Clinical characteristics and risk factors for imaging abnormalities in pediatric Group B Streptococcus meningitis: a multicenter study.

Background: Intracranial imaging abnormalities are highly prevalent in children with Group B Streptococcus (GBS) meningitis and are closely associated with disease severity and prognosis. This highlights the importance of investigating the clinical features of GBS meningitis and the risk factors for imaging abnormalities. This study aimed to identify the risk factors for imaging abnormalities in children with GBS meningitis, thereby providing a basis for the early identification of high-risk patients. Methods: A retrospective analysis of GBS meningitis was conducted involving 12 hospitals across China between January 2019 and December 2020, extending through 2024 for the Children's Hospital of Zhejiang University School of Medicine. Results: A total of 327 cases were included in this study, and the age ranged from 1 day to 4.5 years, with 90.5% under 3 months. Most patients exhibited typical cerebrospinal fluid (CSF) abnormalities, while in 4.0% of patients, the initial CSF cells appeared normal. Imaging abnormalities were developed in 65.2% (210/322) of patients, primarily subdural effusion (30.4%, 98/322). Patients with imaging abnormalities demonstrated higher rates of simultaneous positive CSF and blood cultures, lower CSF glucose (GLU) levels, elevated initial CSF protein concentrations, prolonged hospitalization, increased costs, lower cure rates, and higher incidence of neurological sequelae (P<0.05). Multivariate logistic regression analysis revealed simultaneous positive CSF and blood cultures [odds ratio (OR)=1.945, 95% confidence interval (CI): 1.131-3.346] and initial CSF GLU concentrations <1.57 mmol/L (OR=0.7, 95% CI: 0.557-0.880) as independent risk factors. Conclusions: Pediatric GBS meningitis predominantly affects infants under 3 months, with a high incidence of imaging abnormalities. Simultaneous positive CSF and blood cultures, and lower initial CSF GLU concentrations (<1.57 mmol/L) are independent risk factors for imaging abnormalities.