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Corticosteroides y mortalidad en niños con meningitis bacteriana
Jillian Mongelluzzo1, Zeinab Mohamad, Thomas R Ten Have
1Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
JAMA
|May 8, 2008
Resumen
Los corticosteroides adyuvantes no mejoraron los resultados para los niños con meningitis bacteriana. Este estudio no encontró una asociación significativa entre el uso de corticosteroides y la mortalidad o el tiempo de alta hospitalaria en pacientes pediátricos.
Área de la Ciencia:
- Enfermedades Infecciosas Pediátricas
- Farmacología clínica Farmacología clínica.
- Epidemiología La epidemiología.
Sus antecedentes:
- Se sabe que los corticosteroides adyuvantes reducen la mortalidad en la meningitis bacteriana en adultos.
- Existen pruebas contradictorias con respecto a su eficacia en casos pediátricos.
- La meningitis bacteriana sigue siendo una causa significativa de morbilidad y mortalidad infantil.
Objetivo del estudio:
- Investigar la asociación entre los corticosteroides adyuvantes y los resultados clínicos en niños diagnosticados con meningitis bacteriana.
- Para analizar el impacto de la terapia con corticosteroides en la mortalidad y la duración del alta hospitalaria.
- Proporcionar orientación basada en la evidencia para el uso de corticosteroides en la meningitis bacteriana pediátrica.
Principales métodos:
- Estudio de cohorte retrospectivo en el que participaron 2780 niños con meningitis bacteriana.
- Datos recopilados de 27 hospitales infantiles de cuidado terciario en los EE.UU. (2001-2006).
- Para evaluar los resultados se utilizaron el análisis del puntaje de propensión y los modelos de regresión de Cox ajustados por propensión.
Principales resultados:
- Se administraron corticosteroides adyuvantes al 8,9% de los pacientes pediátricos.
- No se observó una reducción significativa en la mortalidad con el uso de corticosteroides en diferentes grupos de edad.
- La terapia con corticosteroides no se asoció con un menor tiempo hasta el alta hospitalaria.
Conclusiones:
- En los niños con meningitis bacteriana, la terapia adyuvante con corticosteroides no mostró asociación con la reducción de la mortalidad.
- Los hallazgos sugieren que los corticosteroides adyuvantes no alteran significativamente los resultados clínicos en la meningitis bacteriana pediátrica.
- Es posible que se necesite más investigación para aclarar el papel de los corticosteroides en subtipos específicos de meningitis pediátrica.
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