Post-COVID-19 trends in pediatric meningitis in the PICU: A multicenter study

Abstract

Background: Meningitis is a severe and potentially life-threatening infection characterized by inflammation of the leptomeningeal membranes that protect the brain and spinal cord. This study aimed to evaluate the epidemiological and clinical features of pediatric patients with laboratory-confirmed meningitis admitted to pediatric intensive care units (PICUs). Methods: This multicenter retrospective study included patients with laboratory-confirmed meningitis who were admitted to eight tertiary PICUs in Istanbul, Turkey, between January 1, 2023, and December 31, 2024. Results: A total of 66 pediatric patients with laboratory-confirmed meningitis requiring intensive care were included. Of these, 39 (59 %) were diagnosed with bacterial meningitis and 27 (41 %) with viral meningitis. Among the bacterial meningitis cases, the most frequently identified pathogens were Streptococcus pneumoniae (41.0 %), Neisseria meningitidis (15.4 %), and Haemophilus influenzae (10.2 %). In the viral group, the most common pathogens were herpes simplex virus type 1 (25.9 %), enterovirus (22.2 %), and human herpesvirus 6 (22.2 %). The bacterial meningitis group had significantly higher white blood cell counts and C-reactive protein levels, and lower cerebrospinal fluid glucose levels compared with the viral meningitis group (p < 0.05). Signs of meningeal irritation and Pediatric Logistic Organ Dysfunction (PELOD) scores were also significantly higher in the bacterial meningitis group (p < 0.05). Age, sex distribution, PICU length of stay, presenting symptoms, rates of sequelae, and mortality did not differ significantly between the two groups. Intravenous immunoglobulin use was significantly more common in the viral meningitis group (p < 0.05). Conclusions: Bacterial meningitis remains the leading cause of meningitis cases requiring pediatric intensive care. Continued public health efforts are essential to reduce mortality and prevent long-term sequelae associated with this serious condition.