Clinical Characteristics Of Children With Pneumococcal Meningitis And Its Prognosis Influencing Factors

Objective:The clinical feature, laboratory examination,antimicrobial resistance and prognosis were analyzed in 46 children with pneumococcal meningitis(PM),in order to improve clinician awareness of the disease,early identificate the patients at risk and reduce the sequelae.Methods:A retrospectively analysis was performed on the clinical data of 46 children with purulent meningitis caused by streptococcus pneumoniae admitted to Shanxi Children's Hospital from January 1,2012 to December 31,2015.All patients were divided into two groups according to Glasgow Outcome Score,favorable and adverse outcome groups.The differences between the two groups in general condition,clinical symptoms and signs,complications,auxiliary examinations,treatment and so on were compared.We used univariate and multivariate logistic regression models to determine adverse prognosis influencing factors in Children with pneumococcal meningitis.Results:1. 46 cases of pediatric pneumococcal meningitis were included in this study,Male and female ratio was 1.56:1;Twenty-nine cases occurred in the winter and spring;And it often occurred in children below 5 years old,especially those younger than 2 years old.2. Pneumococcal meningitis is associated with fever, vomiting,seizures and nervous system symptoms involvement in varying degrees. And laboratory examination suggestedthat peripheral white blood cells,C-reactive protein, serum procalcitonin,white cells,protein and procalcitonin in cerebrospinal fluid were significantly increased, glucose in cerebrospinal fluid were decreased significantly. Severe or death cases had low white blood cells and low platelets.3.Streptococcus pneumoniae was isolated from cerebrospinal fluid in all cases,and drug sensitive test suggested that 22(56.1%) were not sensitive to penicillin, and the resistant rate was 56.52%,The resistant rate to other type of antibiotics was erythromycin(97.73%),clindamycin(90.91%),tetracycline(68.89%),co-trimoxazole(53.33%),cefotaxime(13.04%),ceftriaxone(12.20%),levofloxacin(2.44%),vancomycin(0%),linezolid(0%) respectively.4.Univariate analysis showed that convulsions,consciousness disorder/coma,vomiting,peripheral white blood cells,blood neutrophils,C-reactive protein,serum procalcitonin,glucose,protein and procalcitonin in cerebrospinal fluid,length of hospitalization were significantly different among two groups(P < 0.05),suggesting that these factors were associated with poor prognosis of children with pneumococcal meningitis.5.Logistic regression analysis(taking ?=0.1,?=0.15 as the test level)showed that peripheral white blood cell count(OR=1.229,95%CI:1.014~1.489;P=0.036) was protective factor,C-reactive protein(OR=0.981,95%CI:0.963~0.998;P=0.088),serum procalcitonin(OR=0.959,95%CI:0.920~0.998;P=0.081)were independent risk factors.Conclusions:Severe pneumococal meningitis causes high morbidity or mortality in childhood,clinicians should pay more attention to it. The study found that decreased white blood cells,increased C-reactive protein(CRP) and serum procalcitonin levels were independent risk factors for adverse outcome of pneumococal meningitis.Early identification of patients of poor prognosis,more positive and effective treatment can improve the prognosis of the patients at risk.