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Bacterial meningitis in 366 children in the Netherlands, 1982-1983. Epidemiology and antibiotic therapy
Insights
This study reviewed bacterial meningitis in 366 children, finding common pathogens like H. influenzae and N. meningitidis. Rare pathogens increased case-fatality rates, highlighting the need for careful antibiotic evaluation.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Microbiology
Background:
- Bacterial meningitis remains a significant cause of childhood morbidity and mortality.
- Understanding the epidemiological patterns and treatment strategies is crucial for improving patient outcomes.
Purpose of the Study:
- To conduct a medical audit of pediatric bacterial meningitis cases.
- To describe the epidemiological characteristics and antibiotic usage.
- To compare patient outcomes and treatment between general and academic hospitals.
Main Methods:
- Retrospective review of 366 children (0-15 years) diagnosed with bacterial meningitis between April 1982 and March 1983.
- Analysis of etiological agents, including Haemophilus influenzae, Neisseria meningitidis, and Streptococcus pneumoniae.
- Comparison of antibiotic administration and case-fatality ratios between general and academic hospital settings.
Main Results:
- Haemophilus influenzae (31%), Neisseria meningitidis (23%), and Streptococcus pneumoniae (10%) were the most common pathogens.
- Overall case-fatality ratio was 6.6%, with higher rates (up to 25%) for rare pathogens like E. coli and group B-Streptococcus.
- No significant differences in age distribution or case-fatality were observed between general and academic hospitals, though rare pathogens were more frequent in academic centers.
- Antibiotic prescribing varied, with chloramphenicol plus penicillin used initially by 30% of patients, and ampicillin being common in general hospitals while combinations and penicillin alone were favored in academic centers.
Conclusions:
- The study underscores the importance of identifying common and rare bacterial pathogens in pediatric meningitis.
- Differences in antibiotic prescribing patterns between hospital types suggest potential areas for guideline refinement.
- The findings support the need for carefully evaluated new antibiotics through multi-centered randomized trials due to the required patient numbers.
Abstract:
Records of 366 children 0-15 years with bacterial meningitis (April 1982-March 1983) were reviewed in the framework of a medical audit. The general epidemiological pattern and the antibiotics administered are described and the patients in general hospitals are compared with those in academic hospitals. H. influenzae has been isolated from 31% of patients, N. meningitidis from 23% and S. pneumoniae from 10%. Case-fatality ratio was 6.6% overall, but it was higher in disease due to rare pathogens like E. coli and group B-Streptococcus (up to 25%). These rare pathogens were more common among patients in academic than in general hospitals. However, this difference was not significant, nor were differences in age distribution or case-fatality ratio between the two hospital categories. As initial therapy chloramphenicol plus a penicillin were administered to 30% of patients. On the fifth day of treatment ampicillin was the most frequently used antibiotic in general hospitals (31%), but in academic centres the above-mentioned combination (27%) and penicillin alone (24%) were most popular. It is argued that new antibiotics need to be evaluated carefully. Because this necessitates several hundreds of patients, multi-centered randomised trials should be carried out.