Management of acute meningococcal septicaemia in Al-Nasser Paediatric Hospital: A retrospective cohort study

Nabil Al-Barqouni, Awni Al Shorafa, Belal Dabour, Sherin Abed, Loai Albarqouni

Research output: Contribution to journalMeeting AbstractResearchpeer-review

Abstract

Background

Acute meningococcal septicaemia is a fulminant disease, and mortality and long-term morbidity can be very high if not treated appropriately. We aimed to evaluate case fatality rate of all children admitted with acute meningococcal septicaemia.

Methods

We did a retrospective cohort study of all paediatric cases of acute meningococcal septicaemia admitted to Al-Nasser Paediatric Hospital, the largest paediatric hospital in the Gaza Strip. Acute meningococcal septicaemia was diagnosed clinically and confirmed on the basis of results from skin smears and blood cultures, and meningitis was diagnosed clinically and confirmed by bacteriological examination of cerebrospinal fluid. Sociodemographic and clinical data and outcome information were obtained from hospital records. Outcome measures were predicted mortality using Paediatric Risk of Mortality score III (PRISM-III), actual mortality, and standardised mortality ratio (SMR).

Findings

Between Jan 1, 2009, and Sept 31, 2015, 240 children were admitted with acute meningococcal septicaemia. 113 (47%) children were boys, and the average age was 3·15 years (SD 2·6). The number of admitted children with acute meningococcal septicaemia decreased from 47–59 cases per year in 2009–11, to 21–22 cases per year in 2012–15. Similarly, there were fewer deaths in 2012–15 (n=14) than in 2009–11 (n=35). The total mortality predicted by PRISM-III was 25·6%, whereas the actual overall mortality was 21% (standardised mortality ratio 0·814; n=49). 41 (82%) children died within 24 h of admission, 69 (29%) children received corticosteroid, 85 (35%) children received inotropic medications, and 46 (19%) children required mechanical ventilation for a median of 24 h (IQR 6–48]. Acute meningococcal septicaemia was associated with meningitis in 75 (31%) children. The most common complications were multiorgan failure (22 [9%] children), skin necrosis or scarring (13 [5%]), convulsions or seizures (13 [5%]), and disseminated intravascular coagulopathy (ten [4%]). Mortality was independently associated with age (odds ratio per 1-year decreased age 1·06, 95% CI 1·03–1·10; p=0·0006), shock (3·83, 1·32–11·70; p=0·015), absence of meningitis on presentation (9·55, 3·25–28·07; p=0·0013), and mechanical ventilation (9·85; 4·31–22·54; p<0·0001).

Interpretation

The mortality and morbidity associated with meningococcemia are improving but remain high. Timely identification of acute meningococcal septicaemia in primary care as well as in emergency departments is crucial.

Original languageEnglish
Pages (from-to)27
JournalThe Lancet
Volume391
Issue numberS1
DOIs
Publication statusPublished - 21 Feb 2018
EventThe Lancet Palestinian Health Alliance Eighth Annual Conference: Health of Palestinians - Birzeit, Palestine, State of
Duration: 15 Mar 201716 Mar 2017
Conference number: 8th
http://icph.birzeit.edu/events/lpha-eighth-annual-conference-march-15-16-2017

Fingerprint Dive into the research topics of 'Management of acute meningococcal septicaemia in Al-Nasser Paediatric Hospital: A retrospective cohort study'. Together they form a unique fingerprint.

  • Cite this