Abstract
Although corticosteroids can serve as an effective anti-inflammatory adjuvant therapy, the role of adjunctive steroid therapy in pediatric bacterial meningitis in Taiwan remains under-investigated. Cases of acute bacterial meningitis, aged between 1 month and 20 years, were divided into a steroid group (empirical antibiotics with adjunctive steroid therapy) and a non-steroid group (empirical antibiotics only). Data were identified from the annual hospitalization discharge claims of the National Health Insurance Research Database using the International Classification of Diseases, Ninth Revision codes. Of the 8083 episodes enrolled in this study, 26% (2122/8083) and 74% (5961/8083) were divided into the steroid and non-steroid groups, respectively. The fatality rates were 7.9% in the steroid group and 1.7% in the non-steroid group during hospitalization (p < 0.0001). In the steroid and non-steroid groups, the median length of hospital stay was 13 and 6 days, respectively (p < 0.0001). Medical costs (median (interquartile range)) of hospitalization were 77,941 (26,647–237,540) and 26,653 (14,287–53,421) New Taiwan dollars in the steroid and non-steroid groups, respectively (p < 0.0001). The steroid group had a more fulminant course at baseline, a higher fatality rate, length of hospital stay, and medical cost of hospitalization. Therefore, the beneficial effects of the adjunctive use of corticosteroids in pediatric bacterial meningitis are inconclusive, and additional prospective multicenter investigations are required to clarify this issue.
Highlights
In this nationwide population-based epidemiological study, we collected the data of children aged between 1 month and 20 years who were treated for bacterial meningitis between 1 January 2000 and 31 December 2013 (Figure 1)
Acute bacterial meningitis is a life-threatening inflammatory response in the meninges and subarachnoid space caused by bacterial infection
A meta-analysis of the use of corticosteroids for acute bacterial meningitis showed no significant reduction in overall mortality, but demonstrated a reduction in mortality rate for S. pneumoniae meningitis in subgroup analyses for causative organisms [5]
Summary
Several studies have demonstrated that children with acute bacterial meningitis treated with adjunctive corticosteroid therapy had a significant reduction in hearing impairment and neurological sequelae. They had similar results in overall mortality rate and length of hospital stay [2,5,6]. Certain concerns have been raised regarding the initiation of adjuvant corticosteroid therapy for pediatric bacterial meningitis. This is due to the limited evidence and conflicting results. This study was designed to report the bacteriology, clinical features, and outcomes of adjuvant corticosteroid therapy in pediatric bacterial meningitis in Taiwan
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