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. 2024 Feb 1;43(2):91-96.
doi: 10.1097/INF.0000000000004140. Epub 2023 Oct 12.

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

Mina Smiljkovic  1 , Jennifer Tat  1   2 , Susan E Richardson  2 , Aaron Campigotto  2 , Sharon L Cushing  3 , Nikolaus E Wolter  3 , Peter Dirks  4 , Ari Bitnun  1
Affiliations

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

Mina Smiljkovic et al. Pediatr Infect Dis J. .

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)-9 and ICD-10 depending on the year and by reviewing all intracranial microbiologic 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 otolaryngologic 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 neurologic 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.

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Conflict of interest statement

The authors have no funding or conflicts of interest to disclose.

References

    1. Marom T, Alvarez-Fernandez PE, Jennings K, et al. Acute bacterial sinusitis complicating viral upper respiratory tract infection in young children. Pediatr Infect Dis J. 2014;33:803–808.
    1. Wald ER, Applegate KE, Bordley C, et al.; American Academy of Pediatrics. Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. Pediatrics. 2013;132:e262–e280.
    1. Adame N, Hedlund G, Byington CL. Sinogenic intracranial empyema in children. Pediatrics. 2005;116:e461–e467.
    1. Bair-Merritt MH, Shah SS, Zaoutis TE, et al. Suppurative intracranial complications of sinusitis in previously healthy children. Pediatr Infect Dis J. 2005;24:384–386.
    1. Patel NA, Garber D, Hu S, et al. Systematic review and case report: intracranial complications of pediatric sinusitis. Int J Pediatr Otorhinolaryngol. 2016;86:200–212.