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Pneumococcal meningitis: clinical course and resource use in Western Australian children
1TVW Telethon Institute for Child Health Research, University of Western Australia, Perth, Western Australia, Australia. barbara.king@health.wa.gov.au
Insights
Pediatric pneumococcal meningitis is challenging to diagnose and manage, often leading to long hospital stays and neurological issues. However, conjugate vaccines can prevent most cases.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- Paediatric pneumococcal meningitis presents significant challenges due to antibiotic resistance and diagnostic difficulties.
- Management is often complex and resource-intensive, impacting child health outcomes.
Purpose of the Study:
- To describe the diagnosis, clinical course, and initial resource utilization for children with pneumococcal meningitis in Western Australia (1990-2000).
Main Methods:
- Retrospective chart review of all children diagnosed with pneumococcal or streptococcal meningitis in Western Australian hospitals.
- Data sourced from the Health Department's Hospital Morbidity Data System using ICD-9 and ICD-10 codes.
Main Results:
- Ninety-four cases of pneumococcal meningitis were identified, with diagnosis often delayed (median 2 reviews).
- High rates of hospitalization (median 11.6 days), Intensive Care Unit (ICU) admission (41.5%), seizures (47.9%), and neurological sequelae (24%) were observed.
- Penicillin resistance emerged (4.6%), though most cases involved serotypes covered by the 7-valent conjugate vaccine (84.5%).
Conclusions:
- Pneumococcal meningitis in children is difficult to diagnose, requires prolonged and complicated hospitalizations, and results in significant neurological sequelae.
- The majority of cases can be prevented through the use of new conjugate vaccines.
Objectives:
Paediatric pneumococcal meningitis causes high rates of neurological sequelae and is presenting challenges due to the emergence of antibiotic resistance. Diagnosis can be difficult and management is frequently complicated and resource intensive. This population-based study outlines the diagnosis, clinical course and initial resource use of Western Australian (WA) children diagnosed between 1990 and 2000.
Methods:
The charts of all rural and metropolitan children discharged from all WA hospitals with International Classification of Disease 9 and 10 codes of pneumococcal or streptococcal meningitis from the Health Department's Hospital Morbidity Data System were reviewed retrospectively.
Results:
Ninety-four episodes of pneumococcal meningitis were confirmed (median age 12.4 months). Initial diagnosis was often difficult with a suggestive prodrome in less than one quarter of cases and a median of two reviews until diagnosis (range 1-7). The median duration of hospitalization was 11.6 days, 41.5% were admitted to the Intensive Care Unit (ICU), and 47.9% had seizures. There were eight related deaths and neurological sequelae occurred in 24. Initial hospitalization cost on average $A 19,900. Penicillin resistance was first noted in 1993 and occurred in 4.6% of isolates. Most cases (84.5%) were caused by serotypes contained in the currently available seven-valent conjugate vaccine.
Conclusions:
Pneumococcal meningitis is often difficult to diagnose, necessitates long and frequently complicated in-patient stays and has high rates of neurological sequelae. It is possible to prevent most cases with new conjugate vaccines.
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