Pediatric intracranial empyema complicating otogenic and sinogenic infection

Mégane Raineau; Ann-Marie Crowe; Kevin Beccaria; Romain Luscan; Francois Simon; Charles-Joris Roux; Agnès Ferroni; Manoelle Kossorotoff; Annie Harroche; Martin Castelle; Edith Gatbois; Marie Bourgeois; Mickaela Roy; Stéphane Blanot

doi:10.1016/j.ijporl.2024.111860

Pediatric intracranial empyema complicating otogenic and sinogenic infection

Int J Pediatr Otorhinolaryngol. 2024 Feb:177:111860. doi: 10.1016/j.ijporl.2024.111860. Epub 2024 Jan 11.

Authors

Affiliations

¹ Pediatric Intensive Care Unit, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France. Electronic address: megane.raineau@aphp.fr.
² Pediatric Intensive Care Unit, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France. Electronic address: ann-marie.crowe@aphp.fr.
³ Pediatric Neurosurgery Department, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France. Electronic address: kevin.beccaria@aphp.fr.
⁴ Pediatric ENT Department, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France. Electronic address: romain.luscan@aphp.fr.
⁵ Pediatric ENT Department, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France. Electronic address: f.simon@aphp.fr.
⁶ Pediatric Radiology Department, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France. Electronic address: charles-joris.roux@aphp.fr.
⁷ Clinical Microbiology Department, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France. Electronic address: agnes.ferroni@aphp.fr.
⁸ Pediatric Neurology Department, French Center for Pediatric Stroke, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France. Electronic address: manoelle.kossorotoff@aphp.fr.
⁹ Clinical Hematology Department, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France. Electronic address: annie.harroche@aphp.fr.
¹⁰ Pediatric Immunology Department, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France. Electronic address: martin.castelle@aphp.fr.
¹¹ Hospitalization at Home Department, Assistance Publique des Hôpitaux de Paris, Hôpital Armand Trousseau - Sorbonne Université, Paris, France. Electronic address: edith.gatbois@aphp.fr.
¹² Pediatric Neurology Department, French Center for Pediatric Stroke, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France. Electronic address: marie.bourgeois@aphp.fr.
¹³ Pediatric Intensive Care Unit, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France. Electronic address: micka_r@hotmail.fr.
¹⁴ Pediatric Intensive Care Unit, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France. Electronic address: stephane.blanot@aphp.fr.

PMID: 38224655
DOI: 10.1016/j.ijporl.2024.111860

Abstract

Objective: To describe and compare clinical and microbiological features, surgical and medical management, and outcomes of children with otogenic and sinogenic intracranial empyema (IE) in an institution with an established multidisciplinary protocol. To use the study findings to inform and update the institutional algorithm.

Methods: Retrospective analysis was carried out on the electronic healthcare records of all children with oto-sinogenic IE admitted in a 5-year period.

Results: A total of 76 patients were identified and treated according to an institutional protocol. Two distinct groups were identified: intracranial empyema related to otogenic infection (OI-IE, n = 36) or sinogenic infection (SI-IE, n = 40). SI-IE was seen in older children and had a significantly higher morbidity. Sub-dural IE was seen in a minority (n = 16) and only in SI-IE and required urgent collaborative ENT-neurosurgery. Extra-dural IE occurred more frequently and was seen in both SI-IE and OI-IE. No death and overall low morbidity were observed. Particularities found in SI-IE and OI-IE groups (as thrombosis, microbiology, antibiotic treatment, duration and outcome) permitted the delineation of these groups in our updated algorithm.

Conclusion: The presence of a collaborative multidisciplinary protocol permits the step-wise co-ordination of care for these complex patients in our institution. All patients received prompt imaging, urgent surgical intervention, and antibiotic treatment. Microbiological identification was possible for each patient and antibiotic rationalization was permitted through use of Polymerase chain reaction (PCR) testing in cases of sterile cultures. Of note, intracranial empyema related to sinogenic infection is shown to have significantly more severe clinical presentation, a higher morbidity, and a longer duration of antibiotic therapy than that related to otogenic infection. Study findings allowed for the update and clarification of the institutional protocol, which now clearly demarcates the clinical presentation, biological evidence, radiology, surgical and medical treatments in children with oto-sinogenic IE.

Keywords: Intracranial empyema; Otitis and sinusitis complications; Pediatric surgical and intensive care management.

MeSH terms

Anti-Bacterial Agents / therapeutic use
Brain Abscess* / diagnostic imaging
Brain Abscess* / etiology
Brain Abscess* / therapy
Child
Empyema*
Empyema, Subdural* / diagnosis
Empyema, Subdural* / epidemiology
Empyema, Subdural* / etiology
Humans
Retrospective Studies

Substances

Anti-Bacterial Agents