Risk Factors for Poor Outcomes in Pediatric Bacterial Meningitis With Cerebrospinal Fluid Shunts: A Nationwide Surveillance in Japan

Background: Bacterial meningitis remains a life-threatening condition in pediatric patients with cerebrospinal fluid (CSF) shunts. While infection prevention has been extensively studied, risk factors for severe outcomes such as death and neurological sequelae remain poorly understood. We examined the clinical characteristics of pediatric bacterial meningitis with CSF shunts, focusing on the risk factors associated with poor outcomes. Methods: This study is part of a nationwide surveillance of pediatric bacterial meningitis in Japan from 2009 to 2021. We extracted pediatric meningitis cases with CSF shunts from the database. Clinical characteristics, risk factors for poor outcomes, defined as death or severe neurological sequelae and causative organisms were assessed. Logistic regression models were used to identify significant risk factors. Results: In this study, 167 pediatric cases of bacterial meningitis with CSF shunts were included. In multivariable analysis, male sex [odds ratio (OR): 2.82, 95% confidence interval (CI): 1.00-7.96, P = 0.04] and younger age (OR: 0.98, 95% CI: 0.97-1.00, P = 0.002) were significant risk factors for poor outcomes. The most common causative organism was Staphylococcus spp. (65.9%), predominantly coagulase-negative Staphylococci (45.3%). While the reduction in Streptococcus pneumoniae and Haemophilus influenzae cases following vaccine introduction was not statistically significant, a decreasing trend was observed. Conclusion: Younger age and male sex were significant risk factors for poor outcomes. In addition, vaccination may have contributed to a decline in Streptococcus pneumoniae and Haemophilus influenzae infections.