Clinical Characteristics And Risk Factors For Poor Prognosis Of Childhood Severe Purulent Meningitis

Objectives To summarize the clinical characteristics of childhood severe purulent meningitis. To investigate the risk factors for poor prognosis of childhood severe purulent meningitis. To explore the duration of antibiotics therapy and the criteria for discharge for childhood severe purulent meningitis.Method Retrospectively analyze and summarize the clinical characteristics of 112 severe purulent meningitis patients admitted to Children’s Hospital of Chongqing Medical University, from February 2005 to July 2013. According to Glasgow Outcome Score,90 cases which successfully follow-up were divided into two groups, favorable and adverse outcome groups. Univariate and multivariate logistic regression models were used to determine the risk factors for poor prognosis of childhood severe purulent meningitis. Analyze the relationship between prognosis and cerebrospinal fluid results.Result (1) The peak age of childhood severe PM is< lyr(78.6%). It occurs every month, while autumn and winter (September to next year’s March) is more common than other months (64.3%). The respiratory/digestive tract infection, or combined infection(54.4%) is the most common cause(complication). High Fever(47.3%), vomit(58.0%), seizure(64.3%), disturbance of consciousness(62.5%), bregmatic eminence(26.8%), positive neck resistance(43.8%) is the common clinical feature. Severe infection cause the high peripheral WBC(75%), high PLT(50%), moderate-severe anemia(49.1%), high CRP and PCT. The positive rate of blood culture(39.22%) higher than CSF culture(22.94%), S. pneumoniae is the most common pathogens. The treatment of most cases is refractory:the period of hospitalization>21d(61.6%), the combination of two or more antibiotics reach 92.9%, more than half cases choose vancomycin% carbapenems,27 cases(24.11%) need surgical treatment. The main complication include:subdural effusion(51.8%), convulsion(27.7%), hydrocephalus(20.5%). (2) The period of follow-up for 90 cases(20 cases failed) between 8 months and 4 years. Glasgow outcome scores showed that: 33 cases in favorable group,57 cases in adverse group(12 cases died). In adverse group 11 cases(24.44%) developed>2 sequelae, developmental retardation(77.78%), epilepsy(20%), hydrocephalus(13.33%), hearing loss(8.89%), motor deficit(6.67%). (3) The result of univariate analysis: anisocoria, Babinski sign(+),CSF-WBC> 500* 106/L, CSF protein> 1.0 g/L, CSF glucose<1.5mmol/L, first test of PCT>0.1ng/dl, Hb<90g/L, the result of brain imaging or EEG abnormal, the 9 factors related to the poor outcome of severe PM. (4) Multiple logistic ananlysis:anisocoria, CSF glucose< 1.5 mmol/L is the independent risk factors. (5) For 90 cases,28 cases(31.11%) of CSF completely back to normal, most the period of time is 1-2months(20 cases). The last result of CSF-WBC and CSF glucose before discharge, no significant differences between favorable group and adverse group. CSF protein has significant differences, which means high CSF protein may lead to poor prognosis. The ROC curve threshold was< 0.87g/L.Conclusions 1、severe PM is more common in children< ly, clinical symptoms more serious and treatment is difficult, can lead to high mortality and remain long-term sequelae.2、anisocoria, CSF glucose< 1.5 mmol/L is the independent risk factors for poor outcome of childhood severe PM.3、 Based on this study, we recommend that the clinical criteria for stopping antibiotic treatment in childhood severe PM should be:absence of fever for more than one week after therapy, disappearance of all acute clinical symptoms, CSF-WBC<28*106/L, CSF glucose> 1.75mmol/L, and CSF protein<0.68g/L.3-5d after the discontinuation of antibiotics, the clinical symptoms are stable.