Pneumococcal meningitis in a pediatric intensive care unit: prognostic factors in a series of 49 children.
BACKGROUND
Despite advances in antibiotic therapy strategies and in pediatric intensive care, prognosis of Streptococcus pneumoniae meningitis remains very poor. However, few prognostic studies have been published, especially in pediatric populations.


METHODS
We conducted a prognostic study to determine the factors associated with hospital mortality of 49 children admitted in a single pediatric intensive care unit during a 12-yr period (1990-2002).


RESULTS
Hospital mortality was 49% (24 of 49 patients), and neurologic sequels were observed in 47% of survivors. Among them, 90% had permanent sensory deafness. Based on univariable analyses, seven variables were associated with the outcome: Pediatric Risk of Mortality II score (p = .000005), Glasgow Coma Score of >8 (p = .001), use of mechanical ventilation (p = .001), platelet count (p = .007), white blood cells count (p = .002), cerebrospinal fluid glucose level (p = .02), and lack of corticosteroids use (p = .02). In multivariable analysis, only three factors were independently associated with in-hospital mortality: Pediatric Risk of Mortality II score (hazard ratio, 1.13; 95% confidence interval, 1.06-1.20; p = .0002), platelets count of >200 x 10/L (hazard ratio, 0.25; 95% confidence interval, 0.08-0.81; p = .021) and white blood cell count above 5 x 10/L (hazard ratio, 0.31; 95% confidence interval, 0.11-0.87; p = .026).


CONCLUSIONS
S. pneumoniae meningitis remains a devastating childhood disease in developed countries. Three variables were independently associated with the in-hospital death in our series-high Pediatric Risk of Mortality II score, low white blood cells count, and low platelet count-reflecting the main importance of severe sepsis and neurologic presentation in establishing the prognosis of these patients.
Wasier
Anne-Pascale
AP
Pediatric Intensive Care Unit, Kremlin-Bicêtre Hospital, Kremlin-Bicêtre, France.
Chevret
Laurent
L
Essouri
Sandrine
S
Durand
Philippe
P
Chevret
Sylvie
S
Devictor
Denis
D
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001772:Blood Cell Count; D002675:Child, Preschool; D005260:Female; D005947:Glucose / Q000134:cerebrospinal fluid; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D008586:Meningitis, Pneumococcal / Q000188:drug therapy / Q000378:metabolism / Q000401:mortality*; D010403:Penicillin Resistance; D011517:Prothrombin Time; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013296:Streptococcus pneumoniae / Q000187:drug effects
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D005947:Glucose