{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T07:02:01Z","timestamp":1775804521551,"version":"3.50.1"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To analyze the risk factors 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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 and laboratory parameters 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The study cohort comprised 27 males and 29 females, including 13 patients with purulent meningitis and 43 without. 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 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). Univariate analysis of laboratory indicators revealed significant intergroup differences in eight parameters (NLR, PCT, Alb, Na, Scr, D-Dimer, FDP, TT) (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05). Further, multivariate analysis identified PCT [odds ratio [OR]\u2009=\u20091.196, 95% confidence interval [CI]: 1.009\u20131.418,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.039] and NLR (OR\u2009=\u20091.190, 95% CI: 1.014\u20131.395,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.033) as independent risk factors for IPD complicated by purulent meningitis. The AUC for the model constructed with PCT\u2009&amp;gt;\u20094.215\u2005ng\/mL and NLR\u2009&amp;gt;\u200912.94 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 vs. 60.71% (34\/56) in non-meningitic strains, and ceftriaxone resistance rates of 28.57% (16\/56) vs. 10.71% (6\/56), respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Elevated PCT and NLR levels constitute independent risk factors for IPD complicated by purulent meningitis. The combined predictive model based on PCT\u2009&amp;gt;\u20094.215\u2005ng\/mL and NLR\u2009&amp;gt;\u200912.94 demonstrates robust clinical utility.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1714634","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T06:07:00Z","timestamp":1775801220000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk factors for pediatric invasive pneumococcal disease complicated by purulent meningitis"],"prefix":"10.3389","volume":"14","author":[{"given":"Mi","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Immunology and Rheumatology, Fudan University Affiliated Children's Hospital Xiamen Hospital (Xiamen Children's Hospital)","place":["Xiamen City, Fujian, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhenxing","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Immunology and Rheumatology, Fudan University Affiliated Children's Hospital Xiamen Hospital (Xiamen Children's Hospital)","place":["Xiamen City, Fujian, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ling","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Immunology and Rheumatology, Fudan University Affiliated Children's Hospital Xiamen Hospital (Xiamen Children's Hospital)","place":["Xiamen City, Fujian, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guangbo","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Xiamen Hospital, Fudan University Affiliated Children's Hospital Xiamen Hospital (Xiamen Children's Hospital)","place":["Xiamen City, Fujian, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhiqiang","family":"Zhuo","sequence":"additional","affiliation":[{"name":"Department of Infection, Fudan University Affiliated Children's Hospital Xiamen Hospital (Xiamen Children's Hospital)","place":["Xiamen City, Fujian, China"]},{"name":"Xiamen Quality Control Center of Infectious Diseases","place":["Xiamen City, Fujian, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dequan","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Xiamen Hospital, Fudan University Affiliated Children's Hospital Xiamen Hospital (Xiamen Children's Hospital)","place":["Xiamen City, Fujian, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1302","DOI":"10.1007\/s12325-020-01248-7","article-title":"Burden of community-acquired pneumonia and unmet clinical needs","volume":"37","author":"Ferreira-Coimbra","year":"2020","journal-title":"Adv Ther"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e00623-19","DOI":"10.1128\/AAC.00623-19","article-title":"Effects of delayed antibiotic therapy on outcomes in children with streptococcus pneumoniae sepsis","volume":"63","author":"Li","year":"2019","journal-title":"Antimicrob Agents Chemother"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e140","DOI":"10.14309\/crj.2016.113","article-title":"Fatal streptococcus pneumoniae sepsis in a patient with celiac disease-associated hyposplenism","volume":"3","author":"Ouseph","year":"2016","journal-title":"ACG Case Rep J"},{"key":"B4","doi-asserted-by":"publisher","first-page":"315","DOI":"10.2147\/IJGM.S105070","article-title":"Streptococcus pneumoniae sepsis as the initial presentation of systemic lupus erythematosus","volume":"9","author":"Erdem","year":"2016","journal-title":"Int J Gen Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1574","DOI":"10.1093\/cid\/ciy1139","article-title":"Burden of Streptococcus pneumoniae sepsis in children after introduction of pneumococcal conjugate vaccines: a prospective population-based cohort study","volume":"69","author":"Asner","year":"2019","journal-title":"Clin Infect Dis"},{"key":"B6","doi-asserted-by":"publisher","first-page":"768","DOI":"10.1097\/00006454-199708000-00008","article-title":"A prospective study of neonatal sepsis and meningitis in southern Israel","volume":"16","author":"Greenberg","year":"1997","journal-title":"Pediatr Infect Dis J"},{"key":"B7","doi-asserted-by":"publisher","first-page":"106970","DOI":"10.1016\/j.ijid.2024.02.013","article-title":"Cerebrospinal fluid inflammatory markers to differentiate between neonatal bacterial meningitis and sepsis: a prospective study of diagnostic accuracy","volume":"142","author":"Groeneveld","year":"2024","journal-title":"Int J Infect Dis"},{"key":"B8","doi-asserted-by":"publisher","first-page":"518","DOI":"10.1080\/23744235.2025.2453581","article-title":"Predictors of mortality in patients with gram-negative bacilli (GNB) blood stream infections (BSI): multicentre data from India","volume":"57","author":"Bansal","year":"2025","journal-title":"Infect Dis (Lond)"},{"key":"B9","doi-asserted-by":"publisher","first-page":"915","DOI":"10.3760\/cma.j.issn.0578-1310.2018.12.006","article-title":"Multi-center clinical study on 1,138 cases of invasive pneumococcal disease in children from 2012 to 2017","volume":"56","author":"Zhu","year":"2018","journal-title":"Chin J Pediatr"},{"key":"B10","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1007\/s00430-024-00797-w","article-title":"Serotype distribution, antibiotic resistance, multilocus sequence typing, and virulence factors of invasive and non-invasive Streptococcus pneumoniae in Northeast China from 2000 to 2021","volume":"213","author":"Xu","year":"2024","journal-title":"Med Microbiol Immunol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"663","DOI":"10.1016\/j.jiac.2022.01.021","article-title":"Penicillin- and third-generation cephalosporin-resistant strains of Streptococcus pneumoniae meningitis: case report and literature review","volume":"28","author":"Ishikawa","year":"2022","journal-title":"J Infect Chemother"},{"key":"B12","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1097\/INF.0000000000004528","article-title":"Severe invasive pneumococcal disease caused by serotype 19A in children under five years in T\u0101maki Makaurau Auckland, Aotearoa New Zealand","volume":"44","author":"Burton","year":"2025","journal-title":"Pediatr Infect Dis J"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1833","DOI":"10.1007\/s10096-021-04238-x","article-title":"Clinical characteristics and serotype distribution of invasive pneumococcal disease in pediatric patients from Beijing, China","volume":"40","author":"Xu","year":"2021","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"B14","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1016\/S1473-3099(16)30466-2","article-title":"Invasive pneumococcal disease in children aged younger than 5 years in India: a surveillance study","volume":"17","author":"Manoharan","year":"2017","journal-title":"Lancet Infect Dis"},{"key":"B15","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1542\/peds.2014-2426","article-title":"Vaccination, underlying comorbidities, and risk of invasive pneumococcal disease","volume":"135","author":"Yildirim","year":"2015","journal-title":"Pediatrics"},{"key":"B16","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1186\/s12877-018-1008-8","article-title":"Procalcitonin is not an independent predictor of 30-day mortality, albeit predicts pneumonia severity in patients with pneumonia acquired outside the hospital","volume":"19","author":"Akagi","year":"2019","journal-title":"BMC Geriatr"},{"key":"B17","doi-asserted-by":"publisher","first-page":"970","DOI":"10.1016\/j.jcrc.2013.04.016","article-title":"Can we predict pneumococcal bacteremia in patients with severe community-acquired pneumonia?","volume":"28","author":"Pereira","year":"2013","journal-title":"J Crit Care"},{"key":"B18","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1001\/jamapediatrics.2018.5501","article-title":"A clinical prediction rule to identify febrile infants 60 days and younger at low risk for serious bacterial infections","volume":"173","author":"Kuppermann","year":"2019","journal-title":"JAMA Pediatr"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1572677","DOI":"10.3389\/fphar.2025.1572677","article-title":"Dynamic risk stratification and treatment optimization in sepsis: the role of NLPR","volume":"16","author":"Chen","year":"2025","journal-title":"Front Pharmacol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1136\/archdischild-2024-327497","article-title":"Epidemiology of childhood invasive pneumococcal disease in Australia: a prospective cohort study","volume":"110","author":"Phuong","year":"2024","journal-title":"Arch Dis Child"},{"key":"B21","doi-asserted-by":"publisher","first-page":"506","DOI":"10.53854\/liim-3204-9","article-title":"Pediatric invasive pneumococcal disease in Bol\u00edvar, Colombia: a descriptive cross-sectional study","volume":"32","author":"Rodr\u00edguez","year":"2024","journal-title":"Infez Med"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1714634\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T06:07:02Z","timestamp":1775801222000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1714634\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,10]]},"references-count":21,"alternative-id":["10.3389\/fped.2026.1714634"],"URL":"https:\/\/doi.org\/10.3389\/fped.2026.1714634","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,10]]},"article-number":"1714634"}}