High-risk factors associated with refractory childhood bacterial meningitis

Background: Refractory bacterial meningitis is acute, it develops rapidly, and mortality and morbidity are higher than in cases of common bacterial meningitis. This study was undertaken to investigate the high-risk factors related to refractory bacterial meningitis cases in children with positive pathogens. Methods We retrospectively analyzed clinical data for 109 cases of childhood bacterial meningitis. Cases were divided into a refractory group (96 cases) and non-refractory group (13 cases) based on classification criteria. 17 clinical variables on risk factors were extracted and evaluated by univariate and multivariate logistic regression analyses. Results There were 64 males and 45 females. The onset age range was from 1 month old to 14 years old, and the median age was 181 days old. the pathogenic bacteria include 67 cases of Gram-positive(G+) bacteria (61.5%) and 42 cases of Gram-negative (G-)bacteria. In patients 1 to 3 months old, E. coli was the most common (47.5%), followed by Streptococcus agalactiae and Staphylococcus haemolyticus (10.0%); in patients > 3 months old, S. pneumoniae was the most common (55.1%), followed by E. coli (8.7%). Multivariate analysis indicated that consciousness disorder (odds ratio [OR] = 13.050), peripheral blood C-reactive protein(CRP) ≥ 50 mg/L (OR = 29.436), andthe isolate bacteria being Gram-positive bacteria (OR = 8.227) were independent risk factors for predicting who would progress to refractory bacterial meningitis in this group. Conclusion For pathogenic positive bacterial meningitis along with consciousness disorder, CRP ≥ 50 mg/L, and/or the isolate bacteria being G + bacteria, it is important to be alert to the potential for progression to refractory bacterial meningitis, which demands the physicians’ significant attention.