Risk Factors for Death and Major Morbidity among Children with Acute Bacterial Meningitis in Guatemala City
Methods: A prospective surveillance study was conducted for all children (aged 0-59 months) admitted to 3 referral hospitals in Guatemala City (2000-2007) and diagnosed with ABM by positive cerebrospinal fluid (CSF) culture or positive latex agglutination for H. influenzae type B (Hib), S. pneumoniae (Spn), or N. meningitidis; CSF WBC > 100; or positive CSF gram stain. Among children with non-missing data, we conducted univariate and multivariate analyses of risk factors documented at hospital admission that predicted death or major morbidity (hydrocephalus, convulsions, cerebral stroke, or cranial nerve paralysis) during hospitalization. We also performed a validation of the Herson-Todd Score (HTS).
Results: Of 827 children with ABM, 404 (49%) survived without major morbidity, 228 (28%) survived with major morbidity, and 195 (24%) died. Among 382 children with non-missing data, the most significant univariate predictors for death or major morbidity were seizure (OR 22.5, p < 0.001), coma (OR 11.8, p <0.001), shock (OR 5.5, p < 0.001), CSF glucose < 20 (OR 4.2, p < 0.001), growth of Hib or Spn on CSF culture (OR 3.5, p <0.001), hemoglobin < 11 (OR 2.4, p = 0.001), symptoms > 4 days (OR 2.3, p = 0.001), and positive CSF gram stain (OR 2.1, p = 0.003); age < 12 months was protective (OR 0.4, p = 0.008). In the multivariate analysis, significant predictors of death or major morbidity were CSF glucose < 20 (OR 27.3, p < 0.001), seizure (OR 4.8, p < 0.001), symptom duration > 4 days (OR 2.7, p = 0.003), shock (OR 2.7, p = 0.036), and coma (OR 1.4, p = 0.049). Of 229 children with a HTS score > 5, 213 (93%) died or suffered major morbidity (OR 12.8, p < 0.001). Among vaccine-eligible children, 101 (98%) of 103 with Hib ABM and 87 (93%) of 94 with Spn ABM were unvaccinated.
Conclusion: ABM is a cause of considerable morbidity and mortality in Guatemala. Several individual factors and the composite Herson-Todd Score predicted death or major morbidity. These predictors could help clinicians in LMIC guide medical care for ABM, and could provide a severity measure for the public health impact of vaccination programs against Hib and Spn.
J. Todd, None
N. Halsey, None
E. J. Asturias, None
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