title: A 15-year retrospective analysis of prognostic factors in childhood bacterial meningitis.
abstract: OBJECTIVE
  This retrospective chart review aimed to identify factors in childhood bacterial meningitis that predicted disease severity and long-term outcome.
  
  
  METHODS
  The study included 112 episodes of microbiologically confirmed bacterial meningitis in children aged three days to 15 years who were admitted to a Singapore hospital from 1998 to 2013.
  
  
  RESULTS
  The mortality rate was 6%, and 44% required intensive care unit (ICU) admission. Predictive factors associated with ICU admission included pneumococcal meningitis, with an odds ratio (OR) of 5.2 and 95% confidence interval (CI) of 1.5-18.2, leukopenia (OR 5.6, 95% CI 1.7-17.9) and a cerebrospinal fluid (CSF):serum glucose ratio <0.25 (OR 4.5, 95% CI 1.4-14.4). An initial CSF white blood cell count >1000/mm(3) (OR 0.26, 95% CI 0.086-0.76) was negatively associated with ICU admission. Five years after meningitis, 32% had residual sequelae, and the associated prognostic factors were Haemophilus influenzae type b (Hib) meningitis (OR 29.5, 95% CI 2-429), seizures during their inpatient stay (OR 10.6, 95% CI 1.9-60.2) and septic shock (OR 8.4, 95% CI 1.1-62.1).
  
  
  CONCLUSIONS
  As mortality was low in this bacterial meningitis study, ICU admission was used as a marker of disease severity. These findings underscore the importance of the pneumococcal and Hib meningitis vaccines.
authors.affiliation: Department of Paediatrics, KK Women's and Children's Hospital, Singapore City, Singapore.
authors.forename: Liang Yi Justin
authors.initials: LY
authors.lastname: Wee
authors.affiliation: Department of Paediatrics, KK Women's and Children's Hospital, Singapore City, Singapore.
authors.forename: Raymond Reinaldo
authors.initials: RR
authors.lastname: Tanugroho
authors.affiliation: Infectious Disease Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore City, Singapore.|Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore.|Duke-National University of Singapore Graduate Medical School, Singapore City, Singapore.
authors.forename: Koh Cheng
authors.initials: KC
authors.lastname: Thoon
authors.affiliation: Infectious Disease Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore City, Singapore.|Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore.|Duke-National University of Singapore Graduate Medical School, Singapore City, Singapore.
authors.forename: Chia Yin
authors.initials: CY
authors.lastname: Chong
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore.|Duke-National University of Singapore Graduate Medical School, Singapore City, Singapore.|Neurology Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore City, Singapore.
authors.forename: Chew Thye
authors.initials: CT
authors.lastname: Choong
authors.affiliation: Department of Paediatrics, KK Women's and Children's Hospital, Singapore City, Singapore.
authors.forename: Subramania
authors.initials: S
authors.lastname: Krishnamoorthy
authors.affiliation: Duke-National University of Singapore Graduate Medical School, Singapore City, Singapore.|Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore City, Singapore.|Department of Microbiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore.
authors.forename: Matthias
authors.initials: M
authors.lastname: Maiwald
authors.affiliation: Duke-National University of Singapore Graduate Medical School, Singapore City, Singapore.|Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore City, Singapore.
authors.forename: Nancy Wen Sim
authors.initials: NW
authors.lastname: Tee
authors.affiliation: Infectious Disease Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore City, Singapore.|Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore.|Duke-National University of Singapore Graduate Medical School, Singapore City, Singapore.
authors.forename: Natalie Woon Hui
authors.initials: NW
authors.lastname: Tan
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D016920:Meningitis, Bacterial / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012846:Singapore / Q000453:epidemiology
keywords: Bacterial meningitis; Disease severity; Paediatric; Prognostic factors; Sequelae