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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  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 S taphylococcus 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.

antimicrobial resistance and infection control

Prevalence and antimicrobial resistance patterns of bacteria isolated from cerebrospinal fluid among children with bacterial meningitis in China from 2016 to 2018: a multicenter retrospective study