Pediatric Pyogenic Meningitis: A Comprehensive Analysis of Clinical Course and Outcomes

Abstract

Background: Pediatric pyogenic meningitis remains a significant global health challenge despite modern therapeutic advances. This prospective observational study aimed to analyze the clinical course, microbiological profile, treatment outcomes, and prognostic factors in children with pyogenic meningitis. Methods: We conducted a comprehensive analysis of 157 children aged 1 month to 12 years diagnosed with pyogenic meningitis at Department of Pediatrics, DBVP RMC, PIMS(DU), Loni. The study evaluated clinical presentations, laboratory findings, microbiological profiles, treatment responses, and outcomes through a structured follow-up period of 6 months. Results: The median age of presentation was 2.8 years, with male predominance (58.6%). Causative organisms were identified in 71.3% of cases, with Streptococcus pneumoniae (42.9%) being the most prevalent pathogen, followed by Neisseria meningitidis (27.7%) and Haemophilus influenzae (16.1%). Significant antibiotic resistance was observed, with 22.9% of S. pneumoniae isolates showing penicillin resistance. The overall mortality rate was 10.8%, while 26.8% of survivors developed neurological sequelae. At 6-month follow-up, hearing impairment emerged as the most common long-term complication (17.2%). Multivariate analysis identified age <1 year (OR 2.8, 95% CI 1.4-5.6), admission Glasgow Coma Scale <12 (OR 3.5, 95% CI 1.8-6.9), and delayed presentation (OR 2.4, 95% CI 1.2-4.8) as significant predictors of adverse outcomes. Conclusions: Our findings highlight the persistent burden of pediatric pyogenic meningitis and identify critical prognostic factors that can guide clinical management. The emergence of antibiotic resistance and high rates of neurological sequelae emphasize the need for enhanced surveillance, updated treatment protocols, and structured follow-up programs. Early recognition and prompt intervention remain crucial for improving outcomes in this serious infection