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Age-Specific Antibiograms for Bacterial Meningitis Pathogens Based on Isolates Collected in a Community Laboratory
Alexsa J Zurowski1, Eugene Y H Yeung2,3,4
1Department of Neuroscience, Faculty of Science, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
Insights
Age-specific antibiograms are crucial for accurate antimicrobial resistance data in bacterial meningitis. Ceftriaxone remains effective for pneumococcal meningitis on Vancouver Island, but age impacts E. coli susceptibility.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Antimicrobial Stewardship
Background:
- Standard antibiograms may not accurately reflect pediatric antimicrobial resistance patterns.
- Current guidelines for bacterial meningitis treatment, particularly for *Streptococcus pneumoniae*, vary regarding monotherapy versus combination therapy.
- The need for age-specific resistance data is highlighted to guide regional treatment strategies.
Purpose of the Study:
- To create age-specific antibiograms for bacterial meningitis pathogens.
- To assess antimicrobial resistance patterns at a regional level using real-world data.
- To determine the necessity of combination antibiotic therapy for meningitis based on local resistance data.
Main Methods:
- Collected susceptibility data for common bacterial meningitis pathogens from LifeLabs on Vancouver Island.
- Data spanned from January 1, 2023, to December 31, 2024.
- Analyzed pathogen susceptibility across different age groups (<18, 18-50, >50 years).
Main Results:
- High susceptibility rates of *Streptococcus pneumoniae* to ceftriaxone (78/83 isolates) were observed using meningitis breakpoints.
- Significant differences in *S. pneumoniae* susceptibility were noted between penicillin-meningitis and non-meningitis breakpoints (82% vs. 99%, p < 0.05).
- Age-specific variations in ciprofloxacin susceptibility were significant for *E. coli* isolates across the three age groups (p < 0.05).
Conclusions:
- Ceftriaxone is recommended as the primary treatment for community-acquired bacterial meningitis and potentially as monotherapy for pneumococcal meningitis on Vancouver Island.
- Age-specific antibiograms are essential for understanding variations in pathogen susceptibility, particularly for *E. coli* and ciprofloxacin.
- The study underscores the importance of localized, age-stratified antimicrobial resistance data for effective treatment guidelines.
Background:
Creating antibiograms solely for adults may overestimate resistance of antimicrobials for certain pathogens in children. The Canadian Paediatric Society comments that areas with no cephalosporin-resistant Streptococcus pneumoniae cases should consider ceftriaxone or cefotaxime monotherapy for meningitis, despite most experts recommending adding vancomycin. The present study created age-specific antibiograms using LifeLabs data to report incidences of resistant bacterial meningitis pathogens at the regional level to determine the need for duo-coverage.
Methods:
Data of common bacterial meningitis pathogen susceptibility was collected from 1 January 2023 to 31 December 2024, in the LifeLabs community laboratory on Vancouver Island.
Results:
Most Streptococcus pneumoniae isolates (78/83) were susceptible to ceftriaxone using the meningitis breakpoint; the remaining five isolates showed intermediate susceptibility to ceftriaxone. There was a significant difference when comparing S. pneumoniae susceptibility using penicillin-meningitis and penicillin-non-meningitis breakpoints (82% vs. 99%, respectively; p < 0.05). There was a significant difference between the three age groups (<18 years, 18-50 years, >50 years) when analyzing ciprofloxacin susceptibility of isolates [82% (n = 462), 77% (n = 2452), 75% (n = 8352), respectively, p < 0.05].
Conclusions:
Ceftriaxone should remain the drug of choice for community-acquired bacterial meningitis and might be sufficient as a monotherapy for pneumococcal meningitis on Vancouver Island. The age-specific differences in E. coli susceptibilities to ciprofloxacin showed the importance of age-specific antibiograms.
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