Nearly Half of Children With Bacterial Meningitis Develop Adverse Outcomes

Adverse clinical outcomes occur in nearly half of children with community-acquired bacterial meningitis (CABM), with abnormal neurologic examination findings, abnormal fontanelle, and mechanical ventilation serving as independent predictors, according to study results presented at IDWeek 2025, held from October 19 to 22, in Atlanta, Georgia.

Researchers aimed to identify clinical factors linked to poor outcomes in pediatric CABM, a neurologic emergency that remains a major cause of morbidity and mortality despite prompt antimicrobial treatment. To address this, researchers conducted a retrospective cohort study of children aged 2 months to 17 years diagnosed with CABM at 3 sites.

Patients were drawn from 3 retrospective pediatric cohorts spanning multiple decades: 195 patients from Yale New Haven Hospital (1985-1998), 166 from 2 hospitals in New Orleans (1980-2005), and 28 from a Houston-based cohort (2017-2023). Individuals with meningitis linked to ventriculoperitoneal shunt infections were excluded to maintain population consistency.

ACO [adverse clinical outcomes] occurred in 44% children with CABM; independent predictors included abnormal neurologic exam, abnormal fontanelle and mechanical ventilation.

Among 389 children included in the final analysis, 57% were boys, 65.8% were African American, and 26.2% were White. Prematurity was reported in 14.9% of patients, developmental delays in 5.1%, and immunocompromised status in 2.8%. A total of 168 (44%) children experienced at least 1 adverse clinical outcome, including hearing impairment in 33%, neurologic sequelae in 27%, and death in 7.6%.

Univariate analysis identified several baseline features significantly associated with adverse clinical outcomes, including seizure at presentation, absence of fever, abnormal fontanelle, developmental delay, elevated cerebrospinal fluid (CSF) protein (>120 mg/dL), low CSF glucose (<20 g/dL), abnormal neurologic examination, and need for mechanical ventilation (all P <.05).

In a multivariate logistic regression analysis, 3 independent predictors emerged: abnormal neurologic examination (odds ratio [OR], 6.54; 95% CI, 1.97-21.71; P =.002), abnormal fontanelle (OR, 2.29; 95% CI, 1.19-4.43; P =.013), and requirement for mechanical ventilation (OR, 5.56; 95% CI, 1.87-16.51; P =.002). These findings were validated through internal bootstrapping.

The researchers concluded, “ACO [adverse clinical outcomes] occurred in 44% children with CABM; independent predictors included abnormal neurologic exam, abnormal fontanelle and mechanical ventilation.”

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

This article originally appeared on Infectious Disease Advisor