Changes in Multidrug-resistant Escherichia Coli of Neonatal Meningitis During 2001–2019: a Study in Eastern China

Abstract Background and objective: Neonatal meningitis (NM) caused by Escherichia coli remains a major health problem in industrialized countries. The purpose of this study was to investigate changes in antimicrobial resistance of E. coli causing neonatal meningitis in a perinatal center in eastern China over the past 19 years.Methods: This survey was investigated during three periods: 2001–2006, 2007–2012, and 2013–2019. NM is diagnosed according to the number of white blood cells in the cerebrospinal fluid and the presence of a single potential pathogenic bacterium in culture extracted from blood or cerebrospinal fluid of any newborn baby. Changes in the antimicrobial resistance of E. coli were analyzed.Results: A total of 209 cases of NM were identified. E. coli was identified from 69 cases, of which extended-spectrum beta-lactamase (ESBL) production was found in 21 cases. E. coli was the main cause of neonatal meningitis in this study. The overall resistance rate of E. coli to third-generation cephalosporins such as cefotaxime increased from 0% in 2001–2006 to 50% in 2007–2012 and subsequently decreased to 29.0% in 2013–2019. This pattern of change is similar to that of ESBL production. Only 15.0% E. coli found in samples from infants with early-onset meningitis (EOM) produced ESBL, while 40.0% of E. coli from children with late-onset meningitis (LOM) produced ESBL. Conclusion: We concluded that E. coli remains the primary pathogen of NM. Compared to LOM, the percentage of ESBL-producing multi-drug resistant E. coli isolated from EOM is significantly decreased. Clinicians should consider this trend when choosing appropriate and effective antibiotics as empirical treatments for NM.