Skip to main content

Advertisement

SpringerLink
Log in

Risk factors of brain abscess in neonatal meningitis: a propensity score–matched study

  • RESEARCH
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Brain abscess is a rare but life-threatening complication of meningitis. The purpose of this study was to identify clinical features and potentially relevant factors of brain abscess in neonates with meningitis. This study was a propensity score–matched case–control study of neonates with brain abscess and meningitis in a tertiary pediatric hospital between January 2010 and December 2020. A total of 16 neonates with brain abscess were matched to 64 patients with meningitis. Demography, clinical characteristics, laboratory results, and pathogens were collected. Conditional logistic regression analyses were performed to identify the independent risk factors associated with brain abscess. The most common pathogen we found in the brain abscess group was Escherichia coli. Risk factors of brain abscess were identified: multidrug-resistant bacterial infection (OR, 11.204; 95% CI, 2.315–54.234; p = 0.003), C-reactive protein (CRP) > 50 mg/L (OR, 11.652; 95% CI, 1.799–75.470; p = 0.010).

  Conclusion: The risk factors of brain abscess are multidrug-resistant bacterial infection and CRP > 50 mg/L. Monitoring the level of CRP is essential. Bacteriological culture and rational use of antibiotics are necessary for the prevention of MDR bacterial infection as well as the occurrence of brain abscess.

What is Known:

• Morbidity and mortality of neonatal meningitis have declined, but brain abscess associated with neonatal meningitis is still life-threatening.

What is New:

• This study investigated relevant factors related to brain abscess.

• It is important for neonatologists to perform prevention, early identification, and appropriate interventions for neonates with meningitis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

The data is available on demand.

Code availability

Not applicable.

Abbreviations

CNS:

Central nervous system

CSF:

Cerebrospinal fluid

CRP:

C-reactive protein

CLSI:

Clinical and Laboratory Standards Institute

MRSA:

Methicillin-resistant Staphylococcus aureus

MDR:

Multi-drug resistant

NEC:

Necrotizing enterocolitis of newborn

ORs:

Odds ratios

PICC:

Peripherally inserted central catheter

PCT:

Procalcitonin

PROM:

Premature rupture of membranes

sPDA:

Symptomatic patent ductus arteriosus

TPN:

Total parenteral nutrition

WBC:

White blood cell

VLBW:

Very low birth weight

References

  1. Ouchenir L, Renaud C, Khan S et al (2017) The epidemiology, management, and outcomes of bacterial meningitis in infants. Pediatrics 140:e20170476. https://doi.org/10.1542/peds.2017-0476.

  2. Pareek P, Gupta B, Chetan C et al (2020) Burkholderia cepacia brain abscess in a term neonate. Indian J Pediatr 87:478–479. https://doi.org/10.1007/s12098-019-03156-3

  3. Sahbudak Bal Z, Eraslan C, Bolat E et al (2018) Brain abscess in children: a rare but serious infection. Clin Pediatr (Phila) 57:574–579. https://doi.org/10.1177/0009922817733301

    Article  PubMed  Google Scholar 

  4. Giovane RA, Lavender PD (2018) Central nervous system infections. Prim Care 45:505–518. https://doi.org/10.1016/j.pop.2018.05.007

    Article  PubMed  Google Scholar 

  5. Gilard V, Beccaria K, Hartley JC et al (2020) Brain abscess in children, a two-center audit: outcomes and controversies. Arch Dis Child 105:288–291. https://doi.org/10.1136/archdischild-2018-316730

  6. Ming K, Rosenbaum PR (2000) Substantial gains in bias reduction from matching with a variable number of controls. Biometrics 56(1):118–124. https://doi.org/10.1111/j.0006-341x.2000.00118.x

    Article  CAS  PubMed  Google Scholar 

  7. Simonsen KA, Anderson-Berry AL, Delair SF, Davies HD (2014) Early-onset neonatal sepsis. Clin Microbiol Rev 27(1):21–47

    Article  PubMed  PubMed Central  Google Scholar 

  8. Felsenstein S, Williams B, Shingadia D, Coxon L, Riordan A, Demetriades AK, Chandler CL, Bassi S, Koutoumanou E, Stapleton S, Sharland M, Bryant PA (2013) Clinical and microbiologic features guiding treatment recommendations for brain abscesses in children. Pediatr Infect Dis J 32(2):129–135. https://doi.org/10.1097/INF.0b013e3182748d6e

    Article  PubMed  Google Scholar 

  9. Özsürekci Y, Kara A, Cengiz AB, Çelik M, ÖzkayaParlakay A, Karadağ-Öncel E, Ceyhan M (2012) Brain abscess in childhood: a 28-year experience. Turk J Pediatr 54(2):144–149

    PubMed  Google Scholar 

  10. Raffaldi I, Garazzino S, Castelli GG, Lipreri R, Lancella L, Esposito S, Giannini AM, Montagnani C, Marseglia GL, Pignata C, Bernardi F, Tovo PA (2017) Sitip Brain Abscesses Registry. Brain abscesses in children: an Italian multicentre study. Epidemiol Infect 145(13):2848–2855. https://doi.org/10.1017/S0950268817001583

  11. Austin PC (2011) An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res 46(3):399–424. https://doi.org/10.1080/00273171.2011.568786

    Article  PubMed  PubMed Central  Google Scholar 

  12. Magiorakos AP, Srinivasan A, Carey RB et al (2012). Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. J Clin Microbiol Infect 18:268–281. https://doi.org/10.1111/j.1469-0691.2011.03570.x

  13. Masand R, Ali A, Purohit A (2015) Neonatal brain abscess: an typical presentation. J Pediatr Neurosci 10:282–284. https://doi.org/10.4103/1817-1745.165722

    Article  PubMed  PubMed Central  Google Scholar 

  14. Angus DC, van der Poll T (2013) Severe sepsis and septic shock. N Engl 369:840–51. https://doi.org/10.1056/NEJMra1208623

  15. Emami CN, Petrosyan M, Giuliani S (2009) Role of the host defense system and intestinal microbial flora in the pathogenesis of necrotizing enterocolitis. Surg Infect (Larchmt) 10:407–417. https://doi.org/10.1089/sur.2009.054

  16. Brunengraber LN, Robinson AV, Chwals WJ (2009) Relationship of serum C-reactive protein and blood glucose levels with injury severity and patient morbidity in a pediatric trauma population. J Pediatr Surg 44:992–996. https://doi.org/10.1016/j.jpedsurg.2009.01.043

    Article  PubMed  Google Scholar 

  17. Al-Baradie RS, Pu S, Liu D, Zeinolabediny Y et al (2021) Monomeric C-reactive protein localized in the cerebral tissue of damaged vascular brain regions is associated with neuro-inflammation and neurodegeneration-an immunohistochemical study. Front Immunol 12:644213. https://doi.org/10.3389/fimmu.2021.644213

  18. Neidert MC, Karlin K, Actor B et al (2015) Preoperative C-reactive protein predicts the need for repeated intracerebral brain abscess drainage. Clin Neurol Neurosurg 131:26–30. https://doi.org/10.1016/j.clineuro.2015.01.015

  19. Brouwer MC, Coutinho JM, van de Beek D (2014) Clinical characteristics and outcome of brain abscess. Systematic review and meta-analysis. Neurology 82:806–813. https://doi.org/10.1212/WNL.0000000000000172

  20. Shachor-Meyouhas Y, Bar-Joseph G, Guilburd JN, Lorber A, Hadash A, Kassis I (2010) Brain abscess in children-epidemiology, predisposing factors and management in the modern medicine era. Acta Paediatr 99(8):1163–1167. https://doi.org/10.1111/j.1651-2227.2010.01780.x

  21. Lee CG, Kang SH, Kim YJ, Shin HJ, Choi HS, Lee JH, Lee MH (2010) Brain abscess in Korean children: a 15-year single center study. Korean J Pediatr 53(5):648–652. https://doi.org/10.3345/kjp.2010.53.5.648

    Article  PubMed  PubMed Central  Google Scholar 

  22. Dubos F, De La Rocque F, Levy C et al (2008) Sensitivity of the bacterial meningitis score in 889 children with bacterial meningitis. J Pediatr 152:378–82

  23. Renier D, Flandin C, Hirsch E et al (1988) Brain abscess in neonates: a study of 30 cases. J Neurosurg 69:877–82. https://doi.org/10.3171/jns.1988.69.6.0877

  24. Kline MW (1988) Citrobacter meningitis and brain abscess in infancy: epidemiology, pathogenesis, and treatment. J Pediatr 113:430–4. https://doi.org/10.1016/s0022-3476(88)80623-1

  25. Makhoul IR, Epelman M, Kassis I et al (2002) Escherichia coli brain abscess in a very low birth weight premature infant. Isr Med Assoc J 4:727–728

    PubMed  Google Scholar 

  26. Ku LC, Boggess KA, Cohen-Wolkowiez M et al (2015) Bacterial meningitis in infants. Clin Perinatol 42:29–45, vii-viii. https://doi.org/10.1016/j.clp.2014.10.004

  27. Issa E, Salloum T, Tokajian S (2020) From normal flora to brain abscesses: a review of Streptococcus intermedius. Front Microbiol 11:826. https://doi.org/10.3389/fmicb.2020.00826

  28. Otto M (2012) MRSA virulence and spread. Cell Microbiol 14(10):1513–21. https://doi.org/10.1111/j.1462-5822.2012.01832.x

  29. Tompkins K, van Duin D (2021) Treatment for carbapenem-resistant Enterobacterales infections: recent advances and future directions. Eur J Clin Microbiol Infect Dis 40(10):2053–2068. https://doi.org/10.1007/s10096-021-04296-1

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Tompkins K, Duin DV (2021) Treatment for carbapenem‑resistant Enterobacterales infections: recent advances and future directions. Eur J Clin Microbiol Infect Dis. 40(10):2053–2068. https://doi.org/10.1007/s10096-021-04296-1

  31. Kielian T (2004) Immunopathogenesis of brain abscess. J Neuroinflammation 1:16. https://doi.org/10.1186/1742-2094-1-16

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Grumann D, Nübel U, Bröker BM (2014) Staphylococcus aureus toxins—their functions and genetics. Infect Genet Evol 21:583–92. https://doi.org/10.1016/j.meegid.2013.03.013

Download references

Author information

Authors and Affiliations

  1. Department of Neonatology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Medical University, Chongqing, China

    Nan Peng, Lizhen Fu & Qi Lu

  2. Department of Clinical Epidemiology and Bioinformatics, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Medical University, Chongqing, China

    Xiaohua Liang

Authors
  1. Nan Peng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lizhen Fu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xiaohua Liang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Qi Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Nan Peng collected the data, analyzed the data, and drafted the original manuscript. Lizhen Fu and Qi Lu conceived the study idea and critically reviewed the manuscript. Xiaohua Liang helped in study conception and data analysis and critically reviewed the data. All authors take full responsibility for the final manuscript.

Corresponding author

Correspondence to Qi Lu.

Ethics declarations

Ethics approval

The study was approved by the Institutional Review Board, Children’s Hospital of Chongqing Medical University. Standards of STROBE initiative were followed by our study.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Conflict of interest

The authors declare no competing interests.

Additional information

Communicated by Peter de Winter.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Peng, N., Fu, L., Liang, X. et al. Risk factors of brain abscess in neonatal meningitis: a propensity score–matched study. Eur J Pediatr 182, 2215–2223 (2023). https://doi.org/10.1007/s00431-023-04860-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-023-04860-1

Keywords

Search

Navigation