Risk Factors and Bacterial Resistance in Pediatric Invasive Pneumococcal Disease Complicated by Purulent Meningitis

Abstract Objective: To analyze the risk factors and bacterial resistance associated with invasive pneumococcal disease (IPD) complicated by purulent meningitis in children, with the goal of enhancing early diagnosis and treatment, preventing complications, and improving patient outcomes. Methods: The study involved 56 pediatric patients with IPD and admitted to our hospital from January 2016 and December 2024. Patients were stratified into two groups based on the presence or absence of purulent meningitis. Clinical characteristics, laboratory parameters, and bacterial resistance profiles were collected and analyzed using univariate and multivariate methods to identify risk factors. A risk prediction model based on logistic regression was developed, and its performance was assessed via the area under the receiver operating characteristic (ROC) curve. Results: The study cohort comprised 27 males and 29 females, including 13 patients with purulent meningitis and 43 without. A significant seasonal distribution was noted, with 58.93% (33/56) of cases occurring between November and January. Underlying diseases were present in 53.84% (7/13) of the purulent meningitis group compared to 4.65% (2/43) in the non-meningitic group (P < 0.001). Univariate analysis of laboratory indicators revealed significant intergroup differences in eight parameters(NLR, PCT, Alb, Na, Scr,D-Dimer, FDP, TT) (P < 0.05). Further, multivariate analysis identified PCT (OR = 1.209, 95% CI: 1.023–1.428, P = 0.026) and NLR (OR = 1.210, 95% CI: 1.010–1.449, P = 0.038) as independent risk factors for IPD complicated by purulent meningitis. The curve analysis results indicate that PCT>4.215 ng/ml and NLR>12.94 individually predicted the presence of purulent meningitis with AUCs of 0.863 and 0.606.The AUC for the model constructed with PCT > 4.215 ng/ml and NLR > 12.94 was 0.885, indicating that its predictive value for combined purulent meningitis is higher than that of the individual indicators, with sensitivity of 84.60% and specificity of 86%. Additionally, drug resistance analysis of 56 Streptococcus pneumoniae isolates revealed penicillin resistance rates of 73.21% (41/56) in meningitic strains versus 60.71% (34/56) in non-meningitic strains, and ceftriaxone resistance rates of 28.57% (16/56) versus 10.71% (6/56), respectively. Conclusion: Elevated PCT and NLR levels constitute independent risk factors for IPD complicated by purulent meningitis. The combined predictive model based on PCT > 4.215 ng/ml and NLR > 12.94 demonstrates robust clinical utility. Furthermore, the higher resistance rates of pneumococcal meningitis isolates to ceftriaxone and penicillin warrant heightened clinical attention.