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Acta Paediatr. 2016 Jan;105(1):e22-9. doi: 10.1111/apa.13228. Epub 2015 Nov 16.

A 15-year retrospective analysis of prognostic factors in childhood bacterial meningitis.

Author information

1
Department of Paediatrics, KK Women's and Children's Hospital, Singapore City, Singapore.
2
Infectious Disease Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore City, Singapore.
3
Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore.
4
Duke-National University of Singapore Graduate Medical School, Singapore City, Singapore.
5
Neurology Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore City, Singapore.
6
Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore City, Singapore.
7
Department of Microbiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore.

Abstract

AIM:

This retrospective chart review aimed to identify factors in childhood bacterial meningitis that predicted disease severity and long-term outcome.

METHODS:

The study included 112 episodes of microbiologically confirmed bacterial meningitis in children aged three days to 15 years who were admitted to a Singapore hospital from 1998 to 2013.

RESULTS:

The mortality rate was 6%, and 44% required intensive care unit (ICU) admission. Predictive factors associated with ICU admission included pneumococcal meningitis, with an odds ratio (OR) of 5.2 and 95% confidence interval (CI) of 1.5-18.2, leukopenia (OR 5.6, 95% CI 1.7-17.9) and a cerebrospinal fluid (CSF):serum glucose ratio <0.25 (OR 4.5, 95% CI 1.4-14.4). An initial CSF white blood cell count >1000/mm(3) (OR 0.26, 95% CI 0.086-0.76) was negatively associated with ICU admission. Five years after meningitis, 32% had residual sequelae, and the associated prognostic factors were Haemophilus influenzae type b (Hib) meningitis (OR 29.5, 95% CI 2-429), seizures during their inpatient stay (OR 10.6, 95% CI 1.9-60.2) and septic shock (OR 8.4, 95% CI 1.1-62.1).

CONCLUSION:

As mortality was low in this bacterial meningitis study, ICU admission was used as a marker of disease severity. These findings underscore the importance of the pneumococcal and Hib meningitis vaccines.

KEYWORDS:

Bacterial meningitis; Disease severity; Paediatric; Prognostic factors; Sequelae

PMID:
26426265
DOI:
10.1111/apa.13228
[Indexed for MEDLINE]

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