946. Long-Term Outcomes of Group B Streptococcal (GBS) Meningitis
Session: Poster Abstract Session: Central Nervous System Infections in Children
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • GBS IDSA poster FINAL.pdf (170.6 kB)
  • Background: 

    Despite use of intrapartum prophylaxis, group B Streptococcus remains the leading cause of meningitis in young infants. Since contemporary long-term outcomes of GBS meningitis are unknown, we sought to assess them and to define features associated with the outcomes.

    Methods:

    Term or near-term infants diagnosed from 1998-2006 with GBS meningitis (positive cerebrospinal fluid [CSF] culture or pleocytosis with positive blood culture) at Texas Children's Hospital (Houston) or Monroe Carell Jr. Children's Hospital (Nashville) participated in an evaluation including physical and neurologic exams, hearing and vision screens, and psychometric testing. Severe impairment physically, neurologically or developmentally (Mullen or WIAT II standard scores >2 SD below means) and mild-to-moderate impairment (scores 1-2 SD below means) were identified.

    Results:

    90 infants with GBS meningitis were identified. 10 died, 5 acutely (5.5%) and 5 at 6 months to 3 years of age. 43 of 80 survivors (54%) were able to be contacted and consented to evaluation (mean age 6.8 range 3-12 years).  Presenting features, laboratory parameters and neurologic status at discharge did not differ for those evaluated and not evaluated. A majority of children (51% n=22) were normal, 13 (30%) had mild-to-moderate impairment, and 8 of 43 (19%) had severe impairment. Severe sequelae included global delay (8), vision loss (4), deafness (4), cerebral palsy (5) and persistent seizures (4). Features at admission associated with death or severe impairment included lethargy (p=0.004), respiratory distress (p=0.002), coma/semicoma (p=0.021), seizures (p=0.013), bulging fontanel (p=0.021), leukopenia (p=0.043), acidosis (p=0.024), CSF protein >300 mg/dL (p=0.003), CSF glucose <20 mg/dL (p=0.029) and need for ventilator or pressor support (p<0.001).  Features at discharge associated with death or severe impairment included failed hearing screen (p=0.003), abnormal neurological exam (p<0.001) or abnormal end of therapy brain imaging (p=0.014). 

    Conclusion: 

    In the era of intrapartum GBS prophylaxis, survivors of GBS meningitis continue to have substantial long-term morbidity. These outcomes highlight the need for prevention strategies, such as maternal immunization.


    Subject Category: P. Pediatric and perinatal infections

    Romina Libster, MD1, Morven Edwards, MD, FIDSA2, Fatma Levent, MD3, Prachi Shah, MD4, Marcia A. Rench, BSN2, Carol J. Baker, MD2, Timothy Cooper, Psy.D1, Robert Sparks, LPN1 and Kathryn Edwards, MD, FIDSA1, (1)Vanderbilt University, Nashville, TN, (2)Baylor College of Medicine, Houston, TX, (3)Texas Tech University Health Sciences Center, Lubbock, TX, (4)University of Michigan, Ann Arbor, MI

    Disclosures:

    R. Libster, None

    M. Edwards, Novartis Vaccines & Diagnostics: Consultant, Consulting fee

    F. Levent, None

    P. Shah, None

    M. A. Rench, None

    C. J. Baker, None

    T. Cooper, None

    R. Sparks, None

    K. Edwards, None

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