Abstract
We aimed to evaluate the occurrence, treatment, and outcomes of neurological complications after bacterial meningitis in young infants. A case series study from a retrospective cohort from two tertiary-level medical centers in Taiwan between 2007 and 2016 was conducted. Eighty-five young infants aged < 90 days with bacterial meningitis were identified. 25 (29.4%) were born at preterm. Group B Streptococcus (GBS) and Escherichia coli caused 74.1% of identified cases. Despite the majority (90.6%) initially received microbiologically appropriate antibiotics, 65 (76.5%) had experienced at least one neurological complication identified at a median of 6 days (range: 1–173) after onset of bacterial meningitis. The most common neurological complication was seizure (58.8%), followed by subdural effusion (47.1%), ventriculomegaly (41.2%), subdural empyema (21.2%), hydrocephalus (18.8%), ventriculitis (15.3%), periventricular leukomalacia (11.8%), and encephalomalacia (10.6%). Nine patients (10.6%) died (including 4 had critical discharge on request) and 29/76 (38.2%) of the survivors had major neurological sequelae at discharge. Nighteen (22.4%) received surgical intervention due to these complications. After multivariate logistic regression, initial seizure (adjusted odds ratio [aOR]: 4.76, 95% confidence interval [CI]: 1.7–13.0, P = 0.002) and septic shock (aOR: 6.04; 95% CI: 1.35–27.0, P = 0.019) were independent predictors for final unfavorable outcomes.Conclusions: Neurological complications and sequelae are common in young infants after bacterial meningitis. Patients presented with early seizure or septic shock can be an early predictor of final unfavorable outcomes and require close monitoring. Further research regarding how to improve clinical management and outcomes is warranted.
Highlights
Bacterial meningitis is associated with high morbidity and mortality in neonates [1, 2]
All previously healthy patients younger than 3 months who presented to the Linkou and Kaohsiung Chang Gung Memorial Hospitals (CGMH) over a 10-year period (January 2007 to December 2016) with neurologic symptoms after bacterial meningitis were eligible for inclusion
A total of 44 (51.8%) episodes of bacterial meningitis were caused by group B Streptococcus (GBS), 19 (22.4%) by E coli, and 16 (18.8%) by other bacteria
Summary
Bacterial meningitis is associated with high morbidity and mortality in neonates [1, 2]. Studies of bacterial meningitis in adults have found that approximately three-fourths of patients have serious intracranial complications such as hydrocephalus, subdural empyema, infarction, and ventriculitis, which contribute to long-term neurological sequelae and final mortality [7,8,9,10,11]. Studies on the incidence and spectrum of complications and prognostic factors in young infants with bacterial meningitis are relatively scarce [12, 13]. Knowledge of the factors associated with poor prognoses could be valuable in selecting patients for more aggressive treatment strategies or at least intensive monitoring, in order to optimize the functional and normal behavioral abilities in neonates, who have had bacterial meningitis. We investigated the occurrence, treatment, and outcome of neurological complications in a large cohort from two medical centers in Taiwan with acute bacterial meningitis
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