Community-acquired cerebral abscess and intracranial empyemas in children: a prospective cohort study

Abstract

Objective: Community-acquired intracranial abscess and empyema can be associated with significant morbidity and mortality among children. Treatment strategies are made with local expert opinion supported by international guidelines, which are based on mostly low-quality evidence. Thus, the authors aimed to report their experience with the presentation, management, and outcomes of a pediatric cohort with intracranial abscess and empyema managed by their regional neuro-microbiological multidisciplinary team (MDT).

Methods: Data were collected from a prospectively collected database and supplemented with retrospective record review for all children (age < 18 years) with intracranial abscess and empyema managed by a neuro-microbiological MDT from January 2014 to June 2023.

Results: Sixty-one children (median age 11.8 years, IQR 6.9-14.4 years) were included; 11 with abscesses, 25 with epidural empyemas, and 25 with subdural empyemas. Empyema was more strongly associated with fever (p = 0.03) and raised inflammatory markers (p = 0.002) as presenting features. Thirty-nine of 61 children (63.9%) had at least 1 previous clinical presentation before diagnosis. The overall mean time from symptom onset to diagnosis was 13.1 days (SD 10.7 days), while patients with cerebral abscesses had a significantly longer time to diagnosis of 23.6 days (SD 3.9 days, p < 0.001). Most cases were secondary to contiguous spread of sinusitis (38/61, 62%) or ear infection (14/61, 23%). Four weeks or less of intravenous (IV) antibiotic treatment was administered in 64% of patients, with no difference in outcome compared with patients who received more than 4 weeks of treatment. Those who received longer courses of IV treatment had a greater risk of drug-induced neutropenia. Overall mortality was 3% (2/61). Full recovery was achieved in 36 patients (59%) at discharge. Of those who completed treatment, there were no cases of recurrence within 6 months.

Conclusions: Using an MDT approach, successful management of intracranial infections was achievable using IV antibiotics for shorter durations. Further work is required to optimize outcomes for patients and to address barriers that delay diagnosis.

Keywords: antibiotic; cerebral abscess; children; empyema; infection; neurosurgery.