Clinical outcome of pneumococcal meningitis during the emergence of pencillin-resistant Streptococcus pneumoniae: an observational study

Table 2 Risk factors for death during hospitalization from pneumococcal meningitis in Salvador, Brazil

Characteristics	No. of cases	No. deaths (%)	Univariate Hazard Ratio (95% CI)	Adjusted Hazard Ratio (95% CI) ^a
Age category
<1 years	189	109 (58)	2.58 (1.90-3.50)	2.61 (1.54-4.43)
1-4 years	55	27 (49)	2.20 (1.49-3.24)	3.14 (1.57-6.29)
5-14 years	98	10 (10)	0.46 (0.24-0.88)	0.67 (0.28-1.56)
15-50 years	170	38 (23)	1.0	1.0
>50 years	33	18 (55)	2.44 (1.61-3.71)	2.14 (1.11-4.10)
Female	193	81 (42)	1.21 (0.97-1.51)
Underlying condition^b	141	42 (30)	0.75 (0.57-1.00)
Clinical presentation
Seizures prior to hospitalization	181	83 (46)	1.40 (1.13-1.74)
Coma on admission	83	47 (57)	1.69 (1.34-2.12)	2.55 (1.66-3.91)
Laboratory values
Blood leukocyte count < 15,000 cells/μL	200	89 (44)	1.36 (1.09-1.69)	3.53 (2.18-5.71)
CSF protein >300 mg/dL^c	308	125 (41)	1.36 (1.07-1.73)	1.88 (1.12-3.17)
Pneumococcal isolate resistant to penicillin^d	93	45 (48)	1.39 (1.09-1.78)	1.62 (1.08-2.43)
Serotype 14	74	36 (49)	1.38 (1.06-1.80)	0.52 (0.29-0.91)
Treatment
Discordant therapy ^e	22	10 (45)	1.24 (0.77-1.98)
Systemic corticosteroids ^f	412/539	159 (39)	1.25 (0.94-1.68)
ICU admission	235/548	130 (55)	2.37 (1.88-2.99)

NOTE: CI, confidence interval; MIC, minimal inhibitory concentration; ICU, intensive care unit.
^a Hazard ratios and 95% confidence intervals from multivariable Cox proportional hazards model including age category, presence of coma, CSF protein >300 mg/dL, blood leukocyte count <15,000 cells/μL, penicillin MIC >0.06 μg/ml and serotype 14.
^b Includes HIV infection, diabetes mellitus, asplenia, sickle cell disease, congestive heart failure, other disorders associated with immunodepression and recurrent meningitis.
^c CSF protein measured at time of admission; data missing for 12 case patients.
^d Defined as penicillin MIC >0.06 μg/ml for a pneumococcal isolate from a patient with meningitis.
^e Antibiotic therapy was defined as discordant when patients did not receive any antibiotic to which the S. pneumoniae isolate was susceptible during the initial 24 hours of hospitalization.
^f Defined as initiation of corticosteroid therapy within 48 hours of admission; information missing for 9 case patients.

ISSN: 1471-2334