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Risk factors of brain abscess in neonatal meningitis: a propensity score-matched study
Nan Peng1, Lizhen Fu1, Xiaohua Liang2
1Department of Neonatology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Medical University, Chongqing, China.
Abstract:
Brain abscess is a rare but life-threatening complication of meningitis. The purpose of this study was to identify clinical features and potentially relevant factors of brain abscess in neonates with meningitis. This study was a propensity score-matched case-control study of neonates with brain abscess and meningitis in a tertiary pediatric hospital between January 2010 and December 2020. A total of 16 neonates with brain abscess were matched to 64 patients with meningitis. Demography, clinical characteristics, laboratory results, and pathogens were collected. Conditional logistic regression analyses were performed to identify the independent risk factors associated with brain abscess. The most common pathogen we found in the brain abscess group was Escherichia coli. Risk factors of brain abscess were identified: multidrug-resistant bacterial infection (OR, 11.204; 95% CI, 2.315-54.234; p = 0.003), C-reactive protein (CRP) > 50 mg/L (OR, 11.652; 95% CI, 1.799-75.470; p = 0.010). Conclusion: The risk factors of brain abscess are multidrug-resistant bacterial infection and CRP > 50 mg/L. Monitoring the level of CRP is essential. Bacteriological culture and rational use of antibiotics are necessary for the prevention of MDR bacterial infection as well as the occurrence of brain abscess. What is Known: • Morbidity and mortality of neonatal meningitis have declined, but brain abscess associated with neonatal meningitis is still life-threatening. What is New: • This study investigated relevant factors related to brain abscess. • It is important for neonatologists to perform prevention, early identification, and appropriate interventions for neonates with meningitis.
Insights
Multidrug-resistant bacterial infections and elevated C-reactive protein (CRP) levels over 50 mg/L are key risk factors for brain abscess in neonates with meningitis. Early monitoring and intervention are crucial for prevention.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Pediatric Neurology
Background:
- Neonatal meningitis, while less fatal, still carries a risk of brain abscess.
- Brain abscesses in neonates are rare but life-threatening complications of meningitis.
Purpose of the Study:
- To identify clinical features and risk factors for brain abscess in neonates diagnosed with meningitis.
- To inform prevention and early intervention strategies for this critical condition.
Main Methods:
- A propensity score-matched case-control study was conducted between 2010 and 2020.
- Data on demography, clinical characteristics, laboratory results, and pathogens were collected from 16 neonates with brain abscess and 64 controls with meningitis.
- Conditional logistic regression analysis identified independent risk factors.
Main Results:
- Escherichia coli was the most common pathogen identified in the brain abscess group.
- Independent risk factors for brain abscess included multidrug-resistant bacterial infection (OR, 11.204) and C-reactive protein (CRP) levels >50 mg/L (OR, 11.652).
Conclusions:
- Multidrug-resistant bacterial infections and elevated CRP levels (>50 mg/L) are significant risk factors for brain abscess in neonates with meningitis.
- Continuous CRP monitoring, prompt bacteriological cultures, and judicious antibiotic use are essential for preventing brain abscess.
- Early identification and appropriate interventions are critical for neonatologists managing meningitis in newborns.
