[Pneumococcal meningitis mortality in children. Prognostic factors in a series of 73 cases].
OBJECTIVE
Despite advances in antibiotic therapy strategies and pediatric intensive care, prognosis of Streptococcus pneumoniae meningitis remains very poor. To determine the factors associated with hospital mortality of children with pneumococcal meningitis.


METHODS
We conducted a retrospective study of 73 cases of childhood pneumococcal meningitis admitted in 4 teaching hospitals in the center of Tunisia during a 8-year period (1995-2002).


RESULTS
Hospital mortality was 13.7% (10 of 71 patients), and neurologic sequela were observed in 34.5% of survivors. Based on univariable analysis, five variables were associated with the outcome: Pediatric Risk of Mortality score (p < 0.001), coma (p=0.0009), use of mechanical ventilation (p=0.0001), convulsions (p = 0.0449), and shock (p=0.0085). In multivariable analysis, only 2 factors were independently associated with in-hospital mortality: Pediatric Risk of Mortality score and the use of mechanical ventilation. 11.8% of pneumococcal isolates were intermediate and resistant to penicillin. Non-susceptible pneumococcus strains to penicillin and the use of steroids were not associated significantly with the mortality rate.


CONCLUSIONS
Pneumococcal meningitis remains a devastating childhood disease. Two variables were independently associated with the in-hospital death in our series (high Pediatric Risk of Mortality score, and the use of mechanical ventilation). According to these data we may recommend the inclusion of vaccination against streptococcus pneumonia in the children's immunization program in Tunisia.
Thabet
F
F
Service de pédiatrie, hôpital Farhat-Hached, avenue Ibn-El-Jazzar, 4000 Sousse, Tunisia. thabetfarah@yahoo.fr
Tilouche
S
S
Tabarki
B
B
Amri
F
F
Guediche
M-N
MN
Sfar
M-T
MT
Harbi
A
A
Yacoub
M
M
Essoussi
A-S
AS
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001925:Brain Damage, Chronic / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D017052:Hospital Mortality; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008586:Meningitis, Pneumococcal / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D010403:Penicillin Resistance; D011379:Prognosis; D018570:Risk Assessment; D014416:Tunisia
D000900:Anti-Bacterial Agents