He Lu, Yu Muchun, Sun Zhihong, Zhao Congcong, Sun Huiqing
Department of Neonatology, Henan Children's Hospital Zhengzhou Children's Hospital, Zhengzhou, Henan Province, 450000, China.
Ital J Pediatr. 2025 Jul 2;51(1):206. doi: 10.1186/s13052-025-02032-5.
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.
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.
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%).
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.
新生儿化脓性脑膜炎是一种化脓性细菌感染，具有较高的发病率和死亡率。由于耐药性增加，传统抗生素的疗效越来越低。此外，致病细菌种类因地区而异，病原体也在不断演变。因此，本研究旨在比较和分析新生儿化脓性脑膜炎致病分布和耐药机制的动态变化，强调持续进行微生物监测和流行病学监测以指导抗菌药物管理和优化抗生素治疗策略的重要性，最终降低新生儿发病率和死亡率。
我们回顾性分析了2017年1月至2022年12月期间脑脊液培养呈阳性、被诊断为化脓性脑膜炎的新生儿。分析各年份之间的致病分布和耐药机制，并比较早产儿和足月儿之间的差异。
在224例脑脊液培养呈阳性的新生儿化脓性脑膜炎病例中，病例数最多的年份是2018年，最少的是2020年。新生儿的发病年龄存在差异，记录最高的是2017年，最低的是2021年。在病因分布中占显著比例的细菌种类有表皮葡萄球菌（17.4%）、肺炎克雷伯菌（17.（0%）、大肠埃希菌（15.2%）和粪肠球菌（8.0%）。其中，肺炎克雷伯菌在各年份的比例存在显著差异（P = 0.025）。关于耐药菌，耐碳青霉烯类肠杆菌科细菌（CRE）和耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）在各年份之间存在显著差异（分别为P = 0.016和P = 0.031）。耐药比例最高的是MRCNS（22.8%），其次是CRE（16.5%）。
2020年至2022年（在新冠疫情之后），新生儿化脓性脑膜炎的发病率逐年下降。粪肠球菌的发病率在疫情之前较高，而MRCNS的发病率在疫情之后有所上升。疫情之后没有耐甲氧西林金黄色葡萄球菌耐药菌。2019年之后，耐药菌的总体发病率逐年下降，疫情影响了病原体和耐药菌的分布。
