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Factors Affecting Time to Death From Start of Treatment Among Children Succumbing to Bacterial Meningitis

Roine, Irmeli MD, PhD*; Pelkonen, Tuula MD, PhD†‡§; Bernardino, Luis MD; Leite, Manuel MD; Kataja, Matti PhD; Pitkäranta, Anne MD, PhD†‖; Peltola, Heikki MD, PhD§

Pediatric Infectious Disease Journal: August 2014 - Volume 33 - Issue 8 - p 789–792
doi: 10.1097/INF.0000000000000350
Original Studies

Background: Many risks of death in childhood bacterial meningitis are well-identified, but factors influencing survival time have received less attention. Better understanding of this issue could help explain why adjuvant medications have performed unevenly in different trials.

Methods: In a post hoc analysis of prospectively collected data from a large bacterial meningitis treatment trial in Luanda, Angola, we compared time to death after initiation of antimicrobial treatment among 206 children with etiology and other patient characteristics. The risks of dying very quickly (0–4 hours), quickly (4–8 hours) or after longer periods were analyzed by logistic regression.

Results: Median time to death was 18.5 hours, half the time in Streptococcus pneumoniae (11.8 hours) compared with Haemophilus influenzae (26.8 hours) meningitis. Of all deaths caused by pneumococcal or H.influenzae meningitis, 42% versus 16%, respectively, occurred within the first 8 hours. In addition, patients who succumbed within 8 hours, unlike those dying later, had a short disease history, shock, hypoglycemia and poor cerebrospinal fluid white cell response.

Conclusions: Time to death in Angola is so short that hardly anything, except perhaps modern intensive care, is likely to improve outcome in a patient with meningitis, especially the pneumococcal disease.

From the *Faculty of Medicine, University Diego Portales, Santiago, Chile; Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland; David Bernardino Children’s Hospital, Luanda, Angola; §Children’s Hospital, Helsinki University Central Hospital, and Helsinki University; National Institute for Health and Welfare; and Department of Otorhinolaryngology, Helsinki University Central Hospital, and Helsinki University, Helsinki, Finland.

Accepted for publication January 9, 2014.

This work was supported by the Sigrid Juselius and the Paediatric Research Foundations, Helsinki, Finland.

H.P. is a scientific consultant of the Serum Institute of India. The authors have no other funding or conflicts of interest to disclose.

Address for correspondence: Irmeli Roine, MD, PhD, Los Misioneros 2237, 7520179 Santiago, Chile. Email: irmeli.roine@gmail.com.

© 2014 by Lippincott Williams & Wilkins, Inc.