased from 75.0 to 87.5%. The proportion of extended-spectrum β-lactamase (ESBL)-producing E. 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 E. coli strains to carbapenems was 5.0%, but the overall prevalence of carbapenem-resistant K. pneumoniae (CRKP) was high (54.5%). CONCLUSIONS:S. epidermidis, E. coli and S. 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 E. coli and K. pneumoniae isolates were concerning. CRKP poses a critical challenge for the treatment of PBM.