Cerebral Hemorrhage in Children with Escherichia coli Meningitis: A seven-year Retrospective Study

Background Escherichia coli meningitis imposes a significant global health burden, however, the risk factors to its morbidity and mortality remains unclear. This study aimed to assess whether the cerebrospinal pathology after infection can early predict disease severity. Methods A retrospective cohort study of pediatric patients diagnosed with Escherichia coli meningitis and undergoing MRI was conducted in two tertiary medical centers in China from March 2015 to October 2022. MRI findings of cerebrospinal pathology and their correlation with outcomes and mortality were evaluated by logistic regression analysis. The basic characteristics and adverse outcomes of patients with and without cerebral hemorrhage complicating meningitis were compared. Results A total of 749 hospitalized children with blood and/or cerebrospinal fluid cultures were included. 88 had Escherichia coli meningitis, with a mortality rate of 19.3% (n = 17). Notably, 28.4% (n = 25) had cerebral hemorrhage, and its presence on MRI was significantly associated with case fatality rate (40.0% vs. 11.1%, P < 0.001, OR 5.3, 95% CI 1.7–16.4). Other findings included subdural effusion (16/88, 18.2%), meningeal enhancement (12/88, 13.6%), and subdural hemorrhage (10/88, 11.4%). Higher levels of interleukin-6 in serum and higher protein levels in cerebrospinal fluid are correlated with intracerebral hemorrhage. Moreover, children with two or more types of hemorrhage on MRI had significantly higher odds of case fatality rate (OR 19.7, 95% CI, 3.2-119.9). No other MRI findings showed significant differences. Conclusions Children with Escherichia coli meningitis frequently exhibit cerebral hemorrhage on MRI, which is strongly associated with adverse outcomes.