Clinical data and factors associated with poor outcome in pneumococcal meningitis.
We carried out a 4-year study of 159 children (ages 1 month-14 years) with pneumococcal meningitis. The study was divided into two periods: the retrospective period (1998-2000: 107 patients), and the prospective period (2001-2002: 52 patients). About 2/3 of the children were under 2 years of age: 72 (45%) were under 1 year of age and 38 (24%) had meningitis during the second year of life. One-third of the patients had signs of otitis media; convulsions were more frequent in patients under 1 year compared with older patients (34.7 vs. 14.9%; P=0.004); 13/159 children (8.2%) died; 93/159 (58.5%) recovered completely, 12.6% had motor sequelae, 6.9% hydrocephalus, 29.8% sensorineural hearing loss; 140/159 (88%) were treated with third generation cephalosporins, yet only 8.7% of the pneumococci identified were completely penicillin-resistant (> or =1 microg/ml); 119/159 were treated with dexamethasone. Four patients had received an injection of heptavalent vaccine. Antibiotics for 1 week prior to admission, shock, abnormal pupils, leukocytes count <6,000 mm(3), and CSF glucose < or =8.5 mg/dl were significantly associated with poor outcome and/or death in the univariate analysis. No patient with leukocytosis >16,000/mm(3) died. Conclusion. Sequelae are very common in pneumococcal meningitis. Poor outcome was associated with pupillary abnormality and a leukocyte count <6,000/mm(3) on admission. Leukocytosis was protective against poor outcome.
Casado-Flores
Juan
J
Paediatric Intensive Care Unit, Hospital Infantil, Universitario del Niño Jesús, Madrid, Spain. jcasadof@line-pro.es
Aristegui
Javier
J
de Liria
Carlos Rodrigo
CR
Martinón
Jose María
JM
Fernández
Cristina
C
D015875:Anisocoria / Q000382:microbiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D002675:Child, Preschool; D003907:Dexamethasone / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D005947:Glucose / Q000134:cerebrospinal fluid; D006319:Hearing Loss, Sensorineural / Q000382:microbiology; D006801:Humans; D006849:Hydrocephalus / Q000382:microbiology; D006955:Hypernatremia / Q000150:complications; D007223:Infant; D007958:Leukocyte Count; D008297:Male; D008586:Meningitis, Pneumococcal / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D010033:Otitis Media / Q000150:complications; D017063:Outcome Assessment, Health Care; D010291:Paresis / Q000382:microbiology; D011446:Prospective Studies; D012025:Reflex, Pupillary; D012189:Retrospective Studies; D012640:Seizures / Q000382:microbiology; D013030:Spain / Q000453:epidemiology
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D005938:Glucocorticoids; D003907:Dexamethasone; D005947:Glucose