Bacterial meningitis in infants: the epidemiology, clinical features, and prognostic factors.
This 16-year (1986-2001) retrospective study enrolled 80 infantile patients (aged, 30-365 days old) with culture-proven bacterial meningitis. The most prevalent pathogens were Salmonellaspecies, Streptococcus (S.) agalactiae, Escherichia (E.) coli, and Haemophilus (H.) influenzae, accounting for about 59% of the episodes. Meningitis caused by Salmonella species, E. coli and H. influenzae occurs more often in the older infants, while that caused by S. agalactiae occurs more often in young infants. Our study revealed a decrease in the proportion of Salmonella meningitis from 27% in the first 8 years to 9% in the second 8 years with E. coli replacing Salmonella species as the leading pathogen of this disease during the second period. Overall mortality rate for both periods of time was 11%. However, if we take those with undesirable poor outcomes into account, 43% of patients could be considered treatment failures. The study also reveals a high prevalence of neurological complications when this disease is caused by H. influenzae, S. pneumoniae, and Salmonella species. Stepwise logistic regression analysis revealed that only initial changing levels of consciousness (P = 0.006) were independently associated with treatment failure. The most frequent neurological complications associated with this disease included subdural empyema, hydrocephalus, cerebral infarctions, and seizures. Because therapeutic regimens may require attention to the eradication of bacterial pathogen but also the neurological complications, early diagnosis and choice of appropriate antibiotics are essential to increasing the possibility of survival.
Chang
Chin-Jung
CJ
Department of Pediatrics, Chang Gung Memorial Hospital-Jiayi, Jiayi, Taiwan.
Chang
Wen-Neng
WN
Huang
Li-Tung
LT
Huang
Song-Chei
SC
Chang
Ying-Chao
YC
Hung
Pi-Lien
PL
Lu
Cheng-Hsien
CH
Chang
Chen-Sheng
CS
Cheng
Ben-Chung
BC
Lee
Ping-Yu
PY
Wang
Kuo-Wei
KW
Chang
Hsueh-Wen
HW
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000187:drug effects; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D016920:Meningitis, Bacterial / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D008826:Microbial Sensitivity Tests; D011379:Prognosis; D012189:Retrospective Studies; D017211:Treatment Failure
D000900:Anti-Bacterial Agents