Bacterial spectrum and antimicrobial resistance of cerebrospinal fluid pathogens in pediatric bacterial meningitis: a 7-year study in Southwest China with emphasis on post-neurosurgical cases.

BackgroundThe etiological profile and antimicrobial resistance (AMR) patterns of pediatric bacterial meningitis (PBM) are region-specific and dynamic. With limited data from Southwest China, this 7-year study aimed to characterize the pathogens and their AMR profiles to guide empirical therapy and infection control strategies.MethodsWe retrospectively analyzed children diagnosed with PBM who had positive cerebrospinal fluid (CSF) cultures at Kunming Children's hospital from September 2018 to September 2025. Clinical characteristics, laboratory findings, pathogen distribution, and antibiotic susceptibility were assessed. Risk factors for refractory meningitis and ICU admission were analyzed.ResultsA total of 258 children (58.1% male; median age 17.0 months) were included. Gram-negative bacteria (GNB) accounted for 26.7% of cases. A significant portion (43.0%) had prior neurosurgery. Overall, 281 non-duplicate pathogens were isolated, with Gram-positive bacteria predominating (203/281, 72.2%) and Gram-negative accounting for the remaining 78 (27.8%). Overall, the three most common pathogens were coagulase-negative Staphylococci (CoNS) (37.0%, 104/281), Streptococcus pneumoniae (S. pneumoniae) (16.7%, 47/281), and Escherichia coli (E. coli) (12.5%, 35/281). Notably, pathogen distribution varied significantly with age: E. coli was predominant in infants (