The etiology and resistance pattern of ABM is age dependent. Unlike the western world, Group B Streptococcus and Listeria are not reported as common causes of neonatal meningitis in India. A significant proportion of late onset neonatal meningitis can also be due to nosocomial pathogens including MRSA and Candida.

H. Influenzae and meningococcus are uniformly susceptible to the 3rd generation cephalopsorins. There is a rising incidence of resistance in S. pneumoniae to penicillins and 3rd generation cephalosporins. In a study from Vellore, India 167 CSF pneumococcal isolates were evaluated from 2008-2016. The penicillin non susceptibility increased from 9.5% in 2008 to 42.8% in 2016 and cephalosporin resistance increased from 4.7% in 2008 to 28.5% in 2016. Overall resistant rates were 43.7% for penicillin and 14.9% for cephalosporins. Of the 25 isolates that were resistant to cephalosporins, 8 were fully resistant (MIC > 2) and 17 were intermediately resistant (MIC 1)