Epidemiologic study of paediatric bacterial meningitis in Greece (1998–2006)

Abstract number: 1733_713

Lebessi E., Papadimitriou M., Paleologou N., Kallergi K., Niniou I., Malliou K., Antonaki G., Ioannidou S., Foustoukou M.

Objectives: To study the epidemiologic data of bacterial meningitis in children treated in ``P. & A. Kyriakou'' Children's Hospital, one of the two major paediatric hospitals in Greece, during a nine-year period (1998–2006).

Methods: The laboratory archives were retrospectively reviewed. Positive CSF cultures of children hospitalised with diagnosis of meningitis were recorded. Children with history of neurosurgical procedures were excluded from the study. Cultures were performed in blood, chocolate, Levinthal agar and BHI broth and strains were identified by standard methods. Susceptibility to antimicrobial agents was tested according to the CLSI guidelines and MICs of penicillin and cefotaxime for Neisseria meningitidis and Streptococcus pneumoniae were determined by E-test.

Results: Overall, 104 strains were isolated from CSF cultures received from 104 patients (males, 63 and females, 41) aged from 3 days to 14 years (median age; 1.33 y). The most frequent pathogens were N. meningitidis (n = 61, 58.6%) and S. pneumoniae (n = 21, 20.2%), followed by Escherichia coli (n = 8, 7.7%), Streptococcus agalactiae (n = 5, 4.8%), Haemophilus influenzae (n = 4, 3.8%), Streptococcus pyogenes (n = 2, 1.9%), Enterobacter cloacae (n = 1, 0.9%), Bacillus cereus (n = 1, 0.9%) and Candida albicans (n = 1, 0.9%). Gram negative rods and S. agalactiae are the most frequent isolates in neonates. About two thirds of cases occurred in infants and children younger than 5 years. There were not significant changes in the annual distribution of cases due to N. meningitidis, although the widespread vaccination. Of the meningococcal strains, 78.7% were typed as serogroup B, 18.1% serogroup C, 1.6% A, and 1.6% W135. Two H. influenzae isolates were type a and two type b. About one quarter of N. meningitidis and 11% of S. pneumoniae isolates showed moderate resistance to penicillin (≥0.094–1 mg/L). High-level resistance to penicillin and other antibiotics was not detected. H. influenzae isolates were found to be susceptible to all antibiotics tested. Results from 2006 will be completed at the end of this year.

Conclusion:N. meningitidis is the most frequent pathogen in bacterial meningitis in infants and children; serogroup B is far more common than serogroup C. S. pneumoniae and H. influenzae strains remain susceptible to currently used antibiotics. However, N. meningitidis strains with reduced susceptibility to penicillin accounted for 25% of isolates, warranting continued monitoring of this problem.