Real-Time Monitoring of Multidrug-Resistant Pathogens in Neonatal Bacterial Meningitis: A Prospective Cohort Study

Background: Neonatal bacterial meningitis remains a critical cause of mortality and long-term neurological sequelae in newborns worldwide. The emergence of multidrug-resistant (MDR) pathogens has complicated treatment protocols and increased mortality rates significantly. Objective: To evaluate the effectiveness of real-time monitoring systems for detecting MDR pathogens in neonates with bacterial meningitis and to assess clinical outcomes associated with early pathogen identification. Methods: This prospective cohort study enrolled 428 neonates diagnosed with bacterial meningitis across eight tertiary care centers from January 2021 to December 2023. Real-time polymerase chain reaction (RT-PCR) and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) were employed for rapid pathogen identification and resistance profiling. Results: MDR pathogens were identified in 156 cases (36.4%). Real-time monitoring reduced time to appropriate antibiotic therapy from 72.4 hours to 18.6 hours (p