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

Autor:	Smiljkovic M; From the Division of Infectious Diseases, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada., Tat J; From the Division of Infectious Diseases, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.; Department of Pediatric Laboratory Medicine., Richardson SE; Department of Pediatric Laboratory Medicine., Campigotto A; Department of Pediatric Laboratory Medicine., Cushing SL; Department of Otolaryngology., Wolter NE; Department of Otolaryngology., Dirks P; Department of Neurosurgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada., Bitnun A; From the Division of Infectious Diseases, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
Jazyk:	angličtina
Zdroj:	The Pediatric infectious disease journal [Pediatr Infect Dis J] 2024 Feb 01; Vol. 43 (2), pp. 91-96. Date of Electronic Publication: 2023 Oct 12.
DOI:	10.1097/INF.0000000000004140
Abstrakt:	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. Competing Interests: The authors have no funding or conflicts of interest to disclose. (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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