836 A retrospective review of paediatric neurosurgical suppurative intracranial infections. (17th August 2022) - Burridge, Isabel
Abstract : Aims Suppurative intracranial infections are rare, with the UK annual incidence estimated at 4–5.3/1, 000, 000. 1 They are associated with significant complications including neurological sequelae. There is conflicting evidence as to prevalence of predisposing factors, which include congenital heart disease, sinusitis, immunosuppression, meningitis, cerebrovascular accident and recent dental/ontological procedures. 1 Streptococcus milleri is the commonest causative organism reported, although as many as 14-21% abscesses contain mixed flora. 2 This audit was a pilot for further work in collaboration with a national network, and support the development of evidence-based guidelines for the management of these patients. Methods: A standard for comparison was generated following a comprehensive literature review of existing guidelines for management of paediatric suppurative brain infections. A retrospective review of notes for all patients who presented to the Bristol Children's Hospital with suppurative intracranial infection who had surgery between 2016 and July 2021 inclusive, was undertaken. Demographic, clinical and microbiological data was collected using the REDCap application and analysed in excel. Results: A total of 28 eligible patients were identified; records were available for 25. Median age was 12 years (interquartile range 6-13); 68% (16/25) were male. Incidence fell by 78% (95%CI 30-96; p<0.003) in 2020-2021 (1.43/1, 000, 000/year) compared with previous years (6.47/1, 000, 000/year). At least one predisposing factor (chronic pre-existing health condition or recent infection) was identified in 80% (20/25) ( figure 1 ); 48% (12/25) of children had presented to healthcare with an infection within the previous 6 weeks. 28% (7/25) had a preceding sinusitis, and 16% (4/25) had a congenital heart defect. One patient was immunocompromised. The most commonly cultured organism was Streptococcus spp ( table 1 ), accounting for 49% (20/41) total isolates. Mixed flora was identified in 28% (7/25) pus samples. Ceftriaxone with Metronidazole was the commonest antibiotic regime ( table 1 ). Culture sensitivities necessitated antibiotic change in 32% (8/25) cases. Median antimicrobial duration was 8 weeks (interquartile range 7-10). Survival rate was 100%, of whom 56% (14/25) survived with a lasting deficit (mild 12%; moderate 24%; severe 20%), the remaining 44% (11/25) recovered completely. Conclusion: Suppurative intracranial infections are rare but serious neurological diseases. This cohort demonstrated a decrease in the incidence of Paediatric Suppurative Brain Infection in 2020-2021 of 78% ( p <0.003). This correlated with the first year of the SARS-CoV-2 pandemic. This audit supports a high clinical suspicion for brain abscess in children with a recent infection, particularly sinusitis. Ceftriaxone and Metronidazole are an adequate first line empiric treatment, with adjustment according to sensitivities. The emerging patterns in this audit are supported by similar, larger studies; this data presents valuable information for the management of paediatric intracranial infections and informs further studies. References: Paediatric focal intracranial suppurative infection: a UK single-centre retrospective cohort study, Van der Velden et al. Clinical and Microbiologic Features Guiding Treatment Recommendations for Brain Abscesses in Children, Felsenstein et al.