Estudio prospectivo multicentrico de la meningitis bacteriana grave pediatrica

We prospectively studied the epidemiologic, clinic signs and outcome of bacterial meningitis in 125 children who were admitted into a PICU (Pediatric Intensive Care Unit) of 11 hospitals of Spain and whose meningitis was diagnosed between May 1994 and April 1995. Results: The median age of the children was 3.55 ± 3.32 years (range 1 month to 16.5 yrs). Eighty-eight were bacterial meningitis, probably bacterial 30 and aseptic 7. The most frecuently isolated organisms were N. meningitidis (52), H. influenzae ripe b (17) and S. pneumoniae (8). Twenty-five percent of N. meningitidis has C serotype. Incidence rate of each germen was depending of age. All patients diagnosed of H. influenzae tipe b meningitis were less than 8 years old. H. infuenzae tipe b and meningococcus had similar incidence rate during the first year of life (27% versus 31%). During the first three years of life H. infiuenzae tipe b produced one third of bacterial meningitis. A mortality rate of 5.6% (seven patients: 3 S. pneurnoniae, 1 N. meningitidis, 1 H. influenzae tipe b and 2 unknown germen) was observed. Patients who die had lower Glasgow coma score (p=0.034) and seizures (p=0.001) at admission. At discharge of PICU, 9 survivors (7.2%) had sequelae: mental retardation in 7 patients and hearing loss in two. One third of patients needed hemodynamic support and a 15% of them ventilatory support. Conclusions: Age is an important epidemiological factor in the etiology of pediatric acute meningitis. H. influenzae tipe b and N. meningitidis had similar incidence rate during the first year of life. S. pneumoniae had the highest mortality rate (37.5%). The presence of coma and seizures at admission were associated with mortality.