ABSTRACT
Objective:
To study the distribution and
antibiotics resistance of the main pathogens of neonatal purulent
meningitis in different regions of
China.
Methods:
A retrospective descriptive clinical
epidemiological study was conducted in
children with neonatal purulent
meningitis which admitted to 18
tertiary hospitals in different regions of
China between January 2015 to December 2019. The test results of
blood and
cerebrospinal fluid, and
drug sensitivity test results of the main pathogens were collected. The distributions of pathogenic
bacteria in
children with neonatal purulent
meningitis in preterm and term
infants, early and late onset
infants, in Zhejiang Province and other regions outside Zhejiang Province, and in Wenzhou region and other regions of Zhejiang Province were analyzed. The
chi-square test was used for
statistical analysis.
Results:
A total of 210 neonatal purulent
meningitis cases were collected. The common pathogens were
Escherichia coli ( E. coli)(41.4%(87/210)) and
Streptococcus agalactiae ( S. agalactiae)(27.1%(57/210)). The proportion of
Gram-negative bacteria in
preterm infants (77.6%(45/58)) with neonatal purulent
meningitis was higher than that in term
infants (47.4%(72/152)), and the difference was statistically significant ( χ2=15.54, P=0.001). There were no significant differences in the constituent ratios of E. coli (36.5%(31/85) vs 44.8%(56/125)) and S. agalactiae (24.7%(21/85) vs 28.8%(36/125)) between early onset and late onset cases (both P>0.05). The most common pathogen was E. coli in different regions, with 46.7%(64/137) in Zhejiang Province and 31.5%(23/73) in other regions outside Zhejiang Province. In Zhejiang Province, S. agalactiae was detected in 49 out of 137 cases (35.8%), which was significantly higher than other regions outside Zhejiang Province (11.0%(8/73)). The proportions of
Klebsiella pneumoniae, and
coagulase-negative
Staphylococcus in other regions outside Zhejiang Province (17.8%(13/73) and 16.4%(12/73)) were both higher than those in Zhejiang Province (2.9%(4/137) and 5.1%(7/137)). The differences were all statistically significant ( χ2=14.82, 12.26 and 7.43, respectively, all P<0.05). The proportion of
Gram-positive bacteria in Wenzhou City (60.8%(31/51)) was higher than that in other regions in Zhejiang Province (38.4%(33/86)), and the difference was statistically significant ( χ2=6.46, P=0.011). E. coli was sensitive to
meropenem (0/45), and 74.4%(32/43) of them were resistant to
ampicillin. E. coli had different degrees of resistance to other common
cephalosporins, among which,
cefotaxime had the highest resistance rate of 41.8%(23/55), followed by
ceftriaxone (32.4%(23/71)). S. agalactiae was sensitive to
penicillin,
vancomycin and
linezolid.
Conclusions:
The composition ratios of pathogenic
bacteria of neonatal purulent
meningitis are different in different regions of
China. The most common pathogen is E. coli, which is sensitive to
meropenem, while it has different degrees of resistance to other common
cephalosporins, especially to
cefotaxime.