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Assessing bacterial prevalence and resistance in paediatric meningitis: safeguarding the central nervous system
Sania Bhatti1, Bipin Chaurasia2,3, Eesha Yaqoob3,4
1Department of Neurosurgery, Holy Family Hospital, Rawalpindi Medical University, Rawalpindi.
Insights
Paediatric bacterial meningitis (PBM) in Pakistan is driven by evolving pathogens and high antimicrobial resistance (AMR). This study identifies key bacteria and their resistance patterns to guide targeted antibiotic treatment for children.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Public Health
Background:
- Paediatric bacterial meningitis (PBM) causes significant global childhood morbidity and mortality.
- Low- and middle-income countries, like Pakistan, face high rates of antimicrobial resistance (AMR), complicating PBM treatment.
- Antibiotic overuse in Pakistan exacerbates AMR, necessitating updated epidemiological data for effective PBM management.
Purpose of the Study:
- To determine recent bacterial etiologies of PBM in Pakistan.
- To characterize antimicrobial resistance (AMR) profiles of PBM pathogens in the region.
- To inform empirical antibiotic therapy for paediatric bacterial meningitis in Pakistan.
Main Methods:
- Prospective observational study of PBM cases in patients under 18.
- Cerebrospinal fluid analysis to identify bacterial pathogens.
- Antibiotic susceptibility testing to determine resistance patterns.
Main Results:
- 152 out of 171 PBM cases yielded bacterial isolates.
- Common pathogens varied by age: *Escherichia coli* and *Staphylococcus epidermidis* were prevalent in infants, while *Staphylococcus epidermidis* and *Streptococcus pneumoniae* predominated in older children.
- Staphylococcal isolates showed high resistance to penicillin and erythromycin but remained susceptible to vancomycin and linezolid.
Conclusions:
- Paediatric AMR is a critical issue in Pakistan, demanding robust surveillance and prudent antibiotic use.
- This study provides crucial, up-to-date epidemiological data on PBM pathogens and AMR.
- Findings will aid in developing context-specific empirical treatment guidelines for paediatric bacterial meningitis in Pakistan.
Introduction:
Paediatric bacterial meningitis (PBM) represents a major contributor to childhood morbidity and mortality globally, with heightened susceptibility in low- and middle-income nations where antimicrobial resistance (AMR) is highly prevalent. Pakistan exemplifies this setting, with widespread antibiotic overuse driving AMR expansion. Thus, expediting PBM diagnosis and targeted antibiotic therapy is imperative yet challenged by the dynamic local epidemiology. This study aimed to delineate the recent bacterial etiologies and AMR profiles of PBM from a major Pakistani diagnostics laboratory to inform empirical treatment.
Materials And Methods:
This prospective observational investigation evaluated PBM epidemiology in patients under 18 years old admitted to the study hospital. Standard cerebrospinal fluid analysis identified bacterial pathogens and antibiotic susceptibility patterns.
Results:
Among 171 PBM cases, 152 (88.9%) had bacterial isolates confirmed via culture. The cohort was 42.7% male with a mean age of 3 months. The most prevalent pathogens among infants younger than 3 months were Escherichia coli, Enterococcus faecium, and Staphylococcus epidermidis, contrasting with S. epidermidis, Streptococcus pneumoniae, and Staphylococcus hominis predominating in older children. Staphylococcal isolates exhibited considerable penicillin and erythromycin resistance but maintained vancomycin and linezolid susceptibility. Other resistance patterns varied.
Conclusion:
These findings highlight the pressing threat of paediatric AMR in Pakistan, underscoring the need for vigilant AMR surveillance and judicious antimicrobial use. This study provides a reference to current PBM epidemiology to guide context-specific empirical therapy.
