Intracranial Empyema in Children: A Single-center Retrospective Case Series

Abstract

We conducted a retrospective, observational study of 42 children with intracranial empyema admitted to a pediatric neurosurgical center over a 9-year period. Intracranial empyema is rare, but causes significant morbidity and mortality. Twenty-eight cases had neurosurgical source control, more commonly for subdural collections. Streptococcus anginosus group bacteria are important pathogens in subdural empyema, whose isolation predicts more complicated postoperative courses.

FIGURE 1.

Demographics and microbiology of intracranial empyema in children. Age distribution of children (n = 42) with intracranial empyema, colored according to the site of empyema (A) and precipitating infection (B). C: Microbiology of empyema in children: isolates are colored/patterned accorded to sample site. D: Antibiotic use among children with empyema; intravenous (i.v.), oral (p.o.). E: Comparison of the proportion of children with Streptococcus anginosus group (SAG) Streptococci isolated at operation by empyema location. F: Comparison of the proportion of children with SAG Streptococci isolated at operation by precipitating infection. G: Comparison of the proportion of children with SAG Streptococci isolated at operation by subsequent need for reoperation. Cases in which SAG Streptococci were isolated are highlighted (gray). The association between SAG Streptococci and subsequent reoperation is independent of the site of empyema (Mantel–Haenszel OR = 8.2, P = 0.020), and precipitating infection (Mantel–Haenszel OR = 9.8, P = 0.018). EDE indicates extradural empyema; OR, odds ratio; SDE, subdural empyema.