Objective To analyze the etiological characteristics of pediatric bacterial meningitis (BM) and change of biochemical indicators in cerebrospinal fluid, and establish a diagnostic model for pathogen differentiation based on biochemical indicators in cerebrospinal fluid.

Methods Eighty children with BM in the Children′s Hospital Affiliated to Zhengzhou University from May 2021 to May 2023 were selected as BM group, and their pathogen distribution as well as cytological and biochemical indicators in cerebrospinal fluid were analyzed. Forty non-central nervous system infections children with cytological and biochemical testing in cerebrospinal fluid in the same period were included as control group. The relationships between indicators in cerebrospinal fluid and pathogen types in BM children were analyzed, and a diagnostic model was constructed.

Results A total of 85 pathogens were detected in 80 BM children, including 48 Gram-negative bacteria (56.47%) and 37 Gram-positive bacteria (43.53%). The BM group showed significantly higher white blood cell count and lymphocyte percentages, lower neutrophil and monocyte percentages, lower glucose and chloride levels in cerebrospinal fluid, and higher protein levels in cerebrospinal fluid when compared to the control group (P < 0.05). Among BM children, those infected with Gram-negative bacteria had significantly higher white blood cell count and lymphocyte percentages, as well as lower glucose and chloride levels in cerebrospinal fluid when compared to those with Gram-positive bacterial infections (P < 0.05). Multivariate Logistic analysis revealed that white blood cell count, lymphocyte percentage, glucose, and chloride levels in cerebrospinal fluid were significantly associated with pathogen types (P < 0.05). A diagnostic model based on these factors demonstrated an area under the receiver operating characteristic (ROC) curve of 0.925 for distinguishing Gram-positive and Gram-negative infections, with a cutoff value of 0.754, asensitivity of 76.25%, and aspecificity of 98.33%.

Conclusion The primary pathogens of pediatric BM include Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, coagulase-negative Staphylococcus, Staphylococcus aureus, and Streptococcus pneumonia, accompanied by elevated white blood cell count and lymphocyte percentages as well as reduced glucose and chloride levels in cerebrospinal fluid, which is helpful in differentiating Gram-positive from Gram-negative infections and guiding antibiotic therapy.