Early Outcomes of Group B Streptococcal Meningitis in the 21st Century

Abstract

Group B streptococcal (GBS) meningitis is diagnosed less frequently than in the 1970s and 1980s. There are few contemporary data regarding outcomes from GBS meningitis and factors that might predict an adverse outcome. A retrospective evaluation was conducted of term and near-term infants (≥36 weeks' gestation) with GBS meningitis hospitalized at Texas Children's Hospital from 1998 to 2006 to assess outcomes and to define features predictive of adverse outcomes. Six infants had early-onset (<7 days) meningitis and 47 had late-onset (≥7 days) GBS meningitis. Three infants died. Infants received broad-spectrum antibiotics initially and then penicillin (68%), ampicillin (28%), or cefotaxime (4%) for a mean of 21 (range, 15-44) days. Among survivors, 11 (22%) were neurologically impaired at hospital discharge with manifestations including persistent seizures (10), hypertonicity (9), and dysphagia (3). The 14 infants who died or had adverse outcomes at hospital discharge were more likely to present with seizures within hours of admission (P < 0.001), have coma or semicoma (P < 0.001), require pressor support (P = 0.001), and have an initial cerebrospinal fluid protein ≥300 mg/dL (P = 0.005) or glucose <20 mg/dL (P = 0.03) than were the 39 with infants with normal neurologic examinations. Seizures at admission remained a significant risk factor (P = 0.024) by multivariate analysis. Despite advances in intensive care, 26% of term and near-term infants with GBS meningitis die or have neurologic impairment at hospital discharge. Additional strategies to prevent GBS meningitis are needed.