Assessing bacterial prevalence and resistance in paediatric meningitis: safeguarding the central nervous system

Abstract

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.

Keywords: LMIC; Pakistan; antimicrobial resistance; bacterial; meningitis; paediatric.

Figure 1

Percentage of organisms causing PBM. *Percentage Organisms causing bacterial meningitis in children. Eco, E-coli; Efa, Enterococcus faecium; GBS, Group B Streptococcus; Kpn, Klebsiella pneumonia; PBM, paediatric bacterial meningitis; SA, Staphylococcus aureus; Sha-, Staphylococcus haemolyticus; Sho, Staphylococcus hominis; Spn, Streptococus.