From the Faculty of Medicine, University of Helsinki, Helsinki, Finland.
Faculty of Medicine, University Diego Portales, Santiago, Chile.
Pediatr Infect Dis J. 2024 May 1;43(5):415-419. doi: 10.1097/INF.0000000000004265. Epub 2024 Feb 7.
Streptococcus pneumoniae meningitis (SpM) remains a major health burden worldwide, particularly in low- and middle-income countries. Identifying the patients at highest risk for mortality and disabling sequelae may reveal potentially avoidable predisposing factors and identify patients most in need of intensive care. We searched for factors that do not require laboratory facilities.
This study was a secondary analysis of prospectively collected data from 5 clinical trials of childhood bacterial meningitis on 3 continents between 1984 and 2017. SpM cases were analyzed by study site and predictors for poor outcome (death or severe sequelae) were identified from the whole series, Latin America and Angola.
Among a total of 1575 children (age range: 2 months to 15 years), 505 cases were due to pneumococci. Compared to other etiologies, SpM doubled the death rate (33% vs. 17%) and tripled poor outcome (15% vs. 6%). In SpM, Glasgow Coma Score <13 [odds ratio (OR): 4.73] and previous antibiotics in Angola (OR: 1.70) were independent predictors for death. Predictors for poor outcome were age <1 year (OR: 2.41) and Glasgow Coma Score <13 (OR: 6.39) in the whole series, seizures in Latin America (OR: 3.98) and previous antibiotics in Angola (OR: 1.91). Angolan children had a 17-fold increased risk for poor outcome when compared with Finnish children ( P = 0.011).
Our study proved the severity of SpM when compared with other etiologies. The outcome was especially poor in Angola. Most patients at risk for poor outcome are easily identified by clinical factors on admission.
肺炎链球菌性脑膜炎（SpM）仍然是全球范围内的一个主要健康负担，尤其是在低收入和中等收入国家。确定死亡和致残后遗症风险最高的患者可能会发现潜在的可避免的致病因素，并确定最需要重症监护的患者。我们寻找不需要实验室设施的因素。
这是一项对 1984 年至 2017 年间在三大洲进行的 5 项儿童细菌性脑膜炎临床研究中前瞻性收集的数据进行的二次分析。通过研究地点分析 SpM 病例，并从整个系列、拉丁美洲和安哥拉确定不良结局（死亡或严重后遗症）的预测因素。
在总共 1575 名儿童（年龄范围：2 个月至 15 岁）中，有 505 例是由肺炎球菌引起的。与其他病因相比，SpM 使死亡率增加了一倍（33%比 17%），不良结局增加了三倍（15%比 6%）。在 SpM 中，格拉斯哥昏迷评分<13（优势比[OR]：4.73）和安哥拉之前使用抗生素（OR：1.70）是死亡的独立预测因素。在整个系列中，年龄<1 岁（OR：2.41）和格拉斯哥昏迷评分<13（OR：6.39）是不良结局的预测因素，拉丁美洲有癫痫发作（OR：3.98）和安哥拉之前使用抗生素（OR：1.91）。与芬兰儿童相比，安哥拉儿童发生不良结局的风险增加了 17 倍（P=0.011）。
与其他病因相比，我们的研究证明了 SpM 的严重性。在安哥拉，结局尤其不佳。大多数有不良结局风险的患者可以通过入院时的临床因素轻松识别。
