Clinical Features and Outcomes of Streptococcus pneumoniae Meningitis in Children: A Retrospective Analysis of 26 Cases in China.

Abstract

Background Streptococcus pneumoniae is an important cause of pediatric meningitis. Objective The aim of this study was to analyze the clinical features and outcomes of children with pneumococcal meningitis at our hospital in China, so as to provide basis for improving the clinical treatment effect. Methods This retrospective analysis included patients aged <16 years treated for pneumococcal meningitis at the Department of Neurology, Children's Hospital of Shanxi (January 2014–February 2016). Clinical data were extracted from the medical records. Patients were followed up for 6 months after discharge. Results The analysis included 26 children aged 2 months to 13 years, with 17 (65.4%) aged <3 years. Presenting symptoms included fever (100%), lethargy (100%), impaired consciousness (88.5%), neck stiffness (69.2%), seizures (53.8%), and headache (50.0%). All patients had positive cerebrospinal fluid (CSF) cultures. The final treatment was vancomycin combined with a third-generation cephalosporin or other antibiotics in 25 patients. Eleven patients (42.3%) were recovered, 3 (11.5%) had neurological sequelae, and 12 (46.2%) died. Impaired consciousness ( p = 0.035), cerebral hernia ( p = 0.037), respiratory failure ( p = 0.004), heart failure ( p = 0.044), septic shock ( p = 0.037), low CSF white blood cell count ( p = 0.036), high CSF protein levels ( p = 0.028), low white blood cell count ( p = 0.036), and low blood neutrophil ratio ( p = 0.016) are associated with a poor prognosis to pneumococcal meningitis. Conclusion Pneumococcal meningitis is associated with a poor prognosis in many children. Poor prognosis might be related to early ineffective antibiotic therapy, a combination of systemic failure, neurological problems, and changed inflammatory response. It is important to rapid initiation of appropriate antibiotic therapy if meningitis is suspected.