Pediatric sinogenic and otogenic intracranial infections requiring neurosurgical intervention: a North American multicenter study in the era of COVID-19.

OBJECTIVE

Early reports from single institutions have suggested that pediatric sinogenic and otogenic intracranial infections increased following the onset of the COVID-19 pandemic. Here, the authors conducted a multicenter study to confirm their hypothesis that the incidence of severe intracranial bacterial infections significantly increased across North America during that time frame and to gain insights into the mechanism and complications of these infections.

METHODS

Consecutive pediatric patients from 31 North American centers who underwent a neurosurgical procedure for a sinogenic or otogenic intracranial infection from January 1, 2015, through March 31, 2023, were retrospectively identified, and information about demographics, clinical features, interventions, complications, and outcomes was collated. An interrupted time series analysis was conducted, and records of patients who presented before versus during the COVID-19 pandemic were compared.

RESULTS

Of 638 patients who met inclusion criteria, 279 (43.7%) presented over a 5-year period before the COVID-19 pandemic and 359 (56.3%) presented over a 3-year period during the pandemic. There were no significant differences in age, sex, race, or ethnicity between the time periods. The interrupted time series analysis confirmed a significant increase in rates of sinogenic and otogenic intracranial infections during COVID-19. During the pandemic, more patients had public insurance (p = 0.004), facial swelling (p = 0.03), and confusion (p < 0.001) and underwent otolaryngological procedures (p = 0.03). The rate of viridans streptococcal isolation decreased > threefold during the COVID-19 pandemic, suggesting that these ubiquitous commensal organisms might play an important role in protecting against invasion by other opportunistic bacteria. There were similar rates of adverse outcomes between the time periods.

CONCLUSIONS

This North American multicenter retrospective study demonstrated a significant increase in the incidence of sinogenic and otogenic intracranial infections requiring neurosurgical intervention but similar rates of adverse outcomes during the COVID-19 pandemic. Possible explanations include direct modulation of the immune system by SARS-CoV-2, a loss of certain commensal respiratory bacteria, and/or indirect effects of the pandemic.