Journal Article

Clinical features, epidemiology, treatment, and prognosis of multicentre pediatric pneumococcal meningitis in China from 2019 to 2021

Tan, Kun, Liu, Gang, Ning, Xue, Bi, Jing, Chen, Biquan, Ye, Lan, Lu, Xuedong, Wang, Yumin, Zhu, Cunhui, Wang, Huaping, Wang, Lixue, Huang, Caizhi, Jian, Binglin, Jia, Li, Zhang, Bo, Deng, Jikui, Shan, Mingfeng, Li, Jian, Li, Wenhui, Liu, Shihua, Zhou, Yan, Zhao, Qing, Jing, Shujun, Shen, Guowu, Liu, Jing, Dong, Fang, Li, Zhi, Li, Lianmei, Li, Juan, Wang, Fang, Liang, Jun, Wang, Yi, Yang, Yonghong, Yao, Kaihu, Zhao, Shiyong, Jiang, Tingting, Zhou, Kai, Zhu, Liang, Zhang, Xiaojia, Sun, Jing, Deng, Huiling, Cai, Huijun

2025

Overview

Objective Pneumococcal meningitis (PM) causes significant illness and death in children worldwide, especially in high-burden countries. This multicenter study aimed to examine the epidemiology, clinical symptoms, prognosis, strain serotyping, antibiotic resistance, and outcome-related factors in children with PM. Methods A prospective surveillance study on children under 18 years old with laboratory-confirmed invasive pneumococcal disease (IPD) was conducted at 19 hospitals, mainly in tertiary pediatric hospitals, from 2019 to 2021. This period was early in the post-PCV13 era in China, when the vaccine had been licensed but coverage was still limited. Given the high morbidity associated with PM, we collected data on children diagnosed with PM between January 1, 2019, and December 31, 2021. We thoroughly analyzed their demographics, epidemiology, vaccination status, clinical characteristics, laboratory results, treatment, and prognosis. Results A total of 157 children participated in this study, with a median age of 30.4 (9.7, 53.7) months. Only three children had received the vaccination before admission. The most common season of onset was winter (37.6%), with a bimodal peak of incidence occurring in January and April. Overall, 61 children (38.9%) had a poor prognosis at discharge, and 30 children (19.1%) died during the disease course or follow-up. Among the 157 patients, serotyping was successfully performed in 118 (75.2%) cases, identifying 25 distinct serotypes. Among the 118 serotyped isolates, the most dominant serotypes were 19F (26.3%), followed by 23F (12.7%) and 6B (11.9%). All strains were sensitive to vancomycin (100.0%) and levofloxacin (100.0%), followed by ceftriaxone (61.9%). Interestingly, serotype 19F was more likely to be resistant to penicillin, ceftriaxone, and trimethoprim-sulfamethoxazole compared with other serotypes, while serotypes 14 and 15A were more sensitive to trimethoprim-sulfamethoxazole than other serotypes. In addition, among the 118 serotyped isolates, 112 (94.9%) were classified as multidrug-resistant (MDR). Among these MDR isolates, 51.7% exhibited combined resistance to β-lactams, macrolides, clindamycin, tetracyclines, and trimethoprim-sulfamethoxazole. Conclusions Children with PM had a poor prognosis and a high mortality rate. Most children with PM were not vaccinated before admission. Nearly three-quarters of isolates were included in PCV13. Pneumococcal vaccination may still be effective in preventing PM. Clinical trial number Not applicable.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adolescent / Anti-Bacterial Agents - pharmacology / Anti-Bacterial Agents - therapeutic use / Antibacterial agents / Antibiotic resistance / Antibiotics / Bacterial meningitis / Blood / Care and treatment / Ceftriaxone / Child / Child, Preschool / Children / Children's hospitals / Children's pneumococcal meningitis / China / China - epidemiology / Clindamycin / Demographic aspects / Demographics / Diagnostic tests / Dosage and administration / Drug resistance in microorganisms / Dyspnea / Epidemiology / Fatalities / Female / Health services / Hospitals / Humans / Incidence / Infant / Infectious disease and antibiotic resistance epidemiology / Infectious Diseases / Internal Medicine / Levofloxacin / Male / Medical Microbiology / Medicine / Medicine & Public Health / Meningitis / Meningitis, Pneumococcal - diagnosis / Meningitis, Pneumococcal - drug therapy / Meningitis, Pneumococcal - epidemiology / Meningitis, Pneumococcal - microbiology / Morbidity / Mortality / Multidrug resistance / Parasitology / Pediatrics / Penicillin / Prevention / Prognosis / Prospective Studies / Proteins / Risk factors / Serogroup / Serotype / Serotypes / Serotyping / Software / Streptococcus infections / Streptococcus pneumoniae - classification / Streptococcus pneumoniae - drug effects / Streptococcus pneumoniae - isolation & purification / Sulfamethoxazole / Tetracycline / Tetracyclines / Trimethoprim / Trimethoprim-sulfamethoxazole / Tropical Medicine / Vaccination / Vaccines / Vancomycin / β-Lactam antibiotics