title: Risk Factors for Death and Major Morbidity in Guatemalan Children with Acute Bacterial Meningitis.
abstract: BACKGROUND
  Acute bacterial meningitis (ABM) remains a significant cause of pediatric illness and death in low and middle income countries. Identifying severity risk factors and predictive scores may guide interventions to reduce poor outcomes.
  
  
  METHODS
  Data from a prospective surveillance study for ABM in children aged 0-59 months admitted to 3 referral hospitals in Guatemala City from 2000 to 2007 were analyzed. ABM was defined as positive cerebrospinal fluid (CSF) culture, positive latex agglutination or CSF white blood cell greater than 100 cells/mL. Univariate and multivariate analyses of risk factors at hospital admission that predicted major morbidity or death during hospitalization were performed, along with validation of the predictive Herson-Todd score (HTS).
  
  
  RESULTS
  Of 809 children with ABM episodes, 221 (27.3%) survived with major morbidity and 192 (23.7%) died. Among 383 children with nonmissing data, the most significant multivariate predictors for death or major morbidity were seizure [odds ratio (OR), 101.5; P < 0.001], CSF glucose less than 20 mg/dL (OR, 5.3; P = 0.0004), symptom duration more than 3 days (OR, 3.7; P = 0.003) and coma (OR, 6.3; P = 0.004). Of 221 children with a HTS greater than 5, 204 (92%) died or suffered major morbidity (OR, 10.3; P < 0.0001).
  
  
  CONCLUSIONS
  ABM is a cause of considerable morbidity and mortality in Guatemala. Several clinical risk factors and the composite HTS predicted death or major morbidity. These predictors could help clinicians in low and middle income country guide medical care for ABM and could contribute to the public health impact assessment in preventing meningitis with vaccines.
authors.affiliation: From the *Division of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; †Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; ‡Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; and §Center for Global Health, Colorado School of Public Health, Aurora, Colorado.
authors.forename: Daniel
authors.initials: D
authors.lastname: Olson
authors.forename: Molly M
authors.initials: MM
authors.lastname: Lamb
authors.forename: James T
authors.initials: JT
authors.lastname: Gaensbauer
authors.forename: James K
authors.initials: JK
authors.lastname: Todd
authors.forename: Neal A
authors.initials: NA
authors.lastname: Halsey
authors.forename: Edwin J
authors.initials: EJ
authors.lastname: Asturias
mesh_terms: D002675:Child, Preschool; D002947:Cities; D005260:Female; D006166:Guatemala / Q000453:epidemiology; D006761:Hospitals; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016920:Meningitis, Bacterial / Q000453:epidemiology* / Q000401:mortality*; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis