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Corticosteroids and Mortality in Children With Bacterial Meningitis
Jillian Mongelluzzo, BA;
Zeinab Mohamad, MS;
Thomas R. Ten Have, PhD;
Samir S. Shah, MD, MSCE
JAMA. 2008;299(17):2048-2055.
Context In adults, adjuvant corticosteroids significantly reduce mortality associated with bacterial meningitis; however, in children, studies reveal conflicting results.
Objective To determine the association between adjuvant corticosteroids and clinical outcomes in children with bacterial meningitis.
Design, Setting, and Patients A retrospective cohort study conducted between January 1, 2001, and December 31, 2006, of 2780 children discharged with bacterial meningitis as their primary diagnosis from 27 tertiary care children's hospitals located in 18 US states and the District of Columbia that provide data to the Pediatric Health Information System’s administrative database.
Main Outcome Measures Propensity scores, constructed using patient demographics and markers of illness severity at presentation, were used to determine each child's likelihood of receiving adjuvant corticosteroids. Primary outcomes of interest, time to death and time to hospital discharge, were analyzed by using propensity-adjusted Cox proportional hazards regression models stratified by age categories.
Results The median age was 9 months (interquartile range, 0-6 years); 57% of the patients were males. Streptococcus pneumoniae was the most commonly identified cause of meningitis. Adjuvant corticosteroids were administered to 248 children (8.9%). The overall mortality rate was 4.2% (95% confidence interval [CI], 3.5%-5.0%), and cumulative incidences were 2.2% and 3.1% at 7 days and 28 days, respectively, after admission. Adjuvant corticosteroids did not reduce mortality, regardless of age (children <1 year: hazard ratio [HR], 1.09; 95% CI, 0.53-2.24; 1-5 years: HR, 1.28; 95% CI, 0.59-2.78; and >5 years: HR, 0.92; 95% CI, 0.38-2.25). Adjuvant corticosteroids were also not associated with time to hospital discharge. In subgroup analyses, the results did not change in either children identified with pneumococcal or meningococcal meningitis or children with a cerebrospinal fluid culture performed at the admitting hospital.
Conclusion In this multicenter observational study of children with bacterial meningitis, adjuvant corticosteroid therapy was not associated with time to death or time to hospital discharge.
Author Affiliations: Divisions of Infectious Diseases (Dr Shah and Mss Mongelluzzo and Mohamad) and General Pediatrics (Dr Shah and Ms Mohamad), The Children's Hospital of Philadelphia, and Departments of Biostatistics and Epidemiology (Drs Ten Have and Shah) and Pediatrics (Dr Shah), Center for Clinical Epidemiology and Biostatistics (Drs Ten Have and Shah), and Center for Education and Research on Therapeutics (Dr Shah), University of Pennsylvania School of Medicine, Philadelphia.
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Corticosteroids in Children with Bacterial Meningitis: The Debate Continues
JWatch Pediatrics 2008;2008:1-1.
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