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Published on: October 29, 2014
Dynamic analysis of pathogenic distribution and drug resistance mechanism in neonatal suppurative meningitis: a
Lu He1, Muchun Yu1, Zhihong Sun1
1Department of Neonatology, Henan Children's Hospital Zhengzhou Children's Hospital, Zhengzhou, Henan Province, 450000, China.
Background:
Neonatal purulent meningitis is a purulent bacterial infection associated with high morbidity and mortality. Conventional antibiotics are becoming less effective due to increasing drug resistance. Moreover, there are variations in the disease-causing bacterial species according to regions, with the pathogens undergoing continuous evolution. Therefore, this study aimed to compare and analyze dynamic changes of pathogenic distribution and drug resistance mechanisms in neonatal suppurative meningitis, emphasize the importance of continuous microbiological surveillance and epidemiological monitoring to guide antimicrobial stewardship and optimize antibiotic treatment strategies, ultimately reducing neonatal morbidity and mortality.
Methods:
We retrospectively analyzed newborns diagnosed with suppurative meningitis having positive cerebrospinal fluid cultures between January 2017 and December 2022. Pathogenic distribution and drug resistance mechanisms were analyzed among the years and compared between preterm and full-term neonates.
Results:
Among the 224 cases of neonatal suppurative meningitis with positive cerebrospinal fluid cultures, the highest number of cases occurred in 2018 and the lowest in 2020. The age of onset in newborns exhibited variation, with the highest recorded in 2017 and the lowest in 2021. Bacterial species constituting significant proportions of the etiological distribution were Staphylococcus epidermidis (17.4%), Klebsiella pneumoniae (17.0%), Escherichia coli (15.2%), and Enterococcus faecium (8.0%). Among them, K. pneumoniae showed significant differences in proportion across the years (P = 0.025). Regarding drug-resistant bacteria, carbapenem-resistant Enterobacteriaceae (CRE) and methicillin-resistant coagulase-negative staphylococci (MRCNS) were significantly different between the years (P = 0.016 and P = 0.031, respectively). The highest proportion of drug resistance was observed in MRCNS (22.8%), followed by CRE (16.5%).
Conclusions:
The incidence of neonatal suppurative meningitis decreased annually from 2020 to 2022 (following the COVID-19 pandemic). The incidences of Enterococcus faecium was higher before the pandemic, whereas that of MRCNS increased after the epidemic. There were no methicillin-resistant Staphylococcus aureus resistant bacteria after the pandemic. After 2019, the overall incidence of drug-resistant bacteria decreased every year, and the pandemic affected the distribution of pathogens and drug-resistant bacteria.
Insights
Neonatal meningitis cases declined post-2020, with evolving pathogen distribution and drug resistance patterns. Continuous surveillance is crucial for effective antimicrobial stewardship and treatment strategies.
Area of Science:
- Neonatal infectious diseases
- Microbiology
- Epidemiology
Background:
- Neonatal purulent meningitis presents significant morbidity and mortality.
- Increasing antibiotic resistance necessitates updated treatment strategies.
- Pathogen distribution and resistance mechanisms evolve, requiring continuous monitoring.
Purpose of the Study:
- To analyze dynamic changes in pathogenic distribution and drug resistance in neonatal suppurative meningitis.
- To compare trends between preterm and full-term neonates.
- To inform antimicrobial stewardship and optimize antibiotic treatments.
Main Methods:
- Retrospective analysis of neonatal suppurative meningitis cases (2017-2022).
- Inclusion criteria: positive cerebrospinal fluid cultures.
- Analysis of pathogenic distribution and drug resistance mechanisms over time and by neonatal group.
Main Results:
- Significant bacterial pathogens included Staphylococcus epidermidis, Klebsiella pneumoniae, Escherichia coli, and Enterococcus faecium.
- Klebsiella pneumoniae proportion varied significantly across years (P=0.025).
- Carbapenem-resistant Enterobacteriaceae (CRE) and methicillin-resistant coagulase-negative staphylococci (MRCNS) showed significant yearly differences (P=0.016 and P=0.031). MRCNS (22.8%) and CRE (16.5%) were the most prevalent drug-resistant bacteria.
Conclusions:
- Neonatal suppurative meningitis incidence decreased annually from 2020-2022, post-COVID-19 pandemic.
- Enterococcus faecium incidence was higher pre-pandemic; MRCNS increased post-pandemic.
- The pandemic influenced pathogen and drug-resistant bacteria distribution, highlighting the need for ongoing surveillance.
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