Impact of the COVID-19 pandemic on the incidence of pediatric intracranial empyemas in Spain.

IF 1.3 4区 医学 Q4 CLINICAL NEUROLOGY
Marina Fidalgo de la Rosa, Gregorio Catalán Uribarrena, Pablo Martín Munarriz, Sara Iglesias Moroño, Marc Valera Melé, Juana María Vidal Miñano, Alicia Godoy Hurtado, María Elena López García, Marta Guzmán, Cristina Ferreras García, Dalila Forte
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引用次数: 0

Abstract

Introduction: Intracranial infections due to sinusitis and otitis, although rare, can progress rapidly and result in significant morbidity, necessitating multifaceted management including extended antibiotic therapy and surgical intervention. Predominantly affecting infants and older children, these infections have seen a perceived increase in incidence following the coronavirus disease 2019 (COVID-19) pandemic.

Objectives: Our study aims to describe the clinical and epidemiological characteristics of intracranial infections secondary to sinusitis or otitis in the pediatric population and assess changes in incidence and clinical presentation post-pandemic. Specific objectives include analyzing neurosurgical management practices, the role of ENT-neurosurgery cooperation, incidence of epileptic seizures, and management of associated venous thrombosis.

Materials and methods: A retrospective multicentric study was conducted in hospitals across the Iberian Peninsula, including data from January 2018 to December 2022. Data were divided into pre-lockdown (January 2018 to March 2020) and post-lockdown (March 2020 to December 2022) periods for analysis.

Results: The study included 60 pediatric cases (38 post-pandemic and 22 pre-pandemic). The average age was 9.8 years, with a male predominance (61.67%). Sinusitis was the most frequent cause (86%), and the frontal region was the most common site of infection (75%). Neurological symptoms were more prevalent post-pandemic (55.26% versus 23.68%). The primary pathogen was S. intermedius (29.6%). Most patients required neurosurgical intervention (81.7%), with a significant portion undergoing combined ENT-neurosurgery procedures (52.9%). The average antibiotic treatment duration was 6.6 weeks. Complications included venous sinus thrombosis (20%) and seizures (39.2%). Mortality was 3.3%.

Conclusion: Although there was a perceived increase in cases post-pandemic, our study observed a normalization of incidence after the lockdown, with a decrease in diagnoses during confinement. The accepted antibiotic regimen lasts 6 weeks, extendable to 8 weeks in non-surgical patients, with at least 2 weeks of intravenous treatment. Sinus surgery combined with antibiotics may suffice to avoid craniotomy in some cases, while combined surgery has a lower reoperation rate in others. Anticoagulation should be individualized and discontinued upon recanalization. Prophylactic antiepileptic drug use remains controversial and should be tailored to patients with specific risk factors. Prolonged antiepileptic drug (AED) therapy may be warranted for those with early seizures and hemorrhagic lesions, whereas others may gradually taper off AEDs after the acute stage.

新冠肺炎疫情对西班牙儿童颅内脓肿发病率的影响
简介:鼻窦炎和中耳炎引起的颅内感染虽然罕见,但可以迅速发展并导致显著的发病率,需要多方面的治疗,包括延长抗生素治疗和手术干预。这些感染主要影响婴儿和年龄较大的儿童,在2019年冠状病毒病(COVID-19)大流行之后,人们认为这些感染的发病率有所增加。目的:本研究旨在描述小儿鼻窦炎或中耳炎继发颅内感染的临床和流行病学特征,并评估大流行后发病率和临床表现的变化。具体目标包括分析神经外科管理实践,耳鼻喉科神经外科合作的作用,癫痫发作的发生率,以及相关静脉血栓形成的管理。材料和方法:在伊比利亚半岛的医院进行了一项回顾性多中心研究,包括2018年1月至2022年12月的数据。数据分为封锁前(2018年1月至2020年3月)和封锁后(2020年3月至2022年12月)进行分析。结果:该研究包括60例儿科病例(38例大流行后和22例大流行前)。平均年龄9.8岁,男性居多(61.67%)。鼻窦炎是最常见的原因(86%),额部是最常见的感染部位(75%)。大流行后神经系统症状更为普遍(55.26%对23.68%)。主要病原菌为中间葡萄球菌(29.6%)。大多数患者需要神经外科干预(81.7%),其中很大一部分接受了联合ent -神经外科手术(52.9%)。平均抗生素治疗时间为6.6周。并发症包括静脉窦血栓形成(20%)和癫痫发作(39.2%)。死亡率为3.3%。结论:尽管大流行后病例有所增加,但我们的研究发现,禁闭后发病率趋于正常化,禁闭期间的诊断减少。接受的抗生素治疗方案持续6周,非手术患者延长至8周,其中至少2周静脉治疗。鼻窦手术联合抗生素在某些情况下足以避免开颅,而联合手术在其他情况下有较低的再手术率。抗凝治疗应个体化,再通后停用。预防性抗癫痫药物的使用仍有争议,应针对具有特定危险因素的患者量身定制。对于那些早期发作和出血性病变的患者,延长抗癫痫药物(AED)治疗是有保证的,而其他患者在急性期后可能逐渐减少使用AED。
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来源期刊
Child's Nervous System
Child's Nervous System 医学-临床神经学
CiteScore
3.00
自引率
7.10%
发文量
322
审稿时长
3 months
期刊介绍: The journal has been expanded to encompass all aspects of pediatric neurosciences concerning the developmental and acquired abnormalities of the nervous system and its coverings, functional disorders, epilepsy, spasticity, basic and clinical neuro-oncology, rehabilitation and trauma. Global pediatric neurosurgery is an additional field of interest that will be considered for publication in the journal.
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