Evolving etiology and resistance patterns in bacterial meningitis: A comparative study over two decades

Abstract

This study examines the evolution of bacterial meningitis etiology and antimicrobial resistance patterns over 20 years at a tertiary care centre in Aligarh, India. Comparing two periods (2001-2009 and 2015-2021), we identified a shift from gram-positive to gram-negative bacteria as the primary pathogens, with Staphylococcus aureus decreasing from 37.7% to 26.6% and Klebsiella pneumoniae increasing from 4.7% to 14.4%. Resistance trends show a significant decline in the effectiveness of antibiotics, particularly macrolides, fluoroquinolones, and cephalosporins. Aminoglycosides retained moderate efficacy, while carbapenem resistance increased from 0% to 56.3%, and Extended-Spectrum Beta-Lactamase (ESBL) production rose from 10% to 22.2%. The study highlights an urgent need for updated treatment protocols and enhanced surveillance to address the rising resistance and evolving pathogen landscape in bacterial meningitis.