ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Pediatric Critical Care
Volume 13 - 2025 | doi: 10.3389/fped.2025.1631570
IDENTIFYING THE NEED FOR SURGICAL INTERVENTION IN PEDIATRIC BACTERIAL MENINGITIS: SINGLE-CENTER EXPERIENCE
Provisionally accepted
Merve Boyraz1
Servet Yuce2*
Mehmet Tolgahan Örmeci1Abdulrahman Özel3
Süleyman Akkaya1Şeyma Köksal Atiş4Edin Botan1- 1SBI. Van Education and Research Hospital, Van, Van, Türkiye
- 2Ministry of Health (Turkey), Ankara, Türkiye
- 3Bagcilar Education and Research Hospital, Istanbul, Türkiye
- 4Yozgat City Hospital, Yozgat, Türkiye
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Intracranial complications of bacterial meningitis can arise at any stage and may necessitate neurosurgical intervention. This study evaluates clinical, laboratory, and imaging findings predictive of surgical need in these cases.Between 2013 and 2023, 52 pediatric patients with severe neurological symptoms due to bacterial meningitis were admitted to PICU at Van Training and Research Hospital. Patients were classified into two groups: those with intracranial complications (Group 1, n=36) and those without (Group 2, n=16). Group 1 was further divided into those requiring surgery (Group 1B, n=9) and those not (Group 1A, n=27). Statistical analyses were conducted.Among 52 patients (67.3% male, mean age 76.7±72.0 months), 36 (69.2%) developed intracranial complications, and 9 (17.3%) required surgery. CRP levels were significantly higher in Group 1B (226 mg/dL) than in Group 1A (63 mg/dL) (p<0.001). Significant differences were also found in CSF protein/glucose ratio (p=0.011) and CSF glucose levels (p=0.049). Subdural empyema (SDE) developed in 25 cases, with single-area involvement significantly more frequent in surgical cases (77.8% vs. 12.5%, p=0.012). ROC analysis was performed for CSF protein/glucose, CSF glucose, and serum CRP values.CRP >150 mg/dL, CSF glucose <6.75 mg/dL, and protein/glucose ratio >18.9 indicate high surgical risk. MRI is recommended for localization, with early neurosurgical consultation and multidisciplinary management for cases with single-area empyema.
Keywords: Meningitis, Intracranial complications, empyema Meningitis, empyema ICC: Intracranial Complications, WBC: White Blood Count, CRP: C-reactive protein, CSF: Cerebro-Spinal Fluid, PICU: Pediatric Intensive Care Unit ICC: Intracranial Complications
Received: 19 May 2025; Accepted: 01 Jul 2025.
Copyright: © 2025 Boyraz, Yuce, Örmeci, Özel, Akkaya, Köksal Atiş and Botan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Servet Yuce, Ministry of Health (Turkey), Ankara, Türkiye
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