Prevalence, Clinical Severity, and Antimicrobial Susceptibility Profiles of Neisseria meningitidis Isolates from a Pediatric Population

Abstract

Invasive meningococcal disease (IMD) remains a significant cause of pediatric morbidity and mortality, particularly in resource-limited settings. Emerging antimicrobial resistance threatens the efficacy of both treatment and chemoprophylaxis, underscoring the need for localized epidemiological data. This retrospective study investigated the epidemiology, clinical severity, and antimicrobial susceptibility profiles of Neisseria meningitidis isolates from pediatric patients (0–5 years) with invasive meningococcal disease (IMD) at a tertiary care hospital in Pakistan from August 2023 to July 2025. Among 68 confirmed cases, meningitis (55.9%) and meningococcemia (35.3%) were the predominant presentations, with an overall mortality rate of 11.8%. Antimicrobial susceptibility testing revealed concerning resistance patterns: 25.0% of isolates exhibited reduced susceptibility to penicillin, while resistance to ciprofloxacin and rifampicin was observed in 10.3% and 8.8% of isolates, respectively. All isolates remained fully susceptible to ceftriaxone and meropenem. Multidrug-resistant (MDR) and extensively drug-resistant (XDR) phenotypes were identified in 13.2% and 2.9% of isolates, respectively. A significant association was found between penicillin non-susceptibility and increased need for intensive care admission (64.7% vs. 35.3%, p=0.042). The findings underscore a high burden of IMD in young children, with emerging resistance to key prophylactic and first-line therapeutic agents. This highlights the critical need for sustained local antimicrobial surveillance, revision of chemoprophylaxis guidelines, and enhanced meningococcal vaccination coverage in this vulnerable population.