A 20-Year Study of Intracranial Pyogenic Complications of Sinusitis in Children

Abstract

Background: Intracranial pyogenic complications of sinusitis in children can lead to serious sequelae. We characterize the clinical, epidemiologic and microbiologic characteristics of children with such complications over a 20-year period. Methods: Single-center retrospective chart review. Cases were identified based on International Classification of Diseases diagnostic codes (ICD)-10 and by reviewing all intracranial microbiological samples. Results: A total of 104 cases of complicated sinusitis were included after review of 1591 charts. Median age was 12 (IQR 9–14); 72 were male (69%). The most frequent complications were epidural empyema (n = 50, 48%), subdural empyema (n = 46, 44%) and Pott’s puffy tumor (n = 27, 26%). 52% (n = 54) underwent neurosurgery and 46% (n = 48) underwent otolaryngological surgery. The predominant pathogen isolated from sterile site specimens was Streptococcus anginosus (n = 40, 63%), but polymicrobial growth was common (n = 24; 38%). The median duration of intravenous antibiotic therapy was 51 days (IQR 42–80). Persistent neurological sequelae (or death, n = 1) were found in 24% (n = 25) and were associated with the presence of cerebritis and extensive disease on neuroimaging (P = 0.02 and P = 0.04, respectively). Conclusions: Intracranial complications of sinusitis continue to cause significant morbidity in children. Polymicrobial infections are common, which reinforces the need for broad-spectrum empiric antibiotic therapy and cautious adjustment of the antibiotic regimen based primarily on sterile site cultures. The association of neurologic sequelae with the presence of cerebritis and extensive intracranial involvement on neuroimaging suggest that delayed diagnosis may be a contributor to adverse outcome.

Increasing Incidence of Streptococcus anginosus Group Intracranial Infections Associated With Sinusitis, Otitis Media, and Mastoiditis in Children

“…1,6 Moreover, as a group, SAG are the most commonly isolated organisms in culture from intracranial abscesses in children. 6,15,16 We investigated the epidemiology of intracranial complications of sinusitis and otitis in children over a 12-year period spanning both the pre-and post-SARS-CoV-2 eras.…”