Infection and Drug Resistance (Jun 2019)

Prognostic factors in pediatric pneumococcal meningitis patients in mainland China: a retrospective multicenter study

  • Wang C,
  • Xu H,
  • Deng J,
  • Yu H,
  • Chen Y,
  • Wang S,
  • Huang W,
  • Hao J,
  • Wang C,
  • Deng H,
  • Chen Y

Journal volume & issue
Vol. Volume 12
pp. 1501 – 1512

Abstract

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Caiyun Wang,1 Hongmei Xu,2 Jikui Deng,3 Hui Yu,4 Yiping Chen,5 Shifu Wang,6 Weichun Huang,7 Jianhua Hao,8 Chun Wang,9 Huiling Deng,10 Yinghu Chen11Infection Disease Department, The Children‘s Hospital of Zhejiang University School of Medicine, Hangzhou, 310052, People’s Republic of China; 2Infection Disease Department, Children‘s Hospital of Chongqing Medical University, Chongqing 400014, People’s Republic of China; 3Department of Infectious Diseases, Shenzhen Children‘s Hospital, Shenzhen 518038, People’s Republic of China; 4Department of Infectious Diseases, Children‘s Hospital of Fudan University, Shanghai 201102, People’s Republic of China; 5Infection Disease Department, Yuying Children‘s Hospital of Wenzhou Medical University, Wenzhou 325027, People’s Republic of China; 6Department of Children’s Medical Laboratory Diagnosis Center, Qilu Children‘s Hospital of Shandong University, Jinan, 250022, People’s Republic of China; 7Department of Clinical Laboratory, Shanghai Children‘s Medical Center of Shanghai Jiaotong University School of Medicine, Shanghai, 200127, People’s Republic of China; 8Infection Disease Department, Kaifeng Children‘s Hospital, Kaifeng 475000, People’s Republic of China; 9Clinical Laboratory, Children’s Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, 200040, People’s Republic of China; 10Department of Infectious Diseases, Xi’an Children’s Hospital, Xi’an, 710003, People’s Republic of ChinaBackground: Prognosis of pneumococcal meningitis (PM) remains very poor, especially in less developed countries. Currently, few multi-centric studies on pediatric PM have been reported in mainland China.Objectives: This study aimed to explore the correlation of clinical and laboratory findings with complications and prognosis in pediatric PM.Methods: The pediatric PM patients were retrospectively recruited from ten pediatric tertiary hospitals across China between January 2013 and June 2018. Clinical, biochemical, and microbiological data and follow-up information were collected. Predictive factors for complications and prognostic factors for overall survival (OS) and sequelae-free survival (SFS) were analyzed.Results: A total of 132 pediatric PM patients were included. Seventy-one patients had complications, 25 patients died, and 39 patients had neurological sequelae. Multivariate logistic regression suggested that age less than 28 months (adjusted OR=2.654, 95%CI=1.067–6.600, P=0.036) and lower white blood cells in blood (aOR=3.169, 95%CI=1.395–7.202, P=0.006) were associated with high risk of complications. Multivariate Cox’s proportional hazard regression suggested that age less than 28 months (aHR=6.479, 95%CI=1.153–36.404, P=0.034), coma (aHR=9.808, 95%CI=2.802–34.323, P=0.000), and non-adjuvant steroid therapy (aHR=4.768 95%CI=1.946–11.678, P=0.001) were independent prognostic factors for poor OS; coma (aHR=5.841, 95%CI=2.652–12.864, P=0.000), septic shock on admission (aHR=2.949, 95%CI=1.049–8.290, P=0.040), and lower glucose level in cerebrospinal fluid (CSF) (aHR=2.523, 95%CI=1.336–4.765, P=0.004) were independent prognostic factors for poor SFS.Conclusion: Age, coma, and adjuvant steroid therapy were independent factors for OS, while coma, septic shock on admission, and lower glucose level in CSF were independent factors for SFS in pediatric PM patients. These factors might be used to identify PM patients with poor prognosis and guide individual treatment.Keywords: pneumococcal meningitis, clinical findings, complication, prognosis, pediatric

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