Paediatric bacterial meningitis in the USA: outcomes and healthcare resource utilization of nosocomial versus community-acquired infection

Abstract

Introduction. Paediatric bacterial meningitis remains a costly disease, both financially and clinically. Hypothesis/Gap Statement. Previous epidemiological and cost studies of bacterial meningitis (BM) have largely focused on adult populations or single pathogens. There have been few recent, large-scale studies of pediatric BM in the USA. Aim. We examined healthcare resource utilization (HCRU) and associated morbidity and mortality of community-acquired versus nosocomial bacterial infections in children across the USA. Methodology. The IBM MarketScan Research databases were used to identify patients <18 years old admitted to USA hospitals from 2008 to 2015 with a primary diagnosis of BM. Cases were categorized as either community-acquired or nosocomial. HCRU, post-diagnosis neurosurgical procedures, 30-day in-hospital mortality, and complications were compared between groups. Multivariable regression adjusted for sex, age and Gram staining was used to compare costs of nosocomial versus community-acquired infections over time. Results. We identified 1928 cases of paediatric BM without prior head trauma or neurological/systemic complications. Of these, 15.4 % were nosocomial and 84.6 % were community-acquired infections. After diagnostic lumbar puncture (37.1 %), the most common neurosurgical procedure was placement of ventricular catheter (12.6 %). The 30-day complication rates for nosocomial and community-acquired infections were 40.5 and 45.9 %, respectively. The most common complications were hydrocephalus (20.8 %), intracranial abscess (8.8 %) and cerebral oedema (8.1 %). The 30-day in-hospital mortality rates for nosocomial and community-acquired infections were 2.7 and 2.8 %, respectively. Median length of admission was 14.0 days (Q1: 7 days, Q3: 26 days). Median 90-day cost was $40 861 (Q1: $11 988, Q3: $114,499) for the nosocomial group and $56 569 (Q1: $26 127, Q3: $142 780) for the community-acquired group. In multivariable regression, the 90-day post-diagnosis total costs were comparable between groups (cost ratio: 0.89; 95 % CI: 0.70 to 1.13), but at 2 years post-diagnosis, the nosocomial group was associated with 137 % higher costs (CR: 2.37, 95 % CI: 1.51 to 3.70). Conclusion. In multivariable analysis, nosocomial infections were associated with significantly higher long-term costs up to 2 years post-infection. Hydrocephalus, intracranial epidural abscess and cerebral oedema were the most common complications, and lumbar punctures and ventricular catheter placement were the most common neurosurgical procedures. This study represents the first nation-wide, longitudinal comparison of the outcomes and considerable HCRU of nosocomial versus community-acquired paediatric BM, including characterization of complications and procedures contributing to the high costs of these infections.

Microorganism and Antibiotik Sensitivity Pattern of Children Bacterial Meningitis in Denpasar Tertiary Hospital 2019-2020

“…In general, patients with bacterial meningitis were dominated by men (55.7%), both in community-acquired and nosocomial cases [16]. Children aged less than 2 years are more susceptible to bacterial meningitis than older children.…”

“…This procedure is quite common, especially for cases of hydrocephalus. Previous studies have stated that the most common bacteria causing meningitis in the use of a VP shunt is Staphylococcus bacteria [16]. Despite advances in surgical techniques and infection control, infections associated with VP shunt placement still range from 5 to 18% and are mostly caused by gram-positive bacteria (59%) [17].…”

“…The microorganisms that cause meningitis are quite varied, depending on geographic location, socioeconomic status, age, availability of vaccinations and a person's health status [18]. Epidemiological studies in the United States found that the most common cause of bacterial meningitis cases in children was Streptococcus (30.7%) [16]. On the other hand, a study in Namibia, South Africa reported Streptococcus pneumoniae, Neisseria meningitidis, group B Streptococci, Listeria monocytogenes, Haemophilus influenzae type b (Hib), and pneumococcal infections [12].…”

A Multicenter Epidemiological and Pathogenic Characteristics Study of Community-Acquired Bacterial Meningitis Children in China: Results from the Chinese Pediatric Bacterial Meningitis Surveillance (CPBMS) 2019–2020

“… 39 Systemic complications such as severe sepsis and/or multiple organ dysfunction syndrome (MODS) occurred in 34.2% of CABM cases in this study, which was higher than previous USA studies. 40 CABM cases who developed systemic complications had complex clinical presentations and some patients had significantly higher rates of sequelae. Therefore, under the premise of effective anti-infection, clinicians must pay attention to monitor the changes of the condition, timely detection of complications, and active management, which is expected to reduce the disability and death rate of children’s CABM, and thus improve the prognosis of children.…”

The Impact and Burden of Neurological Sequelae Following Bacterial Meningitis: A Narrative Review

“…Acute bacterial meningitis can have severe complications with long-term neurological sequelae resulting in disability even in high-income countries (HICs) with appropriate antibiotic therapy and vaccine availability [ 26 ]. For example, a recent study in the United States on paediatric bacterial meningitis demonstrated a 45.9% complication rate at 30 days for community-acquired bacterial meningitis, with hydrocephalus (20.8%), intracranial abscess (8.8%) and cerebral oedema (8.1%) being the most common short-term neurological sequelae [ 27 ].…”